How the Deadly Drug Fentanyl is Getting to Your Community

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During the first quarter of 2016, Sacramento, California experienced 48 overdoses due to fentanyl use (Buck 2016). In all of the cases, the drug was disguised as Hydrocodone pills, most often known by the name Vicodin, Norco and others. There is a big difference between the potency of fentanyl and the potency of hydrocodone. In one prior blog post, I put up an opiate comparison chart that showed the comparative strength of various opiate drugs. Looking at that chart, hydrocodone would be the equivalent of taking 6 codeine pills. But, comparing the potency of fentanyl, taking the drug would be the equivalent of taking 500-1000 codeine pills. Yet another way of looking at it, fentanyl is 100 times more potent than morphine.

Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug (NIDA 2016). It has been found as a cutting agent in heroin for years, but most recently, cocaine has been seized that has been cut with fentanyl.

But, how is fentanyl getting into the hands of our addicts? There are three main ways: diversion, where the drug is taken from a legitimate source and distributed on the street, by making it yourself in a clandestine laboratory or by ordering it from China.

The China Connection

An up and coming way to get fentanyl is to simply order it from China. A simple web search will reveal several sources for ordering the drug from China. Someone using this method would also need a pill press. You can order one online as well for a fairly cheap price. You can also buy dies, that will imprint the pill with a code. As an example, you can press the powder you got from China into a pill using your pill press, using a die that you got on another website that is the imprint of vicodin. Your final product will be a pill that looks like Vicodin, but is actually all fentanyl. Here is a quick video of how a pill press works when you make your own pills:

Manufacturing Fentanyl

Making your own fentanyl is a fairly hard endeavor, but not impossible. You can go online here to see the synthesis for the drug.  DEA has been restricting the precursors, but there are still labs being recovered, although it is very rare.

Diversion of Fentanyl

There are several ways to divert fentanyl. According to the DEA, there were 6.64 million prescriptions for the drug in the United States in 2014. Fentanyl pharmaceutical products are currently available in oral transmucosal lozenges, commonly referred to as “lollipops” (Actiq®), effervescent buccal tablets (Fentora™), transdermal patches (Duragesic®), and injectable formulations (DEA 2016).

'Llollipops’ are given to patients for long term pain relief. The patient will be prescribed them and will suck on the fentanyl to administer the medicine. Usually, you will see less scrupulous people attain jobs with convalescent hospitals or other places where there will be high number of patients with access to the lollipops. They will then steal the lollipops and then divert them to the street. I have recovered several of these from addicts on the street.

Conversely, the fentanyl patch is used for the same purpose, long term pain relief. They will be diverted in the same manner above. But, there have been several reports of people overdosing on the patches because they administered multiple patches on their body. In one case, an OD victim had their entire body covered head to toe with patches when they were discovered deceased in their home.

Lastly, some fentanyl products are used for anesthesia in the operating room. Some medical professionals have been known to divert them from patient use to the street.

Fentanyl Influence

When a person is under the influence of this drug, they will have the same signs and symptoms as any other person under the influence of an opiate. They will have constricted pupils, they may be on the nod, they might have a raspy voice, they will be slow and lethargic, and their pulse will be slow as well as their respirations. Below is a poster of the most common signs and symptoms of opiate influence.

Sources

Buck, Claudia. (2016) Sacramento County fentanyl overdoses now at 48 | The Sacramento Bee.

Retrieved April 14, 2016, from http://www.sacbee.com/news/local/health-and-medicine/article70317137.html

Drug Enforcement Administration. (2016) FENTANIL (Trade Names: Actiq®, Fentora (TM),

Duragesic®). Retrieved April 15, 2016, from http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf

National Institute On Drug Abuse. (2016) Fentanyl | National Institute on Drug Abuse (NIDA.

Retrieved April 14, 2016, from https://www.drugabuse.gov/drugs-abuse/fentanyl

National Institute On Drug Abuse. (2016) Fentanyl | National Institute on Drug Abuse (NIDA. Retrieved April 14, 2016, from https://www.drugabuse.gov/drugs-abuse/fentanyl

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