The death toll from opioid overdoses keeps rising across the country, and the new culprit turning up everywhere is fentanyl. Authorities are suggesting that Prince died of Percocet laced with fentanyl. More and more street drugs are being laced with fentanyl to increase the high. It started with heroin and now many of the street drugs are being laced with this compound. Sometimes it is normal fentanyl, but other times it is a “designer” type of fentanyl that are created to be even stronger and more potent than regular fentanyl.

Drugs on the street have obvious danger, and what is in them is usually unknown. Drug addicts seek out potent opioids for the high that they will get. Typically the high started with plain prescription opioids, often given for relatively minor injuries. For those who are prone to addiction, the legal prescription starts the path toward severe problems with abuse. Initially, it is doctor shopping and doing what ever is necessary to convince a physician to prescribe. Since pain was considered the fifth vital sign and was heavily promoted, obtaining medications for vague pains used to be easy. With increased awareness of opioid abuse, the tide has turned and it is now much more difficult to legally obtain the medications. Most doctors have become scared to prescribe, and those who do by necessity oftentimes check the state Pharmacy Board for reported fills of a prescription by the patient, and they drug test the patients on their own.

Addicts are now turning to the street to obtain their opioid fix since the legal prescriptions are harder to obtain. The most common cheap drug is heroin. However this drug has a definite bad reputation, and prescription drugs have been the preferred safer option for many addicts. Even heroin is now being laced with fentanyl to make the drug stronger. The street drugs are often marketed as the same as those obtained by prescription. Some are actually the drug, such as hydrocodone or oxycodone. Now however they often are being laced with fentanyl to improve the high generated from the drug. Fentanyl is 100 times stronger than oxycodone, hydrocodone or morphine. It’s dosed in micrograms normally for medical uses. Lacing another medication with fentanyl is very tricky since it is easy to add a trace too much. The consequence of too much fentanyl is a significant overdose. Too much fentanyl hits the respiratory centers of the brain hard, preventing breathing. Reversal agents must be given in multiple doses immediately if a patient has any chance of surviving an overdose.

New Fentanyl Problems

The latest drug to be added or laced to street drugs is carfentanil. It is 10,000 times more potent than morphine. Therefore just a trace of this drug mixed with another opioid would obviously give an extreme high, but also would likely kill a person if not treated almost immediately. This drug is now turning up in Ohio and along the East coast, and has been seen in Europe. It was initially used apparently as an elephant tranquilizer. To reverse this drug it often takes a half dozen or more shots of Narcan, the reversal agent for opioids. The rash of deaths linked to drug overdoses is often linked to this compound. Unfortunately it is also attracting addicts to areas where overdoses are occurring, since they know they might be able to find their ultimate high.

Unfortunately, as we become more aware of the latest problems with fentanyl, newer designer formulations are being made that are equally as strong or stronger. A brief search shows about a half dozen types of fentanyl possibly being made and all are deadly. These days, any street drug can be laced with a deadly compound, if you are an addict, death could be easily around the corner. Opioids are dangerous drugs, if addicted, seek appropriate medical treatment.

Chronic pain is a difficult problem. Clearly, opioids are dangerous drugs and are not the preferred treatment. There are multiple treatments available for pain. If your pain is not well managed, find a good pain specialist who will work with you to find alternative management options. Once pain becomes chronic it is extremely complex, and not able to be cured or fully treated. It often needs to be managed such that it is not the focus of life. It is not a perfect solution, but it can be made manageable.