The Rise of Illicit Fentanyl: A Silent Killer

Amid the rising opioid epidemic in the United States, there looms a silent killer ravaging the lives and families of individuals worldwide: fentanyl. This synthetic opioid, disguised as oxycontin when sold, has taken over the illegal drug market and has become a recreational commodity due to its affordability and strength compared to other drugs. The constant import of synthetic opioids from foreign countries, and its large profit, have increased fentanyl flow and sales in the United States in recent years. Laced-fentanyl pills and synthetic opioid use have contributed to the fourth wave of the opioid crisis resulting in the death of many Americans and further strengthening the stigma toward drug abuse. Nowadays, naloxone administration for overdose has been termed an “essential,” as fentanyl has become a specter in schools, clubs, and on the streets. Although this drug has been overlooked for several decades, its presence and impact on American society have only been further exacerbated by the social and economic consequences of the COVID-19 pandemic.


Over the past decade, synthetic opioids like fentanyl have become the leading cause of drug deaths in the U.S. as it has contributed to 59% of drug deaths in comparison to just 14.3% in 2010 [1]. Furthermore, the number of overdose deaths has increased to 100,000 over the span of 12 months this past year [2]. This stark change is attributed to the recent introduction of laced-fentanyl pills in the illegal drug market. At a low cost, this synthetic opioid has higher strength and potency compared to other recreational drugs. This makes it extremely deadly, even in small amounts. Oftentimes, drug users consume fentanyl unknowingly as they are mixed with other drugs like cocaine, crack, MDMA, and other pills [3].


Misuse not only puts the individual user at a high risk of mortality but also increases the incidence of neonatal abstinence syndrome, resulting in severe developmental and health complications in children. Additionally, fentanyl injections have also been linked to higher risk of public health-related diseases including HIV and Hepatitis C [4].


The economic and social upheavals of the COVID-19 pandemic have greatly intensified this crisis. Many individuals have turned to synthetic opioids as a result of isolation, poverty, and hopelessness associated with the pandemic provisions. Social and economic disparities put already endangered individuals at a higher risk of developing substance abuse. Poverty, psychiatric disorders, unstable housing, stress, and environmental factors may influence drug use. Individuals in lower socioeconomic neighborhoods are more likely to be introduced to substance use in early life, leading to higher risks of fentanyl exposure [5].


The imports of illicit fentanyl into the United States from Mexico and China are extremely impactful to the current surge in fentanyl use. With Big Pharma enforcing stricter regulations on prescription painkillers, drug users have depended on accessible fentanyl. Cartels and manufacturers profit off of these cheap pills by disguising them as prescription brands and selling them in bulk. After being manufactured in China, they are shipped to Mexican cartels and distributed to dealers who create lethal doses. As the United States lifted its lockdown restrictions and borders, fentanyl was easily transported and accessible in the open market [6]. This influx of imports and increased usage has contributed to the fourth wave of the opioid epidemic [7].


To address these emergent issues, preventative and harm reduction interventions have been researched and tested for efficacy. The distribution of Naloxone kits and overdose prevention programs have been implemented to train community members to reverse an overdose. These interventions have already shown success in lowering overdose rates in many communities [8]. The Biden administration has also recently funded state and local governments to obtain fentanyl test strips used to identify traces of fentanyl in unregulated drugs. The administration also instituted a campaign titled “One Pill Can Kill” spreading awareness of the dangers of fentanyl-laced pills. Finally, efforts have been made to increase resources like clean syringes to prevent infections and transmitted diseases [9]. As more harm reduction strategies continue to be developed and implemented, there is a growing hope of curbing widespread opioid overdose sooner rather than later.


Ultimately, over the past few years, synthetic opioid use has become a public health crisis stripping the livelihoods of millions of Americans. Opioid addiction is an overlooked issue because of the stigma and shame surrounding addicted individuals. Although there is no immediate comprehensive solution to prevent addiction, high rates of overdose need to be controlled by providing individuals with the resources and support. There is a crucial need for a collective effort among drug users, the public, and our administration. Although treatment procedures have been implemented to combat overdose, there is a need for governmental and administrative involvement to tackle this crisis at its root. As the trade of illicit fentanyl has become a major catalyst for overdose and death, there is a dire need to address the stealthy yet deadly rise of this poison.


References


1. Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Balwin, G. (2019, January 4). Drug and opioid-involved overdose deaths - United States, 2013–2017. Morbidity and Mortality Weekly Report (MMWR). https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm#:~:text=Synt hetic%20opioids%20were%20involved%20in,to%202017%20(Table%202).


2. Centers for Disease Control and Prevention. (2021, November 17). Drug overdose deaths in the U.S. top 100,000 annually. National Center for Health Statistics.https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/ 20211117.htm


3. New York State Department of Health. (2021, July). Fentanyl : The 411. The New York State Department of Health Aids Institute. https://www.health.ny.gov/publications/9971.pdf


4. U.S. Department of Health and Human Services. (2021, March 11). Opioid overdose crisis. National Institutes of Health. https://nida.nih.gov/drugtopics/opioids/opioid-overdose-crisis


5. Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018, February). Opioid crisis: No easy fix to its social and economic determinants. American journal of public health. Retrieved March 15, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846593/


6. Nir, S. M. (2021, November 20). Inside Fentanyl's mounting death toll: 'this is Poison'. The New York Times.https://www.nytimes.com/2021/11/20/nyregion/fentanyl-opioiddeaths.html


7. Ciccarone, D. (2021, July). The rise of illicit FENTANYLS, stimulants and the fourth wave of the opioid overdose crisis. Current opinion in psychiatry. https://pubmed.ncbi.nlm.nih.gov/33965972/


8. Naumann, R. B., Durrance, C. P., Ranapurwala, S. I., Austin, A. E., Proescholdbell, S., Childs, R., Marshall, S. W., Kansagra, S., & Shanahan, M. E. (2019, August 30). Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug and alcohol dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107918/


9. The United States Government. (2022, January 18). White House releases list of actions taken by the Biden-Harris Administration since January 2021 to address addiction and the overdose epidemic. The White House.https://www.whitehouse.gov/ondcp/briefingroom/2022/01/18/white-house-releases-list-of-actions-taken-by-thebiden-harris-administration-since-january-2021-to-address-addictionand-the-overdose-epidemic/

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