The UK has only recently been woken up to the emergence of the powerful drug, fentanyl, at street level. Drugs generally have a tendency to come in and out of fashion. When a new drug first emerges there is an inevitable crackdown before users often move on to alternatives that tend to be cheaper, stronger and more accessible.
Fentanyl is a prime example of this, and has been implicated in the deaths of musicians like Michael Jackson, Prince and Tom Petty. In addition, it is alleged to have been the cause of Demi Lovato’s recent opiate overdose. In November 2018, the Metropolitan Police in London seized a large number of counterfeit percocet pills (otherwise known as oxycodone) that were actually found to contain this much more potent opiate.
In the UK, in 2016, there were 3,744 drug poisoning deaths and 69% of these involved drug misuse of either legal or illegal drugs. Of this, 54% involved an opiate and there were over 60 deaths in the UK that implicated fentanyl – the first time such a number has been recognised.
Fentanyl is a synthetic opiate of the same class as heroin and morphine. Medically, it is used for its analgesic properties and can be given as a skin patch, intravenously or directly into the central nervous system as an epidural or in spinal anaesthesia. Recreational use is categorised as a Class A drug under the Misuse of Drugs Act (1971) but nonetheless it’s swallowed, smoked, snorted or injected intravenously for its euphoric, relaxing and sedating effects.
The difference is it that is about 100 times more potent than morphine and 50 times more potent than heroin. It can be an intended substitute to heroin, or an additive aiming for a more intense high or compensate for poorer quality heroin. The user may have no knowledge that their product contains fentanyl, and with this comes a huge potential for addiction and fatal overdose. Two milligrams of fentanyl can be fatal for an adult. Compare that to morphine where giving 2.5 milligrams intravenously is at the low end of prescribed doses.
It can be manufactured in the lab but reports suggest a substantial amount is imported from China and Russia. It also continues to be readily sold on the streets and on the dark web. According to reports in America, a kilo of heroin costs just over £4,000 to manufacture and sells for about £100,000. Fentanyl on the other hand can be synthesised for just under £3,000 per kilo and sells for £1 million per kilo. It’s strong, addictive, easy to make, cheap and it has massive profit margins. Is it any wonder we’ve seen this drug become a problem?
Just as with the novel psychoactive substances and synthetic cathinones, recreational use of opiates has become more dangerous and unpredictable. A combination of reinvestment in NHS addiction services (which have already been heavily privatised), a change in perception towards injecting rooms and an increase in access towards clean needles and the opiate antagonist, naloxone without prescription are just some of the approaches which could contribute to a much needed harm reduction approach to managing opioid abuse in all aspects of our society.
Dr Elliott Carthy is a medical doctor training in psychiatry in Oxford, UK. He is an AUTP scholar with his own educational YouTube channel, Mental Health with Dr Elliott and is passionate about medical education, learning disabilities, neurodevelopmental disorders and substance misuse. He obtained his MBBS from Imperial College London, graduating in 2015 with distinctions. He also holds a 1 st class BMedSci (Hons) from the University of the Sunshine Coast, in Australia. You can connect with his through Twitter @elcarthy.