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Sober Nation

Putting Recovery On The Map

12-18-17 | By

We Need to Talk about Fentanyl

Some of you may have heard or read about fentanyl. I, for one, can’t seem to pick up a newspaper without reading something about it. The best defense is a good offense, and it looks like the illicit drug market just got its newest MVP.

What is Fentanyl?

Fentanyl is a very powerful schedule II synthetic opioid typically used to treat severe chronic pain, primarily because it is 50 to 100 times more potent than morphine. It’s been around since 1964 and like other opiates, it’s an analgesic (relieves pain) so the effects are similar to heroin, Percocet, Vicodin, etc. When it is prescribed, it is administered as an injection, a trans-dermal patch, a tablet, a lozenge, or a film. Under medical supervision and responsible prescribing, fentanyl is a great treatment for pain; however, that’s not the fentanyl I’m going to talk about.

China White. Goodfella. Tango and Cash. These are just some of the street names that have been given to non-pharmaceutical fentanyl, which is illicitly produced and has recently emerged in the drug market. Fentanyl also happens to be one of the key players in the current U.S. overdose epidemic.

The Risks

The high potency of fentanyl puts the user at a significantly higher risk for overdose. There were over 700 overdose deaths related to fentanyl in 2014. The DEA reported that the number of items positive for fentanyl seized by law enforcement nationwide has increased by almost 400% in one year. 400%. The majority of the seizures took place in the northeast of the U.S., an area which has subsequently experienced some of the highest overdose rates. Nonetheless, the Midwest and west coast have also seen their fair share of fentanyl within the last decade.

The risk is further elevated if the user is unaware that their drugs contain fentanyl. Initially, public health officials targeted opioid-using populations for education on fentanyl. This is no longer the case, as fentanyl has been found in heroin, cocaine, methamphetamine, and even pills marketed as Xanax.

The Analogues

In addition to fentanyl, there are similar substances, called fentanyl analogues, also consistently being found in the drug market. The research on analogues is sparse; about 20 analogues have been identified at this point, including carfentanil and acetyl fentanyl. Though potency varies across the analogues, being a part of the fentanyl family still makes them extremely dangerous.

The Testing Strips

Harm reductionists, drug users, and public health officials everywhere rejoiced at the prospect of fentanyl testing strips, which would be able to detect the presence of fentanyl in a drug sample. And though they are a potentially life-saving tool, it is still unclear how well they work. DanceSafe found that many test strips can’t detect the different analogues. Health Canada just released a report that fentanyl-detection strips could result in false positives. So there are definitely more questions than answers right now.

The Implications

Not only did this rise in illicit fentanyl shake up the drug-using communities, it also put many public health officials in the corner. How do you fight this tornado that is going after every drug user, regardless of substance of choice? Why, harm reduction of course. Many states, including my own New York, have implemented evidence-based messaging to educate people who use drugs and prevent overdose deaths and other harmful outcomes. While we here at SoberNation promote abstinence, some of the advice includes:

  • Never use alone. But if you must, make sure to create a “Check-in” system with a friend, such as having them call you every 10-15 minutes.
  • Take turns using. At least one person should always be prepared to call for help. Check out your local Good Samaritan laws.
  • Get trained in and always carry Naloxone (Narcan). Show others where it is and how to use it.
  • Test your drugs. Use a small amount first – “test shot” – to see how strong or different the drugs are.
  • Avoid mixing drugs. This includes alcohol. The more substances, the higher the risk of overdose.

These are, of course, always in conjunction with the standard tips such as always using clean needles (or maybe switching to another method of administration altogether).

Further Questions

With all the attention fentanyl is getting, there are a ton of questions that have yet to be answered. Researchers are looking at not only how much fentanyl is out there, but where it’s coming from and more importantly (to me, at least), whether this change in the drug market has influenced substance users’ behaviors.

As always, I encourage you to ask questions, make comments, and if you’d like, share your experiences below!

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