The Dangers of Fentanyl

As the opioid crisis continues to grow across the nation, authorities in Orange County reported last week that they seized 18 pounds of fentanyl with a street value of $1.25 million in a single bust.

The results of an Oct. 16, 2019, fentanyl bust in Orange County. (O.C. Sheriff’s Department)

The Oct. 16 seizure equaled nearly half the total fentanyl Orange County Sheriff’s deputies had seized in all of 2018.

It was enough fentanyl to cause about 4 million fatal overdoses, the sheriff’s department said.

“We’re seeing the overdose rate go through the roof,” O.C. Sheriff Don Barnes said. “That was enough fentanyl in one seizure to kill the entire county’s 3.2 million residents three times over.”

Along with the fentanyl, deputies also seized 5 pounds of heroin, a half-pound of meth, a loaded handgun and $71,000 in cash.

Deputies arrested a man who was being held on $2 million bail.

“It’s coming right over the Mexican border into the United States, trafficked up the 5 and 15 freeways,” Barnes said. “It’s going east from here throughout the rest of the country.”

Fentanyl is a powerful synthetic opioid painkiller that is 50 to 100 times more powerful than morphine. The sheriff’s department said the amount of fentanyl it sees has exploded in recent years. In all of 2016, the department seized less than a pound of fentanyl. In 2017, that jumped to 22 pounds. In 2018, it seized 44 pounds. So far in 2019, it has seized more than 100 pounds.

Officials said the increase in fentanyl trafficking is due in part to its relatively low cost and its addictive nature. Furthermore, because it’s relatively new, the drug does not carry the same punishment as selling heroin. Barnes said he is pushing for new laws to crack down on those dealing fentanyl, especially given the dangers of fentanyl.

Understanding the Dangers of Fentanyl

What is shocking to most people is how little fentanyl is required to kill a person. A dose of 2 milligrams is lethal in most people.

It’s deadly because it’s so much stronger than heroin.

Drugs users generally don’t know when their heroin is laced with fentanyl, so when they inject their usual quantity of heroin, they can inadvertently take a deadly dose of the substance. In addition, while dealers try to include fentanyl to improve potency, their measuring equipment usually isn’t fine-tuned enough to ensure they stay below the levels that could cause users to overdose. Plus, the fentanyl sold on the street is almost always made in a clandestine lab; it is less pure than the pharmaceutical version and thus its effect on the body can be more unpredictable.

Heroin and fentanyl look identical, and with drugs purchased on the street, “you don’t know what you’re taking,” Tim Pifer, the director of the New Hampshire State Police Forensic Laboratory, told STAT in an interview. “You’re injecting yourself with a loaded gun.”

New Hampshire, like the rest of New England, has been particularly hard hit by the opioid epidemic. The state saw a total of 439 drug overdoses in 2015; most were related to opioids, and about 70 percent of these opioid-related deaths involved fentanyl. The state has seen 200 deadly opioid overdoses this year so far, said Pifer.

Fentanyl was originally used as an anesthetic. Then doctors realized how effective it was at relieving pain in small quantities and started using it for that purpose. In the hands of trained professionals — and with laboratory-grade equipment — fentanyl actually has a pretty wide therapeutic index, or range within which the drug is both effective and safe.

The difference in strength between heroin and fentanyl arises from differences in their chemical structures. The chemicals in both bind to the mu-opioid receptor in the brain. But fentanyl gets there faster than morphine — the almost-instantaneous byproduct when the body breaks down heroin — because it more easily passes through the fat that is plentiful in the brain. Fentanyl also hugs the receptor so tightly that a tiny amount is enough to start the molecular chain of events that instigates opioids’ effects on the body.