By Sara Burnett, CNN
What has been a scourge for years is coming into its own as the result of an ever more potent drug. In 2017, the United States Attorney’s Office in Los Angeles says it’s seen more than 3,000 overdose deaths involving synthetic opioids — commonly known as heroin, fentanyl or carfentanil — in the city. In June, the US Attorney’s Office in New York City said carfentanil contributed to an 18% increase in overdose deaths there from 2015 to 2016.
“This is poison,” says U.S. Attorney Eileen Decker. “If you make synthetic drugs that are more deadly, the consequences will be worse.”
Fentanyl is a powerful synthetic opioid produced by China and Pakistan. The drug is part of a group of synthetic opioids behind the surge in overdoses, and while it started out as a painkiller prescribed to cancer patients, it’s now being cut with other drugs for illicit use in large quantities. Carfentanil, a highly-addictive opiate used as a tranquilizer for elephants, is 50 times stronger than morphine. It can be up to 100 times more potent than fentanyl.
This use of the drug is largely responsible for the sharp increase in overdose deaths. “We’re seeing a lot of fentanyl being mixed with heroin,” says Alex Keim, the CDC’s senior director for Prescription Drugs and Overdose Prevention.
But instead of causing a fatal overdose, the drug can cause a very dangerous chain reaction. “Fentanyl is more potent than heroin, which can make it more addicting,” Keim says. “It also increases the potential of other deadly substances entering into the bloodstream.”
What happens once you come into contact with the drug? Instead of being snorted or smoked, synthetic drugs can be absorbed through the skin or through the body’s mucous membranes. “The problem with synthetic drugs is when you get them in your nose and mouth, you don’t know where they are coming from,” Keim says. “It can cause respiratory depression.”
This is a pulmonary toxicity. In the lungs, a drug like fentanyl — or any other synthetic opioid, for that matter — can cause significant respiratory depression leading to death, although if there’s no evidence of this in the autopsy, the risk is deemed low. “Fentanyl is a prescription painkiller — and a legal opioid. But if someone has an access to it illegally, the chance of getting a bad batch is greatly increased,” Keim says.
CNN previously reported on a widespread outbreak of heroin laced with fentanyl and carfentanil in New York, New Jersey and Pennsylvania — the largest such outbreak in U.S. history. Keim says prescription painkillers like hydrocodone and oxycodone are still “the most abused prescription opioid,” but synthetic opioids are “increasingly showing up as the biggest contributors in overdose deaths.”
Experts warn that because synthetic drugs can be cut in any way, including with other drugs, overdose deaths can occur in any setting. “When someone is ingesting synthetic drugs, they may be in a bar, on a park bench, on a bus, on a airplane or on a plane toilet, and if they inhale that when they don’t know what’s in it, there’s a potential to inhale a toxic aerosol,” Decker says.
Keim says it’s possible that synthetic opioids such as fentanyl and heroin will continue to be key ingredients in illicit drug supply in the United States. “It will only get worse,” he says. “As the United States gets on top of it, it will only get worse.”