Thank Drug Warriors for the Escalating Death Toll From Superpotent Synthetic Opioids

New data show the share of opioid-related fatalities involving fentanyl analogs is rising.


New Hampshire State Drug Lab

Highly potent fentanyl analogs are playing an increasingly prominent role in opioid-related deaths, accounting for one in five such fatalities during the year ending in June 2017, according to a new CDC analysis of data from 10 states. During that period, the CDC counted 11,045 "opioid overdose deaths" in those states, including 2,275 cases where fentanyl analogs were detected. The number and proportion of deaths involving fentanyl analogs "nearly doubled" between the second half of 2016 and the first half of 2017. This trend is yet another illustration of prohibition's effectiveness, assuming the goal is to make drugs as deadly as possible.

Most opioid-related deaths now involve illicitly produced fentanyl. In the 10 states tracked by the CDC (Kentucky, Maine, Massachusetts, New Hampshire, New Mexico, Oklahoma, Rhode Island, West Virginia, and Wisconsin), fentanyl was detected in 57 percent of opioid-related fatalities from July 2016 through June 2017. Fentanyl analogs showed up 21 percent of the time. The most commonly detected analog was carfentanil, followed by furanylfentanyl. Ohio alone accounted for 90 percent of the 1,236 carfentanil deaths in the 10 states during this period. The other analogs detected were 3-methylfentanyl, 4-fluorobutyrfentanyl, 4-fluorofentanyl, 4-fluoroisobutyrfentanyl, acetylfentanyl, acrylfentanyl, butyrylfentanyl, cyclopropylfentanyl, cyclopentylfentanyl, furanylethylfentanyl, isobutyrylfentanyl, and tetrahydrofuranylfentanyl.

The CDC notes that "carfentanil, the most potent fentanyl analog detected in the United States, is intended for sedation of large animals and is estimated to have 10,000 times the potency of morphine." By comparison, the National Institute on Drug Abuse says fentanyl is 50 to 100 times as potent as morphine, while heroin is said to be about twice as potent as morphine. Prescription conversion tables indicate that hydrocodone (the opioid in Vicodin) is about as strong as morphine, while oxycodone (Percocet) is a bit stronger.

In other words, the crackdown on prescription analgesics is pushing opioid users toward increasingly potent substitutes: heroin (roughly twice as potent as morphine), which is often mixed with or replaced by fentanyl (50 to 100 times as potent) and fentanyl analogs (as much as 10,000 times as potent). Worse, the purity and potency of black-market drugs are highly variable and unpredictable, making consumers vulnerable to lethal dose miscalculation, especially when they are taking more than one substance at a time (as is typically the case in drug-related deaths). The wider the range of purity and potency, the greater the potential for fatal mistakes.

Prohibition contributes to this problem in several ways. It creates a black market where consumers don't know what they're getting, encourages dilution along the supply chain that dealers may try to counteract by adding fentanyl or fentanyl analogs to heroin, and pushes traffickers toward more potent drugs, which reduce the volume that must be smuggled for any given number of doses. Increased enforcement of prohibition magnifies these tendencies, exposing users to greater risks and feeding the upward trend in opioid-related deaths.

So how is Attorney General Jeff Sessions responding to the proliferation of fentanyl and fentanyl analogs? With increased enforcement, of course.

Last week Sessions announced Operation Synthetic Opioid Surge, which aims to "reduce the supply of deadly synthetic opioids in high impact areas" by federally prosecuting "every readily provable case involving the distribution of fentanyl, fentanyl analogues, and other synthetic opioids" in 10 U.S. attorney districts. This strategy may send more people to prison for longer periods of time and temporarily disrupt retail markets. But judging from a century of drug prohibition in America, Sessions' innovative plan to arrest and imprison readily replaced drug dealers will not have a substantial and lasting impact on the availability of opioids or reduce the death toll associated with them. To the contrary, the enforcement pressure is apt to make drug use even more dangerous.

"When it comes to synthetic opioids, there is no such thing as a small case," Sessions said in his press release. "Three milligrams of fentanyl can be fatal—that's not even enough to cover up Lincoln's face on a penny." Based on the CDC's estimate, the equivalent amount of carfentanil would be 0.03 milligram, or 30 micrograms, which is not even enough to cover Lincoln's right nostril. Perhaps that is where the market is headed, with a little encouragement from drug warriors like Sessions.

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  1. In other words, the crackdown on prescription analgesics is pushing opioid users toward increasingly potent substitutes

    I think you'd be better off substituting "opioid dealers" for "opioid users".

    If I had to smuggle something across the border, and I had the option of making the item I was smuggling 10,000 times smaller, I would take that option.

    If I was dealing with a situation where I was likely to be charged with a crime based on the mass of the drugs I have on me, I have a strong incentive to make the mass of that drug as small as possible.

    1. Oh, I see that you do mention that, later.

      1. *throws the obvious Libertarian Macho Flash*

        "Legalise Heroin!"

    2. And the problems associated with these black market items are nothing new - back in the 90's there was a mini-epidemic of heroin users developing severe dystonias due to a toxic contaminant from a sloppy lab.

  2. How many times do we have to try escalating the war on drugs before we declare the war to be a lost cause?

    1. No retreat, no surrender.

      1. Think about all the families ruined by drugs. We have to ruin them first, so that drugs can't ruin them.

        1. Government really hates competition.

  3. Next thing you know, they'll be combining malt liquor and caffeine.

    1. Thanks Paul. I'm LITERALLY crying at work out of fear of what you just described.

    2. That combination has an infinite% increase in both alcohol and caffeine potency over that found in tap water... unless you live in Flint, MI.

  4. I will never thank a drug warrior for anything.

    1. Surrender is the only thing they should be thanked for.

  5. A guy I grew up with, who was only about four months older than me, recently overdosed on this stuff and to say that he was an 'experienced' user is to undersell the amount of drugs he consumed.

    So, yeah, I'd say legislation in this arena definitely contributed to his death even while ultimately it's the users responsibility to know what they're taking and how much is appropriate.

    1. Ohio alone accounted for 90 percent of the 1,236 carfentanil deaths in the 10 states during this period.

      Also, what the fuck Ohio?

      1. My guess, one dealer ordered the wrong shit from China, cut it way too strong, and killed everyone in his distribution network.

        1. Bullshit. It was the Russians making Trump do it.

    2. ultimately it's the users responsibility to know what they're taking and how much is appropriate

      I mean, I don't disagree... obviously, no one has as much of an interest in that as the end user. But it still seems pretty harsh to point it out, in the context of people who were in a situation where it was literally impossible for them to have access to that information.

      I dunno.

      I guess it's like pointing out that the Second Amendment still exists, the morning after a school shooting. It's true, but you feel like a jerk for it.

  6. The purity and potency (along with risks of of contaminants or dangerous adulterants) of black-market drugs are so highly variable and unpredictable as to render their use reckless if not outright self destructive.

    Liberty, and libertarianism does not mean shit if we do not hold people accountable for their own actions.

    Bad laws make you preferred intoxicants not (reasonably) safely available? That's an insult to your liberty, but it does not excuse you doing something phenomenally stupid and dangerous.

    Anymore than bad gun laws mean it's not your fault when your poorly made homemade gun blows up in your hand.

  7. Worse is how they tied in pain pills with "opioid overdoses" and cracked down on doctors. My back doctor ordered up muscle relaxants that knock you out (literally) because he's trying to not prescribe Oxy's for pain (I said, no thanks either way). Screw the general population, tax everybody to pay for the war (Operation Synthetic Opioid Surge "OSOS"?), and make the problem you are trying to solve worse. Guvmint 101. And the PR guy who named the operation needs to be replaced.

  8. Sessions is an ignorant little troll. He is the biggest fuck up in the entire administration. Trump has fired everyone but this knuckle dragger remains.

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