Mad About Science: Fentanyl

By Brenden Bobby
Reader Columnist

These articles are usually filled with an adequate level of snark and silliness tucked between lines of dense information. This week may not have so many giggles.

Fentanyl is a serious problem in the United States and Canada, but is it truly the devil the news media makes it out to be? That’s a loaded question with no simple answer.

Fentanyl is a synthetic opioid. Its primary function is that of an analgesic, or a pain reliever. It works to move onto µ-opioid receptors in the brain to block its ability to process pain, and it’s extremely effective at doing this — up to 100 times more effective and potent than morphine. This, along with a few other characteristics, makes fentanyl extremely addictive and shockingly lethal.

Fentanyl is a fantastic tool in our pharmaceutical arsenal — when it is produced in a clean facility that’s actively monitored by an organization with a clear chain of command and legal distribution — and particularly if it’s monitored by doctors for use in surgical anesthesia, hospice and palliative care to control intense and otherwise unmanageable pain.

The problem with fentanyl is when it’s not used as directed, or when part of the distribution chain becomes compromised by criminal entities seeking to profit from its addictive nature.

You might be wondering at this point what the differences are between opiates, street drugs like heroin and fentanyl — we’ve all heard these terms thrown around as boogeymen in the news, but many people have avoided exposure to these things outside of television.

Opiates are a substance extracted from the seed capsules of the opium poppy. Humans have a long history with the opium poppy and its ability to treat pain and deliver a mind-altering high. It’s unknown exactly when humans first harvested the poppy, but there is evidence that Neolithic gatherers were utilizing it as far back as 5,000 B.C.E. near the Mediterranean Sea.

Most opiates are derived from poppy plants to this day. Opium poppies designated for the illegal heroin market made headlines during the U.S. Invasion of Afghanistan, as terrorist organizations like Al Qaeda had been using it to finance their operations. As these harvesting operations have come under increased pressure from governmental agencies around the globe, the scarcity of the opium poppy has driven up the cost of both legal and illegal opiates. Paired with the opioid epidemic raging throughout North America since the 1990s, a cascade effect has formed to decrease supply, increase demand and bolster criminal organizations around the world. Basically, it’s bad news for everyone.

Fentanyl is a synthetic opiate, which means that it achieves the same effects as something like morphine or heroin, but doesn’t require opium poppies as an input. Where a kilogram of heroin has an estimated cost of somewhere around $100,000, a comparable amount of fentanyl has a production cost of about $6,000, with each dose using far less due to its potency. You can see the problem emerging here.

Let’s say you’re going to a car dealership. You really want the Mercedes-Benz and you’ll give anything to drive it. Unbeknownst to you, the dealership has been using a mix of Mercedes parts and junkyard scrap from wrecked vehicles tied to spent rocket materials they were able to slap together for pennies on the dollar. You’re going to die when you drive off the lot, but the dealer doesn’t really care — you just paid $100,000 for a $6,000 death trap.

This is the issue with fentanyl in a nutshell. Criminal organizations are cramming cheap synthesized fentanyl into heroin with little regard for the safety of their consumers. In the regular world, it doesn’t make a lot of sense to kill off your clientele, but in the criminal underworld this is considered collateral damage in pursuit of profit. New users are easy to hook on addictive numbing agents when grief spreads in a web.

The criminal aspect is the real issue behind fentanyl and its distribution. Based on information collected by government agencies from all over the world, the bulk of fentanyl is produced in China, Laos and Myanmar, a section of Southeast Asia referred to as the Golden Triangle. It is then shipped overseas by triads, which operate similarly to organized crime syndicates like mafia crime families in the western world. America’s illicit fentanyl pipeline seems to involve a number of Mexican drug cartels that purchase raw fentanyl from East Asian triads, then press the drug into its final form before smuggling it into the U.S. Common practice seems to be cutting heroin with fentanyl to deliver a more intense effect for the user while also intensifying the addiction, provided the user isn’t killed by overdose.

The amount of fentanyl required to trigger an overdose is an extremely small amount — as small a dose as 2 milligrams, which can fit on the tip of a sharpened pencil. Between 2015 and 2021, accidental overdose deaths from fentanyl exploded from fewer than 5,000 per year to more than 100,000 in 2021.

Luckily, there is a solution to deal with opioid overdoses. Naloxone, sometimes referred to as Narcan, is a substance that is loaded into a saline solution inside a spring-loaded sprayer, similar to medication like Flonase. EMTs may carry an intravenous injection of naloxone that can reach the brain in fewer than two minutes. Naloxone acts as an opioid antagonist, which kicks the opioids off the receptors in the brain to reverse the effects of an overdose. Due to the sheer potency of fentanyl, multiple doses may need to be taken, but naloxone carries no known side effects and is safe to dose multiple times.

Looking for more information on this subject? Check out the Panhandle Health District’s website and search for “Opioid Reversal Medication,” or stop by the library and ask a desk attendant. Our staff recently took training on the subject and can link you up with the resources you need.

Stay curious, 7B.