MENU

Reason.com

Free Minds & Free Markets

New CDC Numbers Show the Drug War Continues to Make Opioids Deadlier

Deaths involving pain pills and heroin are falling, while deaths involving fentanyl and its analogs continue to rise.

The CDC's latest estimates of opioid-related fatalities in 2017 show that the war on drugs continues to drive people toward deadlier substances. Based on preliminary estimates, the total number of deaths involving opioids (the blue line below) rose by 8.5 percent last year, from about 45,000 to about 49,000. Yet deaths involving heroin (gray line) and prescription analgesics (yellow) fell by 4 percent and 2 percent, respectively. The increase was due entirely to a 37 percent jump in deaths involving synthetic opioids other than methadone (orange), a category that nowadays consists mainly of illicit fentanyl and fentanyl analogs. That increase follows even bigger jumps of more than 70 percent in 2015 and more than 100 percent in 2016.CDCCDC"The death toll reflects two major factors," writes New York Times health reporter Margot Sanger-Katz. "A growing number of Americans are using opioids, and those drugs are becoming more deadly. Experts who are closely monitoring the epidemic say the second factor most likely explains the bulk of the increased number of overdoses last year." That much seems clear, since in recent years opioid-related deaths have been rising much faster than the number of opioid users.

Between 2010 and 2016, for example, the number of heroin deaths increased roughly eight times as fast as the number of heroin users. To put it another way, heroin was eight times deadlier in 2016 than it was in 2010. The proliferation of fentanyl-fortified heroin is the most obvious explanation. The most recent numbers suggest that such mixtures have been eclipsed by "heroin" that consists entirely of fentanyl (which is much more potent than heroin) or its analogs (which are even more potent).

"Unlike heroin, which is derived from poppy plants," Sanger-Katz notes, "fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated." Not only has the crackdown on pain pills driven opioid users toward black-market substitutes that are more lethal because their potency is unpredictable, but the crackdown on heroin has pushed traffickers toward fentanyl, which is easier to make and smuggle, thereby magnifying the uncertainty that can lead to fatal dosing errors. Fentanyl analogs such as carfentanil, which is something like 5,000 times as potent as heroin, further reduce the amount that must be manufactured and smuggled for a given number of doses.

"Unexpected combinations of those drugs can overwhelm even experienced drug users," Sanger-Katz writes. "In some places, the type of synthetic drugs mixed into heroin changes often, increasing the risk for users. While the opioid epidemic was originally concentrated in rural, white populations, the death toll is becoming more widespread. The penetration of fentanyl into more heroin markets may explain recent increases in overdose deaths among older, urban black Americans; those who used heroin before the recent changes to the drug supply might be unprepared for the strength of the new mixtures."

The lethal effects of the government's anti-opioid efforts were entirely predictable and by now should be obvious to anyone who is paying attention. Which apparently does not include the legislators crafting a response. Congress is "debating a variety of bills to fight the epidemic," Sanger-Katz notes. "Many of the measures, which have passed the House but have not reached the Senate floor, are focused on reducing medical prescriptions of opioids."

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • John||

    I am all for legalizing all of this stuff. That being said, if you could buy opioids over the counter like Advil, I think the people who are today killing themselves with fentyal would probably kill themselves with over the counter opioids. It might take them a bit longer. But anyone irresponsible and desperate enough to risk their lives taking fentynal is probably not going to be responsible enough to keep from oding if opioids could be bought over the counter.

    That doesn't mean that the stuff shouldn't be legalized. It should. But I don't think we should kid ourselves and think it will solve the problems that come with people's irresponsibility and self-destructiveness.

  • BYODB||

    Yeah, the wisest course of action isn't the emphasis 'saving lives' since it probably won't save many long term. Heroin and other hard drugs don't necessarily kill you, but most people willing to get into those sorts of drugs don't care about themselves in particular. If it wasn't heroin, it'll just be something else at some later time.

  • Rossami||

    re: "would probably kill themselves with over the counter opioids."

    I disagree but for different reasons. If over-the-counter opioids were available, there would be a market incentive to make them safe and consistent. Most of the deaths are not the result of the intended use of the opioid itself but are instead the result of
    a) impurities (dealers cutting the product with other chemicals that are much more dangerous for the user but more readily available to the manufacturer) and/or
    b) mis-dosages (because the actual concentration is unknown).

    Essentially nobody dies accidentally from the use of sleeping pills even though they are objectively just as dangerous as many opioids. Manufacturers of legal products have an incentive to maintain quality control.

  • ThomasD||

    "Most of the deaths are not the result of the intended use of the opioid itself but are instead the result of
    a) impurities (dealers cutting the product with other chemicals that are much more dangerous for the user but more readily available to the manufacturer) and/or
    b) mis-dosages (because the actual concentration is unknown)."

    Sorry, while those factors do contribute to deaths and other adverse events eliminating them would not eliminate the problem of self destructive people self destructing.

  • ThomasD||

    Thinking one step further, even if these drugs were not legally restricted who would manufacture and sell them on the open market given that what you say is quite likely true?

    The liability issues tending to be rather huge when you sell a product knowing full well that when used as intended - ie. ingested (you are not fertilizing the roses with the stuff) there is a high risk of death.

    While I too would be glad if drug laws were eliminated, it seems to me that there would need to be other substantial alterations to the legal system to affect any meaningful change in availability.

  • Rob Misek||

    42 kg of Carfentanil was found with a cache of guns in the basement of the Toronto Danforth shooters friends basement. That was enough to kill every Canadian 58 times over.

    An amount the size of a grain of salt touches your skin and you can die. It is a weapon of mass destruction.

    You want to make that shit available over the counter? What are you, a liberal?

  • John||

    What is Carfentanil and what does it have to do with opioids?

  • Rob Misek||

    Perhaps you should read the article.

  • John||

    The article is about fentynyl. Perhaps you should explain what the fuck you are talking about.

  • Echospinner||

    Carfentanyl is an analog of fentanyl. Both are synthetic opioids.

    Fentanyl has medical use in humans in anesthesia and sedation. It is one of the drugs more difficult to use and the patient must be monitored with resuscitation and naloxone available. It is used in microgram amounts and should only be used by those trained in anesthesia.

    Carfentanyl is a chemical analog of fentanyl. By comparison it is about 100x more potent than fentanyl because of its binding to certain opiod receptors. Per dose it is about 10,000 more potent than morphine. It is far too dangerous to use in humans. It has limited use in large animal veterinary medicine.

    Heroin has been cut with both. Produced by illicit labs somewhere. It is cheap and profitable for dealers.

  • Rossami||

    Perhaps you should re-read the article. Carfentanil is a substitute product introduced to the market because it "reduce[s] the amount that must be manufactured and smuggled for a given number of doses."

    In other words, if real opioids were available over the counter, there would be no incentive to use such dangerous alternatives.

    By the way, while Carfentanil can be absorbed through the skin, the Material Data Safety Sheet for Carfentanil shows that your estimate of skin toxicity is off by several orders of magnitude. It takes a lot more than "an amount the size of a grain of salt" and a whole lot longer than a brief "touch". The first aid for Carfentanil contact is "wash with soap and plenty of water".

  • MichaelL||

    Thank you for that clarification on the "skin exposure" causing deaths! I was in a discussion, only the other day, when I had to deal with this outrageous claim of the exposure killing cops! I thought maybe the fact was that they were using grain as a unit of measurement. One grain of anything, is equal to 65 mg of medication. If one were to get a dose of one grain of Carfentanyl, it is very likely to kill! It is dosed in micro-grams! The absorption of any medication through the skin, is so poor that many medications have to be placed in special carrying agents to get the skin to absorb it. It is another myth used by the drug warriors to try to sensationalize the problems with "opioids".

    They want to take opioids away from intractable pain patients without good cause. Sadly, the intractable pain patients are being targeted when they have the lowest rates of addiction. Drug addiction is more commonly associated with mental disorders than painful ones! The addiction rates among chronic pain patients is much less than that of the general population! This is what we get when politicians, news media , and law enforcement make the decisions about drugs, that doctors should be making. The ignorant use old wive's tales, and myths, to get an emotional reaction out of the general public! But, IT'S FOR THE KIDS!

  • Echospinner||

    "What is Carfentanil and what does it have to do with opioids?"

    And you have an opinion here?

    SMH

  • gaoxiaen||

    From Wikipedia. "A unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine." I think that you'd die from a dose the size of a speck of dust. It would be difficult for your average gang-banger to maintain consistent QC.

  • MichaelL||

    It might, if given orally, or parenterally (IM, IV). Otherwise, the skin is very hard structure to get to absorb medication. I takes special carrying agents to get the skin to use topically applied medication. I think I would be referencing medical texts, and not "Wikipedia" to get reliable information about these drugs.

  • ThomasD||

    "Otherwise, the skin is very hard structure to get to absorb medication. I takes special carrying agents to get the skin to use topically applied medication."

    While that may be true for many drugs, in the case of fentanyl it is not true.

    Fentanyl patches do consist of the drug, dissolved in a matrix, but between that matrix and the skin is a membrane. Only the fentanyl passes through that membrane, and it is the membrane that controls the absorption of the drug (this is also why the different dosages of fentanyl patches have different size - it is the surface are of that membrane that dictates the rate of delivery.) From the Duragesic (brand name fentanyl patch) prescribing information.

  • ThomasD||

    DURAGESIC is a drug-in-adhesive matrix designed formulation. Fentanyl is released from the matrix at a nearly constant amount per unit time. The concentration gradient existing between the matrix and the lower concentration in the skin drives drug release. Fentanyl moves in the direction of the lower concentration at a rate determined by the matrix and the diffusion of fentanyl through the skin layers. While the actual rate of fentanyl delivery to the skin varies over the 72-hour application period, each system is labeled with a nominal flux which represents the average amount of drug delivered to the systemic circulation per hour across average skin. While there is variation in dose delivered among patients, the nominal flux of the systems (12.5, 25, 50, 75, and 100 mcg of fentanyl per hour) is sufficiently accurate as to allow individual titration of dosage for a given patient.

  • ThomasD||

    Following DURAGESIC application, the skin under the system absorbs fentanyl, and a depot of fentanyl concentrates in the upper skin layers. Fentanyl then becomes available to the systemic circulation. Serum fentanyl concentrations increase gradually following initial DURAGESIC application, generally leveling off between 12 and 24 hours and remaining relatively constant, with some fluctuation, for the remainder of the 72-hour application period. Peak serum concentrations of fentanyl generally occurred between 20 and 72 hours after initial application (see Table 7). Serum fentanyl concentrations achieved are proportional to the DURAGESIC delivery rate. With continuous use, serum fentanyl concentrations continue to rise for the first two system applications. By the end of the second 72-hour application, a steady-state serum concentration is reached and is maintained during subsequent applications of a patch of the same size (see Figure 1). Patients reach and maintain a steady-state serum concentration that is determined by individual variation in skin permeability and body clearance of fentanyl.

    ...

    IOW fentanyl - and it's analogs (alfentanil, sufentanil, carfentanil) are skin permeable. The technology of the patch is used to slow absorption, and provide a controlled rate of administration.

  • Homple||

    "New CDC Numbers Show the Drug War Continues to Make Opioids Deadlier"

    No, the people who concoct fentanyl-laced opiods are making opiods deadlier. The war on drugs does not force illegal drug makers to produce an adulterated product.

  • John||

    True. But it does help to create the market for that product. If opioids were legal over the counter, only a nut would buy the stuff made on the black market.

  • Homple||

    If the drugs were legalized, what would prevent the manufacturers from selling an adulterated product?

  • sarcasmic||

    Good point. I mean, before the FDA everything was adulterated. Beer, wine, liquor, food, you name it. Every drink or bite was a roll of the dice. Because evil profiteers will do anything for a profit, including killing their customers. They don't want repeat customers. Sell something once and watch them die. Profit!

  • JFree||

    You do know that the FDA was created specifically as a response to a series of articles called The Great American Fraud - which impelled the chief govt chemist (Harvey Wiley) to test those medicines and found that many were in fact toxic and had probably caused thousands of deaths (but impossible to prove because people died by drinking the evidence - and the products couldn't be tracked back to manufacturer because labels were crap/fraud).

    The original FDA - to be enforced through that Dept of Chemistry:

    1. prohibit 'patent medicine' companies from putting arsenic and other pure toxics in their product.
    2. require them to label the inclusion of other ingredients (alcohol, opium, cocaine, etc)
    3. for those latter ingredients, prohibit the targeted marketing of those as for children

    Those were all actual problems. The ACTUAL free market did not fix anything. Your hypothetical free market won't either.

  • sarcasmic||

    I don't know. I think that in this age of information someone would have to be pretty dumb to be duped.

  • JFree||

    That is a moronic twit derp derp response.

    What age of information? Those articles described how the press itself was coerced into silence by the terms of the ad contracts. Nebraska had tried to force ingredients disclosure/labels 30 years before - and had had to back off because their press then was already dependent on those ad revenues. You think TV now is LESS dependent on pharma revenues - and every one of those ads already has to go through the FDA because the pharma companies continually try to push images of really happy people (going way beyond the actual efficacy) taking their drugs with no mention of side effects or likely effects? Shiny happy people taking drugs.

    NOTHING has changed at all - except that advertising/PR is far more effective at manipulating our lizard brain. We are duped all the fucking time - and every libertarian knows it even if they can only bring themselves to admit that only gummint does the duping.

    And getting rid of the FDA also gets rid of 99% of any legal recourse as well - since the data they gather is the source of pretty much all the evidence of problems.

  • sarcasmic||

    Between patents allowing companies to charge arbitrary prices, third parties picking up the tab, FDA shielding companies that follow all of their rules, and plenty of other things I can't think of off the top of my head, the market is so distorted that it's hard to fathom what alternatives may have arisen without government intervention.

  • BYODB||

    This just in, you can't save people from themselves. Have those 'warning labels' stopped people from going to a guy in a van down by the river and getting fix-a-flat injected into their tits and ass? Oh, wait, nope people still do that.

    Riddle me this: If a 'medicine' is killing people because it contains arsenic, than why is the person that manufactured it or sold it not guilty of some crime other than breaking some FDA rules and paying a fine, such as (just for example) murder.

    If it's because the 'label' is a fraud, than who did they buy it from? Answer that, and congrats you've found the source to prosecute.

  • JFree||

    If a 'medicine' is killing people because it contains arsenic, than why is the person that manufactured it or sold it not guilty of some crime other than breaking some FDA rules and paying a fine, such as (just for example) murder. If it's because the 'label' is a fraud, than who did they buy it from? Answer that, and congrats you've found the source to prosecute.

    You think they were just stupid back then? Or that they didn't give a shit that someone in their family died? Read the linked article. There was no effective legal recourse. Even obituaries were not allowed to mention the sources of poisons found by coroners - by those ad contracts.

    One of the reasons IMO the legislation occurred so quickly after those articles - initiated by the Senate - was because they were read by lawyers - familiar with their states laws and realized there was no way that states could prosecute those. And like it or not, states have to be able to prosecute murder cuz dead people can't. 'Poisoning' was always a personal crime - where motive is important. These were industrial poisoning.

  • John||

    Sure there were problems. There always are. But the problems such as they were are dwarfed by the number of people the FDA has killed by keeping effective drugs off the market while they are tested beyond all levels of reason.

  • JFree||

    the problems such as they were are dwarfed by the number of people the FDA has killed by keeping effective drugs off the market while they are tested beyond all levels of reason.

    Oh bullshit. There's probably 100+ countries on Earth where there is no required testing of anything at all. I don't see a long line of people heading to Zimbabwe for life-saving treatment.

    So specifically what are all these life-saving medications - Laetrile? ground up rhino penis? Or are you one of those who believes that the Fountain of Youth was actually discovered and immortality is possible - but it isn't available in stores so you have to call in the next 5 minutes?

  • BYODB||


    Oh bullshit. There's probably 100+ countries on Earth where there is no required testing of anything at all. I don't see a long line of people heading to Zimbabwe for life-saving treatment.


    Interesting that you use Zimbabwe instead of, oh I don't know, Cuba. Is it because you're purposefully mendacious, or because you forgot about all those 3rd world countries that people literally do go to for cheap(er) medical care and drugs?

  • Kaatje||

    Right on, stem cell 'treatment', homeopathy etc.

  • ThomasD||

    The elixir sulfanilamide tragedy of 1937 is what got us the FDA (requirements for both safety and efficacy) we have today.

    https://tinyurl.com/ycz82ef6

  • John||

    Their desire not to kill their customers and the legal and financial ramifications of doing so? Maybe Price Pfister has more skin in the game than some retard mixing shit in his basement. Just saying.

  • Echospinner||

    Legal heroin has been tried. It is available in Switzerland, Denmark, and elsewhere. Research it yourself.

    Substitutes such as methadone and suboxone are legal here if prescribed and under medical supervision.

  • Rossami||

    Your comment implies that you believe that legal heroin has been tried and failed. I am curious what evidence you have for that position. From what limited data I've been able to find, Switzerland, Denmark and the other places with legalize heroin have far, far smaller problems with overdoses and adulteration (and correspondingly fewer accidental deaths).

  • JFree||

    Those places also all have national health coverage. That's 180 degrees different than here - where you're arguing that someone has to pay for someone else's heroin while they can't even go to the doctor themselves.

    In those places, those programs - with serious gatekeeping and non-libertarian controls - SAVE money compared to the street stuff. Here - it's just creating a form of govt subsidized privilege.

  • ThomasD||

    "what would prevent the manufacturers from selling an adulterated product?"

    In libertopia the restrictions on such actions would be legal - contract law (fraud) and liability for associated harms; and free associations created for the purpose of policing the practices of it's members (something along the lines of Underwriters Laboratories.)

    Both tending to drive up costs, thus making prices higher.

    Which sounds great until you consider the sorts of risky behaviors many drug users are willing to engage in

    https://tinyurl.com/ybed4r5y

    willingly consuming something they know to be effectively mislabeled.

    Do you really think these are the sorts of people who are going to pay extra in order to feel safer?

  • ThomasD||

    And again, to be clear, not that this is in any way an argument for maintaining our current legal and regulatory regime.

    Merely to note that eliminating the current regime is unlikely to significantly reduce the sorts of outcomes seen in that New Haven park.

  • ThomasD||

    So, by all means let's do the right thing (legalization.)

    Just do not attempt to sell it by promising an outcome that is unrealistic and/or unlikely to occur (reduced morbidity/mortality.)

  • sarcasmic||

    When bad things happen after policy is put into place with good intentions, there can't possibly be any cause and effect. Good intentions do not cause bad things. They cause good things. If bad things happen they are caused by people with bad intentions. Like drug dealers. They are the bad guys. And if you dare to question the policy of people with good intentions, you must have bad intentions. You're one of the bad guys.

    This is how the road to hell is paved.

  • Cory Crockett||

    Forget ideology. We need to get some millennials in DC. According to conventional-wisdom they're sufficiently-lazy; ergo, logic dictates the War On Drugs will end when Millennials run the United States of America.

  • Sedona Vortex Hunter||

    I disagree with people that assume if opiates were legal that people would just eventually die from taking them as well. One reason I disagree is because opiate overdose was quite rare when opiates actually were available over the counter prior to 1914.

    This is not to say there were not addicts, but that addiction to a substance which is widely and legally available (and also quite safe and non-toxic, especially compared to other drugs and pain medications) is really not much of a problem for the 'addict' or society. In such a scenario many addicts would exist and thrive without anyone being the wiser, and I think this is actually something drug warriors hate to contemplate-- if they could even admit that such a reality could exist (which they largely won't admit)

    Just because an addict can not control his or her use does not mean they will simply consume lower known concentrations of opiates until they pass out or die. Its actually very difficult for a habitual user to OD prior to the widespread availability of extremely potent synthetic opioids.

  • ThomasD||

    "opiate overdose was quite rare when opiates actually were available over the counter prior to 1914."

    At best that assertion is highly suspect - how many deaths even got a documented cause of death, never mind how many would have been erroneous.

  • Sedona Vortex Hunter||

    I am sure you could bring up lots of arguments and questions, opiate overdose is really rare in cases where people know the actual dosage of the drugs they are taking. I don't feel like searching for the proof, or having a source link battle about it either, one because I am fairly secure in this opinion, but 2nd because I think it is an aside, "my body, my choice" being the mantra of the day and all...

  • Sedona Vortex Hunter||

    cont--

    Many people view this with the mind that they simply don't care because the addicts are making the choice to use. I think one unspoken truth that people will not admit is that the idea of addicts using safe drugs and not actually dying is something many people don't want to see. They get off on feeling morally superior and believe death is the earned result from using a substance they have been conditioned to believe is 'bad'.

    Another truth people won't want to accept is that a regulated and legal opiate drug would be far safer than many of drugs we currently either accept the usage of, or consider 'safe' OTC remedies. For instance the deaths caused by alcohol or cigarettes dwarfs even current opiate deaths. The deaths caused by legal OTC pain medicines is also greater or at the very least rivals the current opiate death rate, and that without patients needing to take illegal and dangerous substitutes in the case of legal OTC pain medications. A legal and regulated opiate market would likely see death rates a tiny fraction of the current OTC pain medicine death rate we gladly tolerate.

    But for whatever reasons, the fact that opiates cause 'undeserved euphoria' is part of the societal problem with them, and its a problem that confounds and confuses the discussion since it is rarely acknowledged-- partly because I believe people won't admit or don't recognize this aspect of the issue.

  • bedpageseo10||

    madison-backpage | Site similar to backpage | Alternative to backpage | Sites like backpage
    If you are looking for Sites like backpage then you must visit madison-backpage.com . Here , we allow people to post their ads fast and free of cost. There are many website that let you advertise whatever you wish to but there is no Site similar to Backpage. Whether you are a newbie or just someone looking for another Alternative to backpage , then please visit https://www.madison-backpage.com/

  • bedpageseo10||

    guelph-backpage | Site similar to backpage | Alternative to backpage | Sites like backpage
    The site guelph-backpage is the best Site similar to backpage . So if you want to promote your business or startup ideas online then guelph-backpage is the best Alternative to backpage. It provides you unlimited services with efficiency, flexibility and easy to use interface.We are providing you classified ad posting site for free. For more information , visit: https://www.guelph-backpage.com/

  • bedpageseo10||

    oxford-backpage | Site similar to backpage | Alternative to backpage | Sites like backpage
    Backpage is the best web site of all free ads web sites. It provides you services like inexpensive advertisements, wide reach, and fair price. These features make oxford-backpage the best Site similar to backpage. It is a free ads posting site and provides unlimited services for oxford-backpage users. And oxford-backpage.com stands out as the best Alternative to backpage.
    For more queries please visit : https://www.oxford-backpage.com/

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online