Why Fentanyl Mixing Is So Common — and Fueling Overdose Deaths

59% of drug overdose deaths in 2017 were linked to fentanyl.

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The opioid epidemic is already a cause for concern, and one of the largest drivers of opioid-related deaths is fentanyl. The majority of drug overdose deaths in 2017 were linked to fentanyl—and what worries experts even more is that many users don’t even realize they’re taking fentanyl.

Fentanyl is a synthetic opioid that mimics the natural opioids like morphine, according to the National Institute on Drug Abuse (NIDA). However, fentanyl is mega powerful: It’s 50 to 100 times more potent than morphine. As such, it’s highly addictive, and has a higher risk of overdose than natural opioids.

Although fentanyl can be prescribed by doctors as a severe pain reliever (such as for end-of-life cancer care), the majority of synthetic opioids come from illicit drug dealers, according to the Centers for Disease Control and Prevention. In particular, street dealers are engaging in fentanyl mixing: Lacing street drugs like heroin or cocaine with fentanyl (which is more potent and thus cheaper), and then adding fillers like baby powder, in order to make a bigger profit.

In Ohio, for example, drug submissions that tested positive for fentanyl increased by 196 percent between 2014 and 2015. This is incredibly dangerous since many users do not know they are taking fentanyl, making them vulnerable to overdose on the potent product.

When too much fentanyl gets in the body, it can cause breathing to slow or stop altogether, resulting in hypoxia—lack of oxygen to the brain. Hypoxia can cause coma, brain damage, or even death.

This is why deaths linked to fentanyl have skyrocketed in the last decade, from 14 percent of drug overdose deaths in 2010, to 59 percent in 2017, according to the NIDA. The rise in fentanyl overdose deaths are part of a larger concern dubbed the “deaths of despair,” or deaths linked to economic adversity. Rural areas experiencing high rates of poverty, unemployment, and low educational attainment are at a higher risk of substance abuse, including opioids, and the isolation of many rural communities can make seeking help for opioid addiction difficult.

Fentanyl is, of course, highly addictive, but treatment for fentanyl addiction is possible. A combination of medication and behavioral therapies can help break the gripping cycle of drug addiction and prevent an overdose. (Here are tips to talk to your doctor about your worries about addiction.)

It’s not just an individual fight: Improving community outreach programs for drug addiction and recovery could help bring overdose numbers down, and social programs throughout the country, and throughout the world, are doing just that. Many people in the U.S. are pushing for clean injection sites: places where users can safely and cleanly inject their drugs under the supervision of trained staff. These are found throughout Europe, as well as in Canada and Australia. While safe injection sites sound counterproductive at first, they provide a host of benefits, such as reducing the risk of overdose, preventing the spread of HIV and hepatitis C, and actually increasing the entry for substance use disorder treatment, according to the Drug Policy Alliance.

While clean injection sites can't currently be found in the U.S., there are plenty of other community programs providing relief to those with addictions. Check out this directory for opioid treatment programs in your state here.