Is fentanyl more lethal than heroin

The most dangerous of all drug kicks

The substance is so dangerous that touching it can lead to an overdose. Not only is the drug fentanyl currently fueling America's opiate epidemic, it is also a threat to police officers.

The story, like so many dramas, begins with good intentions. It starts in Turnhout, a small town in the Flemish part of Belgium, about halfway between Antwerp and Eindhoven. Here the chemist and physician Paul Janssen built up a model company in the pharmaceutical industry in his father's company from 1953 with several new developments. The company first draws attention to itself with painkillers and then with groundbreaking psychotropic drugs.

Put everything in the shade

Shortly before Janssen Pharmaceutica was taken over by the American company Johnson & Johnson in 1961, “Dr. Paul »developed another« hit »in his laboratories: a pain reliever that eclipsed everything else. The synthetic opiate fentanyl, between fifty and a hundred times more potent than morphine, has since been used for long surgical interventions, acute pain after such interventions and - increasingly as a plaster on the skin or as a lozenge - for severe pain in cancer patients.

The derivative carfentanyl is a hundred times more powerful than fentanyl; it gained fame as a means of euthanizing large wildlife that must be moved from one to another wildlife park. It is so strong that it cannot actually be used in humans - but carfentanyl has also appeared on the black market and has cost lives.

How does a drug over fifty years old suddenly make headlines because it is believed to be responsible for thousands of deaths? First of all, it must be made clear that in the countless reports of fatal overdoses of fentanyl, there is rarely any mention of the original, naturally prescription-only drug. Rather, it is about non-medical variations that are illegally manufactured. The fact that there are laboratories in which these highly dangerous substances are brewed can be explained by the ratio of effort and return: The drug control agency DEA estimates that one kilogram of heroin costs 6,000 to 7,000 dollars and generates 80,000 dollars on the street. It only costs about $ 5,000 to make a kilo of fentanyl, but because it's so potent, it can be stretched much more and generate more than $ 1.5 million in sales.

Switch to heroin

The synthetic opiates, one of which is fentanyl, spread whenever an existing opiate epidemic makes business profitable. They reach the USA via two supply routes: either directly from China or via Mexican drug cartels, which they either manufacture themselves or purchase in China. What they have in common is that they were able to expand in the slipstream of the almost limitless prescription of medical, prescription-only opiate painkillers from the 1990s onwards. Countless Americans became addicted. The great availability swept the funds en masse at relatively low prices on a flourishing black market.

Startled by the extent of the abuse, American authorities and companies began, on the one hand, to control the spread of painkillers more closely. On the other hand, the manufacturers changed their structure so that they could no longer be injected or snorted for the «kick». The sudden shortage of pills on the black market attracted an alternative: heroin. It was soon cheaper than pain reliever pills, but just as readily available as the pills used to be. But heroin - an illegal drug, often contaminated and mixed with other substances - caused health risks to explode. Rural areas in particular were in no way prepared for this. The completely overwhelmed authorities believed at first that they could pull themselves out of the swamp by arresting the addicts.

The Mexican drug cartels, which took over the supply of the market in the USA, but also some local dealers, now like to stretch heroin with fentanyl, which makes the drug so dangerous in street sales. In illegality there are no quality standards or controls, there is only the blind trust that nothing will happen and the irrepressible longing for the «kick» or - in the case of withdrawal symptoms - for the end of the pain.

The post as a drug courier

Fentanyl is also mailed to the US from Chinese laboratories. According to the "Wall Street Journal", which is based on figures from the border guards, in 2016 around 37 kilograms of fentanyl were confiscated in international mail and express shipments. Five years ago it was 90 grams. In view of the fact that more than 600 million parcels were sent from abroad to the USA in 2016, the seized shipments are probably only a very small drop in the ocean. The postman as a drug courier - unknowingly, of course.

The distribution of the drug by mail is by no means restricted to the United States. Canada, more precisely the province of British Columbia on the Pacific coast, appears to be the first area in North America to have been hit by the full force of this new development. As the Toronto newspaper “The Globe and Mail” recently reported, suppliers are becoming more and more sophisticated in disguising their deliveries. They hide the drug in the small sachets of drying gel that come with so many overseas shipments.

Policemen with overdose

The danger posed by fentanyl cannot be overestimated. Unlike heroin or the opiate pain relievers, it does not even need to be taken specifically: it is absorbed through skin contact. Chris Green, an officer with the City Police of East Liverpool, Ohio State, had to experience this firsthand: In mid-May, while checking a suspicious vehicle in which apparently drugs were being carried, some white powder got onto his uniform shirt. Back at the police station, colleagues pointed this out to him. Although vehicle controls are now carried out with protective clothing precisely because of the dangerous opiates, Green carelessly wiped the substance off his shirt in the canteen. Minutes later he passed out.

While he was still at the police station, colleagues gave him the drug Narcan, which combats the effects of an overdose and is now standard equipment for emergency services and police officers. At the hospital he needed three more cans of Narcan. Green is not an isolated incident: a week later, this time near Baltimore, Maryland, another police officer and two paramedics had to be treated with Narcan after an emergency call.

One of the bitter truths of the current fentanyl epidemic in America is that the skyrocketing death rate from the proliferation of the illegally manufactured drug is by no means new. Between 2005 and 2007, more than a thousand people died from overdoses associated with the non-medical fentanyl, mostly in larger cities in the Rust Belt and the Midwest.

But the knowledge of the danger seems to have been lost in the meantime. America's opiate addicts are appropriating it again - at brutally high costs.