Add the words ‘narcan’ and ‘fentanyl’ to your vocabulary

Add the words ‘narcan’ and ‘fentanyl’ to your vocabulary – by Peter Burrows 8/20/19   Blog: 

Synthetic heroin is becoming the equivalent of a weapon of mass destruction. Efforts to stop its spread have been pathetic. War on drugs? More like a pillow-fight on drugs.  

While drug overdose deaths recently dropped below an annual rate of 70,000 for the first time in two years, that doesn’t mean the war on drugs is starting to be won.  It just means the frontline casualties have gone down a bit. After all, OD deaths were “only” 36,000 in 2010.   

Still, the recent drop in deaths is a rare bit of good news in the war on drugs. Two years ago, the federal government began an aggressive program to treat overdoses with the drug naloxone, and it’s starting to pay off. Naloxone is easy to administer, works quickly and is standard carry for police and EMTs. In April of 2018, the Surgeon General issued an advisory that recommended even the general population carry naloxone.  

Naloxone is now available without a prescription in at least 45 states.  Walmart, for example, carries it at over 8,000 outlets, and you can watch brief You Tube videos on how to use it. It’s commonly called narcan, although Narcan is the brand name of just the nasal-spray treatment.  

It works against opioids such as heroin, oxycontin and, importantly, the synthetic opioid fentanyl. It does not work against cocaine or meth. Since 70 percent of overdose deaths are from opioids, Narcan is an indispensable life saver. It is a sad fact that being “narcanned” is a becoming a common experience for drug users, and that overdose remedies are now over-the counter products.  

Unfortunately, narcan will be needed more and more as use of the synthetic heroin fentanyl grows.  Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. For the cost of a stamp, a few dozen doses can be mailed to your neighborhood drug dealer, which makes interdiction nearly impossible.  

Fentanyl is so potent that TOUCHING it can lead to a fatal overdose.  I read about an officer who threw a bag of powder into an evidence container and then passed out on his way to the station and had to be narcanned on the side of the road.  The powder was fentanyl.  

In fact, the war on drugs is becoming less a war on cocaine and heroin, which are organic drugs derived from plants, and more of a war on fentanyl and methamphetamines, which are synthetic drugs that are produced in labs, primarily in Mexico and China. Both are cheap and getting cheaper, proof that we aren’t hindering the supply very much.   

Fentanyl is the bigger problem. It has legitimate medical uses, e.g. it is frequently prescribed to treat chronic pain, but absent proper dosage control, it’s a killer.  An amount covering Lincoln’s beard on a penny will get you high, two beards will get you dead.  In fact, “drop dead” is one street name for fentanyl.   

It killed 48,000 people in 2017, up from 3,000 in 2010, a 16-fold increase in only seven years.  Without narcan, the death toll would have been greater, but that is small comfort in a drug war we are obviously losing. And it will get worse before it gets better.    

Drug dealers, not being stupid, now add inexpensive fentanyl to their heroin, meth and cocaine to increase the number of hits per kilo, in the process making those drugs even more dangerous. It is also the main ingredient in many counterfeit pills that look like prescription drugs, e.g. Oxycontin or Percocet.   

More and more, the unsuspecting street buyer, regardless of the drug, is staking his life on the fentanyl dosage skills of his dealer’s supplier. That is not a good idea.    

Both drug dealers and users know this, and some of them keep narcan kits handy.  Thus, to a certain extent, narcan encourages more drug use and MORE overdoses.  I read that addicts now have overdose parties where somebody with narcan is at the ready, sort of a “designated driver.”  

What a mess.   

We can expect, even hope, that over the next few years the drug suppliers will get much better at quality control.  If they can reduce accidental overdoses, they will do so. Dead customers are not good customers. This means that if the drug cartels act more like drug companies, deaths will be reduced.  

What does that tell us? It tells me that maybe we should figure out a way for addicts to get this poison from real drug companies. That would mean fewer accidental overdoses, but would still leave us with a drug mess, just less of a mess.   

The bad news is that fentanyl is a precursor of more troubles to come.  Chemists are creating fentanyl analogues that are breathtakingly potent —and dangerous.  For example, Carfentanil is a drug used to sedate elephants. It is 100 times stronger than fentanyl and only one grain, the size of a grain of salt, will kill you.   

It doesn’t take much imagination to realize the harm this could do if vaporized into the air ducts of an auditorium, sprinkled over a buffet table, etc.  It is so potent that probably even terrorists will be afraid to handle it, at least for now. That won’t last.  

There is no “civilized” way to combat synthetic drugs. A mandatory death penalty for being involved in the sale of meth or synthetic heroin would work, but it would face many legal obstacles.  As a start, I would suggest that selling these drugs be considered legally equivalent to assault with a deadly weapon. The next step would be to institute the death penalty as an optional penalty for assault with a deadly weapon.  

The final step is the steepest one: such a death penalty must be more than just a threat. It must be a near certainty for drug dealers, much less so for the armed robber. Drug dealers are killing us, and the only thing that will stop them is if we kill them in return.   

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