The opioid epidemic in our state is becoming ever more deadly by the rapid spread of fentanyl, a powerful synthetic opiate users often aren’t even aware they are taking.
According to the Department of Public Health, so far this year there have been 488 confirmed opioid-related deaths state-wide, but that figure could be as high as 1,000 as many investigations have not been wrapped up. Of the confirmed opioid deaths this year, according to DPH data, 66 percent involved fentanyl. In 2015, 57 percent of the opioid-related deaths involved fentanyl.
We find out only after the fact — oftentimes, months after someone has been buried — that the heroin they injected was laced with fentanyl or that the oxycodone pills they took were really fentanyl. This discovery is made in toxicology reports, but it is information that is unlikely to be recorded anywhere unless someone specifically asks for it. In other words, we don’t really have a handle on just how bad the fentanyl problem is because even when it is the cause of death, it might not appear on a death certificate.
Fentanyl is a synthetic opioid 50 to 100 times more powerful than morphine and 30 to 50 times more potent than heroin. It is now manufactured in China and by drug cartels in Mexico and often included in the products drug dealers sell as heroin. Sometimes it is made into pills that are sold as illegal oxy pills.
Fentanyl is a ruthless killer, hidden because many users don’t know they are using it and many dealers don’t know they are selling it. Sometimes it is fatal so quickly that even doses of naloxone, the overdose reversal drug that has saved so many lives, is challenged to match it.
There’s another way fentanyl winds up killing silently: It can’t be detected in urine screens, which means that probationers required to submit to random drug screens will not be flagged as endangering their lives, never mind violating their probation.
The fentanyl situation is so dire it prompted 11 doctors to send an urgent letter to Surgeon General Vivek Murthy imploring him to declare a public health emergency. Since the fall of 2013, it is believed that fentanyl has contributed to at least 5,000 overdose deaths in the United States.
“The fentanyl crisis represents an extraordinary public health challenge — and requires extraordinary public health response,” the physicians wrote in May in the letter to Murthy and others who lead the nation’s drug policy efforts.
We’ve seen upticks in fentanyl related deaths before, but these doctors believe the current spike is different because, as they put it: “It is more widespread geographically, involves a more diverse group of users (including opiate-naïve users) and appears to be intensifying after two years.”
Fentanyl has a constructive use — it can relieve suffering for cancer patients and is effective in palliative care. But mixed with heroin, it is among the deadliest cocktails. These doctors believe the presence of fentanyl is why nationwide efforts to reduce the number of overdose deaths caused by opiates are not as effective as experts had hoped.
An article on the front page of the New York Times in June, which singled out Massachusetts as among the states hardest hit by fentanyl, explains in stark terms why fentanyl is being used in such great quantities: pure profits.
Massachusetts Attorney General Maura Healey sees the danger. That’s why she authored a law, supported by my office — the Northwestern District Attorney — and those of other district attorneys across the state, that could put a dealer convicted of trafficking fentanyl in prison for up to 20 years. At the opening of the new Family Drug Court in June, Healey talked about the multi-pronged efforts to deal with the deadly reality of heroin and fentanyl coming into our state, saying, “Lives hang in the balance.”
In their appeal for the declaration of emergency, the public health doctors suggest that communities consider these steps: setting up labs that anonymously check the contents of illegal drugs; creating safe consumption sites so users are not alone when using; launching a campaign to educate the community about fentanyl and the increased risks it brings; having law enforcement wage a concerted effort to shut down the fentanyl supply; continuing efforts to increase opiate addiction treatment options in jails, prisons and emergency rooms.
Yes, these are drastic and costly measures, and some of the ideas no doubt are controversial. But these are the steps we must put on the table for consideration.
Our attorney general is right: Lives do hang in the balance.
It’s an emergency. We must respond with treatment and recovery services before the next bag of fentanyl-laced heroin an addicted friend or family member takes is his or her dead last.
Because of the devastation caused by fentanyl, the next meeting of Hampshire HOPE, the county’s heroin and opioid abuse prevention coalition will be devoted entirely to the issue. The meeting will be held in late September or early October. Watch for details.
Northwestern District Attorney David E. Sullivan is co-chair of the Hampshire HOPE opioid task force. He is one of several individuals who contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.