Breaking News
January 18, 2019 - Researchers develop artificial enzymatic pathway for synthesizing isoprenoids in E. coli
January 18, 2019 - Scientists advise caution in immunotherapy research
January 18, 2019 - How children across the world develop language
January 18, 2019 - Columbia Medical Student Receives McDonogh Scholarship
January 18, 2019 - Secretive ‘Rebate Trap’ Keeps Generic Drugs For Diabetes And Other Ills Out Of Reach
January 18, 2019 - Plant based diet could be the best option for the planet says commission
January 18, 2019 - New conservation practice could reduce nitrogen from agricultural drainage, study shows
January 18, 2019 - UIC researchers receive $1.7 million NCI grant to study Southeast Asian fruit
January 18, 2019 - New study determines the fate of DNA derived from genetically modified food
January 18, 2019 - Scientists develop new gene therapy that prevents axon destruction in mice
January 18, 2019 - Study finds critically low HPV vaccination rates among younger adolescents in the U.S.
January 18, 2019 - Brain cells involved in memory play key role in reducing future eating behavior
January 18, 2019 - Risk for Conversion of MS Varies With Different Therapies
January 18, 2019 - Investigational cream may help patients with inflammatory skin disease
January 18, 2019 - Medical school news office receives six writing awards | News Center
January 18, 2019 - County By County, Researchers Link Opioid Deaths To Drugmakers’ Marketing
January 18, 2019 - Research reveals risk for developing more than one mental health disorder
January 18, 2019 - Scientists discover a dramatic pattern of bone growth in female mice
January 18, 2019 - Study finds link between lengthy periods of undisturbed maternal sleep and stillbirths
January 18, 2019 - New nuclear medicine method could improve detection of primary and metastatic melanoma
January 18, 2019 - Combination therapy shows high efficacy in treating people with leishmaniasis and HIV
January 18, 2019 - Health Tip: Don’t Ignore Changes in Skin Color
January 18, 2019 - Dietary Recommendations for Healthy Children
January 18, 2019 - Eliminating the latent reservoir of HIV
January 18, 2019 - Pain From The Government Shutdown Spreads. This Time It’s Food Stamps
January 18, 2019 - Newly discovered regulatory mechanism helps control fat metabolism
January 18, 2019 - New rapid blood tests could speed up TB diagnosis, save the NHS money
January 18, 2019 - Researchers develop intelligent system for ‘tuning’ powered prosthetic knees
January 18, 2019 - Monoclonal antibody pembrolizumab prolongs survival in patients with squamous cell carcinoma
January 18, 2019 - New research detects mosquito known to transmit malaria for the first time in Ethiopia
January 18, 2019 - ACCC survey finds multiple threats to growth of cancer programs
January 18, 2019 - Meeting the challenge of engaging men in HIV prevention and treatment
January 18, 2019 - Furloughed Feds’ Health Coverage Intact, But Shutdown Still Complicates Things
January 18, 2019 - Experts discuss various aspects on health risks posed by fumigated containers
January 18, 2019 - Researchers use gene-editing tool CRISPR/Cas9 to limit impact of parasitic diseases
January 18, 2019 - Alpha neurofeedback training could be a means of enhancing learning success
January 18, 2019 - Innovative ‘light’ method demonstrates positive results in fight against malignant tumors
January 18, 2019 - The cytoskeleton of neurons found to play role in Alzheimer’s disease
January 18, 2019 - New resource-based approach to improve HIV care in low- and middle-income countries
January 18, 2019 - Bedfont appoints Dr Jafar Jafari as first member of the Gastrolyzer Medical Advisory Board
January 18, 2019 - New study shows link between secondhand smoke and cardiac arrhythmia
January 18, 2019 - DZIF scientists reveal problems with available diagnostics for Zika and chikungunya virus
January 18, 2019 - Breast cancers more likely to metastasize in young women within 10 years of giving birth
January 18, 2019 - Over 5.6 million Americans exposed to high nitrate levels in drinking water
January 18, 2019 - Blood vessels can now be created perfectly in a petri dish
January 18, 2019 - Study identifies prominent socioeconomic and racial disparities in health behavior in Indiana
January 18, 2019 - Young-Onset Type 2 Diabetes Tied to Increased Hospitalization Risk
January 18, 2019 - For-profit nursing schools associated with lower performance on nurse licensure test
January 18, 2019 - Considering the culture of consent in medicine
January 18, 2019 - Researchers identify comprehensive guidelines for managing severe atopic dermatitis
January 18, 2019 - Analyzing proteins in blister fluid may classify burn severity more accurately
January 18, 2019 - Study finds higher suicide rates among youth who were Medicaid enrollees
January 18, 2019 - Opioid drugs often overprescribed to children for pain relief, say CHOP surgeons
January 18, 2019 - New biodegradable wound dressing material accelerates healing
January 18, 2019 - Life in Space May Take Toll on Spinal Muscles
January 18, 2019 - Bulldogs’ screw tails linked to human genetic disease
January 18, 2019 - Immunotherapy target identified for pediatric cancers
January 18, 2019 - Financial stress may increase heart disease risk in African Americans
January 18, 2019 - Scientists solve another piece of Ebola virus puzzle
January 18, 2019 - New project finds how endocrine disruptors interfere with thyroid functions
January 18, 2019 - Research finds decline in ketone body utilization when coronary circulation is reduced
January 18, 2019 - Let’s map our DNA and save billions each year in health costs
January 18, 2019 - AI demonstrates potential to identify irregular heart rhythms as well as humans
January 17, 2019 - Study shows link between air pollution and increased risk of sleep apnea
January 17, 2019 - Neck-strengthening exercises can protect athletes from concussions
January 17, 2019 - Computer model shows how to better control MRSA outbreaks
January 17, 2019 - Pain is unpleasant, and now scientists have identified the set of responsible neurons
January 17, 2019 - CUIMC Celebrates 2018-2019
January 17, 2019 - Study reveals potential pathway for endothelial cells to avoid apoptosis
January 17, 2019 - Hamilton Storage launches LabElite DeCapper SL to expand LabElite product family
January 17, 2019 - Location of epigenetic changes co-locate with genetic signal causing psychartric disorder
January 17, 2019 - Researchers awarded 6.1 million euros to address female fertility problems
January 17, 2019 - Counseling appointments fail to reduce weight gain during pregnancy, shows study
January 17, 2019 - Contraceptive patch that could provide 6 months of contraception within seconds
January 17, 2019 - Yeast model may pave way for development of novel therapies for metabolic disorders
January 17, 2019 - Study determines impact of antibiotic perturbation of the gut microbiome on skeletal health
January 17, 2019 - Cardiometabolic Risk Up With Tourette, Chronic Tic Disorder
January 17, 2019 - Hong Kong scientists claim ‘broad-spectrum’ antiviral breakthrough
January 17, 2019 - Researchers discover the brain cells that make pain unpleasant | News Center
January 17, 2019 - Hepatitis Is Common in New Cancer Patients
Drug wholesalers drove fentanyl’s deadly rise, report concludes

Drug wholesalers drove fentanyl’s deadly rise, report concludes

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

Fentanyl, a powerful synthetic opioid implicated in nearly 29,000 overdose deaths in the United States last year, most likely spread because of heroin and prescription pill shortages, and also because it was cheaper for drug wholesalers than heroin, according to a report on illicit US drug markets by researchers at UC San Francisco.

First synthesized in a Belgian lab in 1960, illicitly produced fentanyl has swept through U.S. drug markets in waves, the latest beginning in 2013, and has claimed an extraordinary number of lives. The researchers who wrote the report said having a better understanding of whether fentanyl’s deadly spread is being driven by the economic imperatives of suppliers or the tastes of drug users would help policymakers find ways to curb it.

Made entirely in the lab, fentanyl is far more powerful and much cheaper to produce than heroin, which is derived from poppy opium. It is usually sold deceptively—as heroin or brand name prescription drugs like OxyContin and Xanax. The researchers said drug users and street-level dealers, who may also be using the drugs, often don’t know whether they are taking or selling drugs adulterated with fentanyl, since it is added to the supply higher up the distribution chain. Therefore, the researchers said, demand from drug users is unlikely to have played a role in its spread.

“Fentanyl is rarely sold as fentanyl,” said Sarah Mars, Ph.D., a researcher in the Department of Family and Community Medicine at UCSF and the first author of the paper, published Tuesday, Dec. 4, in Addiction. “The dealers selling fentanyl directly to the users often don’t know what’s in it. Not only is this particularly dangerous, but it also means penalizing low level dealers isn’t going to make any difference in the fentanyl poisoning epidemic.”

The researchers sifted through the scientific literature on fentanyl use, pored over United Nations opium production data as well as data on heroin price and purity from the U.S. Drug Enforcement Administration, and analyzed results from their ongoing NIH-funded study, Heroin in Transition, which is led by senior author Daniel Ciccarone, MD, MPH, a professor of family and community medicine at UCSF.

“Our research has focused on talking to people who are using heroin and fentanyl-laced heroin, and asking them about their experiences,” said Mars, who directs the study’s qualitative research. “Most of the illicit fentanyl has been in the Northeast and Midwest, and we’ve been to places where the death rate is very high. We asked drug users how they detect it, if they can—how they try to prevent overdose.”

Mars said users expressed opposing views on fentanyl, which causes a more sudden and powerful but usually shorter high than heroin. While some said they liked fentanyl, because it brought on the euphoria they had lost the ability to feel from tolerance built up by long-term heroin use, or because it broke through the opioid blocking effects of medications like buprenorphine, others said they feared fentanyl and disliked its harsh effects.

“Whether or not they prefer fentanyl, users don’t have any influence over what drugs are being sold,” Mars said. “Without accurate information about these drugs, they can’t make an informed choice about what they are buying. Also, very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic.”

The researchers said users do try in various ways to detect fentanyl in the drugs they buy, but it’s impossible for them to determine which synthetic opioid is present or how potent it is before they use it.

Different chemical versions of fentanyl, known as analogues, with wildly varying potency, appear unpredictably in different locations around the country. Some analogues are so new they have not yet been deemed illegal and some, like carfentanil, which was designed to tranquilize large animals, are incredibly powerful—as much as 10,000 times the strength of morphine.

“We believe it’s the fluctuation in the potency of the drugs containing fentanyl that makes them so dangerous,” Ciccarone said. “You might have one dose that had hardly any fentanyl in it or none at all. Then, you might have one with a different fentanyl analogue, of different potency, or even mixtures of multiple fentanyls and heroin.”

The researchers said the data suggest that heroin shortages or ‘supply shocks’ occurred before the current and prior fentanyl waves struck in both Europe and the U.S. Prescription opioids were also becoming harder to obtain in the U.S. at the time. Fentanyl, which has also appeared in drug markets in many European countries, as well as Russia, Brazil and Canada, is an easy substitute for heroin since it can be produced in the lab year round and is not subject to blight, pests or climate conditions. It is about 30 to 40 times stronger than heroin and considerably cheaper to produce.

The full motives of wholesale suppliers still remain hidden, but there are significant incentives for them to shift over partially or completely to fentanyl, even though it often causes users to overdose. The researchers said it may just be a matter of time before fentanyl takes over more of the illicit U.S. and worldwide drug market, as has already happened in Estonia.


Explore further:
Fentanyl in more than half of opioid deaths in 10 states

More information:
Addiction (2018). DOI: 10.1111/add.14474

Journal reference:
Addiction

Provided by:
University of California, San Francisco

Tagged with:

About author

Related Articles