As I typed this out, I received an email from the Franklin County Coroner, Dr. Anahi Ortiz. She let me know that there were seven overdose deaths in Franklin County this weekend. Unfortunately, this is not the worst email I have received from Dr. Ortiz. In September, there were ten overdose deaths in one day.
Statistically, it is highly likely that this weekend’s deaths were the result of one drug: Fentanyl.
Fentanyl is an extremely powerful synthetic opioid. It was originally manufactured to manage the most severe pain. Licit Fentanyl is made by pharmaceutical companies and is legally used in hospitals and hospice care. According to the DEA, pharmaceutical Fentanyl is well guarded and rarely makes it into the black market to be abused.
However, illicit Fentanyl and its analogues are made in labs in China and Mexico and smuggled into the United States. This illicit Fentanyl and its analogues are driving today’s illegal drug trade and they, along with other opioids, are by far the most deadly illicit drugs in American history. In 2017, almost 50,000 Americans died from opioid overdoses.
Fentanyl is 50 times more powerful than pure heroin. A few grains the size of salt can kill the average person. People have died by simply touching it. Traditionally, it is mixed or “cut” with heroin, and most heroin addicts know, and even desire, this. A drug dealer can take 100 grams of heroin, 18 grams of fentanyl, and 882 grams of caffeine and create a kilogram (1000 grams) of what amounts to be pure heroin. This increases the drug dealer’s profit by nearly 900%. If this seems exacting – it is! If a drug dealer does a poor job and adds even a few additional grams of Fentanyl, even long-time heroin addicts can – and do – die.
I would like to say the opioid crisis is getting better. However, in Franklin County and in much of Ohio, it is getting worse – and more deadly, due to Fentanyl-related drugs. In the first nine months of 2019, there were 421 overdose deaths in Franklin County. This is 15% higher than in the previous year. Fentanyl-related drugs were responsible for 83.6% of these deaths.
The most disturbing trend is that over a third of these overdose deaths were due to cocaine laced with Fentanyl-related drugs. This was almost unheard of a few years ago. Cocaine is a stimulant, while heroin and Fentanyl are depressants. However, they all create a sense of euphoria. Unlike heroin consumers, it is likely that most people consuming cocaine laced with Fentanyl don’t know it is laced with Fentanyl. Worse still, those people have not built up a tolerance for Fentanyl and are more likely to overdose. Like heroin, drug dealers make far more of a profit by cutting cocaine with Fentanyl. When they cut it poorly, people die.
Fentanyl analogues are created by drug cartels to circumvent U.S. drug laws. Labs in China and Mexico simply change a single molecule in the chemical structure of Fentanyl, creating an analogue that is just as powerful and sometimes more powerful than Fentanyl. But it is legally not Fentanyl. Many of the opioids found in the Southern District of Ohio are in fact Fentanyl analogues.
For a time, while Fentanyl was illegal without prescription, its analogues were not. The class of Fentanyl analogues were not made illegal in the United States until 2018 when they were designated a Schedule I controlled substance. That designation, however, expires on February 6. The Senate has recently passed legislation approving a 15-month extension on the designation. The House has not yet approved the legislation and if they do not, all Fentanyl analogues will become legal on February 6.
CALL TO ACTION: The House should act quickly to pass this extension and both Houses of Congress should work together to make all Fentanyl-related drugs a permanently designated Schedule I controlled substance. Or, and I’m sorry to put it so bluntly, we may need to build more morgues.