Opioids have traditionally played a key role in the daily medication regime for many people suffering chronic pain. But the continuing war on opioids has seen doctors becoming increasingly more reluctant to write prescriptions, particularly new prescriptions, for drugs in this class. With the tightening squeeze on the supply of prescribed drugs, it is not surprising that ‘recreational’ users are not the only ones turning to illicit sources, with the internet proving an increasingly popular and convenient choice.
A huge problem is that many drugs purchased illicitly are counterfeit, with no control over their content or other standards of manufacture. A particular issue has been encountered with Fentanyl.
At up to 100 times the strength of morphine, Fentanyl was developed over 60 years ago to treat extreme cancer pain. Medically, it can be administered in a number of ways; orally, by injection, topically via a skin patch or as a nasal spray. It has also become widely used recreationally, often mixed with heroin or cocaine to increase their potency, particularly if the user has developed a tolerance to the other drug.
Medically, many people suffering a variety of forms of chronic pain rely on Fentanyl. Our client Paul, who suffers CRPS in his right foot and lower leg, has been using Fentanyl patches for over two years now. “I’ve tried all the painkillers under the sun, but Fentanyl patches are the only thing that even remotely takes the edge off the pain” he says.
However, as a result of its potency, even used medically, accidental overdose from Fentanyl is a serious risk and there have been high profile fatalities, including the musicians Prince, Tom Petty and Mac Miller.
Indeed, in the US the government believes that Fentanyl and its derivatives were behind 30,000 of the overdose deaths which occurred there in 2017, over 40% of the total.
The risk of overdose is substantially greater if the drug is purchased from an unregulated source. In the US, the Drug Enforcement Administration (DEA) has published the results of the laboratory analysis of a sample of 106 Fentanyl tablets seized by its officers around the country. The results are terrifying, with 27% of them containing a potentially lethal dose of the drug. One pill seized in California contained more than twice the lethal amount.
It is tempting to imagine these counterfeit drugs being the product of small, amateur laboratories – think ‘Breaking Bad’ – but the reality is that huge drug-trafficking organisations have swiftly sought to exploit an opportunity created by an ever-reducing legitimate supply. Investing in large scale operations capable of high volume production, the drugs are distributed through sophisticated supply chains.
This has resulted in geographical spikes in Fentanyl-related deaths, presumably as a result of a particular ‘bad’ batch of drugs arriving in one location for sale and distribution. One dramatic spike occurred in King County, Seattle, between mid-June and mid-September 2019, involving a staggering 141 suspected and confirmed overdose deaths.