Here’s a stunning figure from the federal Drug Enforcement Administration: Six of every 10 counterfeit pills sold in this country now contain a potentially lethal dose of fentanyl, a 50% increase from four out of 10 in 2021.
That means when the 2022 death rate statistics from this very strong and very often faked and polluted opioid come in, they are likely to be far higher than the 5,722 who died in California in 2021, the last full year for which figures are available. In that same year, the national toll topped 107,000.
These were mostly patients suffering pain who took the drug after filling legitimate prescriptions. So common is illicit fentanyl that drug agents in Los Angeles alone last year seized 38 million doses of it, almost one for every person in this state. With drug enforcers finding just a fraction of all fabricated fentanyl, these figures make counterfeit fentanyl a very serious death threat but one that cannot be mitigated by masks or vaccines.
All this is from a drug once used mainly as an anesthetic or to treat patients with severe pain, especially after surgery. It also can be used by people suffering chronic pain who don’t respond to other opioids. Properly used via injections, skin patches or lozenges shaped like cough drops, the phony versions of fentanyl are often taken unknowingly by people following up on doctors’ prescriptions for other drugs.
That’s one reason for a California law known as AB 2760, signed in 2018 by former Gov. Jerry Brown. This requires prescribers to offer patients taking fentanyl a companion prescription for the opioid-reversing agent Naloxone (often called Narcan) if they are taking more than 90 milligrams of fentanyl or a morphine equivalent daily. People with histories of drug misuse who take fentanyl must also be offered prescriptions for the Naloxone antidote even if they take much smaller amounts than that.
Addiction is also a danger for patients taking fentanyl for pain. In addition to extreme happiness, drowsiness, sedation, it can also induce respiratory depression and arrest, comas and death. Those former addictive qualities all push the massive trade in fake fentanyl, which the National Institute on Drug Abuse (NIDA) says is also known as Apace, China Girl, China Town, China White, Dance Fever, Goodfellas, Great Bear, He-Man, Poison and Tango & Cash.
Much of the fake fentanyl sold in America is taken mixed with other drugs like heroin and methamphetamine. When the other drugs are mixed with fentanyl, NIDA reports, they induce a high with far smaller doses, making drugs laced with fentanyl a considerably cheaper fix for addicts.
That, in turn, can lead to overdoses, which cause breathing to slow or stop. Comas, permanent brain damage or death can follow. It’s no wonder this state tries to place the Naloxone antidote in the hands of as many users as possible.
Mostly concocted in secret labs in China and Mexico, fake fentanyl is also laced with impurities that sometimes lead to other forms of toxicity. A big danger comes when it is secretly added to frequently prescribed pressed pills of anti-anxiety drugs like Xanax, Valium, Ativan, Klonopin, Librium and Serax, where it can lurk entirely unsuspected by pharmacists and patients.
This makes for an unprecedented danger, as nonaddicts suddenly become at risk for addiction if inadvertent doses of impure fentanyl diminish sensitivity to other stimuli, making it hard to feel pleasure from anything else.
The only good news here — and it’s actually a small consolation — is that despite its high death toll from fentanyl, California is among the least-affected states, with just under seven deaths per 100,000 people in 2021, compared with states like West Virginia (81) and Wisconsin (28). The reality is that even when government enforces purity standards, counterfeiters have managed to insert doctored pills into enough pharmacy stocks to cause serious trouble.
That’s why a new state law requires community colleges and California State University campuses to distribute fast-acting Naloxone for free, often as a nasal spray. Merely eyeballing a pill does not reveal whether it’s impure, so patients who use morphine-related drugs and strong doses of anti-anxiety medications should make sure they get the Naloxone antidote that’s supposed to be available to them and keep some on hand.
Thomas Elias can be reached at [email protected]. To read more of his columns, visit californiafocus.net online.
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