Deaths from Fentanyl-Laced Cocaine on the RiseShelby Wall
Across the country, people who buy cocaine are discovering too late that it contains potentially lethal fentanyl. In a recent Morbidity and Mortality Weekly Report (MMWR), The Centers for Disease Control and Prevention highlights this issue as it manifested in Fresno earlier this year.
A Crisis in Fresno, California
In January of 2019, three patients arrived at a community medical center after snorting what they thought was cocaine. One of them went into cardiac arrest, and the other two were experiencing side effects typically connected to opioids: respiratory depression and depressed mental status in particular. The first patient was stabilized, only to be declared brain-dead just three days later. The other two patients responded to naloxone but required repeated dosing in order to maintain their respiratory status. Routine drug screens, which are blind to synthetic opioids, did not detect any opioids in the patients’ systems. This finding, when considered along with the required dosages of naloxone, led the medical toxicology team to become concerned that a synthetic opioid was involved – specifically, fentanyl.
Why is Fentanyl So Dangerous?
Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than its cousin, morphine. Originally a prescription drug, users have begun making it in home labs. Its pharmaceutical applications include use as a potent analgesic for those in severe pain, particularly after surgeries or invasive procedures. It is also occasionally used to medicate patients with chronic pain who have developed a tolerance to other, weaker opioids.
Fentanyl is dangerous because of the way it operates. It binds to the body’s opioid receptors – its targets are located in the parts of the brain responsible for pain and emotions. When this occurs, it boosts dopamine levels and creates a feeling of relaxation or euphoria.
However, it binds in a non-discriminatory way, meaning that it also ventures into other areas of the brain and attaches to the opioid receptors responsible for breathing. While the drug creates a powerful high, it can also suppress breathing and lead to death.
Because of its chemical structure, fentanyl arrives at the receptors much, much faster than heroin; it also adheres more tightly to the receptors than other opioids, meaning that a small dosage of fentanyl can have the same risk as a large dose of heroin.
If fentanyl is so dangerous, how and why are people consuming it? As illustrated in the story from Fresno, many times, people take this substance without being aware of it at all. Some drug dealers combine fentanyl with other drugs, particularly cocaine and heroin, because it is so cheap to produce a high, relative to these other substances. Those who are opioid-naïve are at an even higher risk of overdose, as they have no baseline tolerance for the substance.
Fentanyl is also a public health risk due to the fact that it generally goes underdetected, probably because it is not routinely included in hospital urine tests; each institution has limitations to its screening techniques. Traditional toxicology is catered to the detection of specific known drugs, meaning that novel substances are difficult to detect. To find evidence of fentanyl and other synthetic opioids, targeted analyses are required. Between the lethal side effects, small required dosage, and difficulties in detection, this substance has become a major concern for hospital staff nationwide.
A Disturbing Trend
Unfortunately, the events of that January night are not limited to Fresno. Just days later, a similar overdose incident was reported in Chico. There was also one in neighboring Madera County, where the patient in question was pronounced dead at the scene. Fresno, Chico, and Madera are all located along the same state highway corridor, bordering CA-99.
Death rates involving cocaine have skyrocketed by around one third during the years of 2016 and 2017. Over the same time frame, it was discovered that nearly three quarters of cocaine deaths also included opioids – a trend primarily driven by the introduction of synthetic opioids. There have also been reports of fentanyl disguised as cocaine in the northeast, specifically in Philadelphia, Pennsylvania and New Haven, Connecticut.
This pattern has developed within the last decade. Synthetic opioids, including fentanyl, are now the most common drugs involved in U.S. overdose deaths. In 2017, 59 percent of opioid-related deaths included fentanyl – compared to just 14.3 percent seven years prior.
Because it’s nearly impossible to predict where this drug will strike next, it’s important to increase awareness and access to health care nationwide. Dr. Harshal Kirane, director of addiction treatment and research at Wellbridge in Calverton, New York, says that there is a “persistent yet unpredictable risk for all communities.”
In Fresno, health care staff worked alongside members of law enforcement and the press to make the public aware of the dangers of altered cocaine. They also encouraged others to order fentanyl lab tests in these instances; home tests are available to the public.
Of course, the primary recommendation is to stop using drugs altogether. If one avoids consuming any cocaine or heroin, the risk of taking drugs laced with lethal fentanyl is completely removed.
Recovery from Drug Addiction
If you or a loved one are concerned about substance use, we encourage you to reach out to Concise Recovery today. We provide the full continuum of addiction treatment services in our two Southern California locations. Call 888-978-5424 today.