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As a Virginia dangerous drug attorney, I have tracked the tragic consequences of the overprescribing and illegal sale of powerful prescription painkillers for more than two decades. Doctors, dentists and pharmacists who did too little to limit access to medications like OxyContin (oxycodone) and Vicodin (hydrocodone and acetaminophen) contributed to creating a group of opioid-dependent and addicted patients who turned to the chemically similar street drug heroin when their supplies of pharmaceuticals became restricted.

Now, heroin users are increasingly seeking out cheaper and more-potent fentanyl. Drug traffickers have also taken to combining fentanyl with heroin to reduce their own costs and meet a demand for stronger products. These market forces — for lack of a better term — introduced carfentanil to American opioid abusers.

Ten Thousand Times as Potent

The U.S. Drug Enforcement Administration on Sept. 22, 2016, issued a warning to law enforcement officers, first responders and health care providers that carfentanil “is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin.” Harmful doses of each drug appear in the photo to the left.

The DEA warning on carfentanil followed a similar March 18, 2015, statement on the dangers of fentanyl. Overdose deaths from all types of opioids, which the DEA noted “can come in several forms, including powder, blotter paper, tablets, and spray — they can be absorbed through the skin or accidental inhalation of airborne powder,” rose steadily from 2009 to 2015. In the last year for which complete data are available, some 34,000 Americans died after overdosing on opioids.

An estimate of 2016 opioid overdose deaths in Virginia put the number at 1,420, with 600 of those being attributable to heroin, fentanyl or a combination of the two. On June 22, 2017, a traffic stop in Norfolk, VA, resulted in the seizure of a combination opioid product called Grey Death for its frequently lethality. It delivers a mixture of fentanyl, carfentanil and U-47700, which has properties similar to morphine but is stronger.

No Police Crackdown Will Solve the Problem

German Lopez skillfully traces much of this history and carnage in a May 16, 2017, Vox article. A possibly surprisingly insight is that regulatory and law enforcement efforts to curb opioid prescribing begun about a decade ago propelled the turn toward heroin, fentanyl and carfentanil. In his words: “If you go after opioid painkillers, people will eventually go to heroin. If you go after heroin, they’ll eventually go to fentanyl. And if you go after fentanyl, they might resort to some of its analogs, like carfentanil.”

More hopefully Lopez pointed to evidence showing that fewer opioid prescription in recent years have created fewer addicts. He also highlighted promising developments in addiction treatment and maintenance therapy that have already begun saving lives.

When Virginia Gov. Terry McAuliffe declared a state opioid addiction crisis on Nov. 21, 2016, he empowered public health officials to employ some of those innovative methods. EMTs and police in Virginia now have greater access to naloxone, which reverses the effects of opioids almost immediately after being injected. Prescribers have agreed to comply with patient treatment plans that emphasize addiction and diversion risks from day one, and additional money will go to in-patient detox and counseling.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis called for a similar declaration and commitment of resources for a national health emergency in late July 2017. The White House has sent mixed signals on whether it will take that step.

Again, as someone who has watched opioids exact an ever-growing toll on Americans, I urge all local, state and federal officials to develop and fund programs that reduce addiction and save lives. Doctors, pharmacists, mental health professionals and other health care providers must do their parts, as well.



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