In this episode of Stuff You Should Know, the hosts explore the history and impact of fentanyl, from its development as a medical anesthetic in the 1960s to its current role in the opioid crisis. They explain the drug's extreme potency—100 times stronger than morphine—and how its presence in the illicit drug supply has led to a surge in overdose deaths, with fentanyl now accounting for 69% of all overdose fatalities.
The hosts trace the evolution of the opioid crisis through multiple waves, examining how fentanyl entered and transformed the illegal drug market. They also discuss the ongoing debate between law enforcement and public health approaches to the crisis, covering various harm reduction strategies including medication-assisted treatment, Good Samaritan laws, and the use of overdose reversal medications.
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In the 1960s, Paul Janssen and his company in Belgium developed [restricted term] as a synthetic opioid anesthetic for surgical use. Initially approved by the FDA only in combination with a tranquilizer called [restricted term], [restricted term]'s medical applications expanded significantly by the mid-1980s to include post-surgical recovery, with various forms like skin patches and lozenges becoming available.
Josh Clark explains that while [restricted term] is safe under medical supervision, it poses significant risks on the streets due to its extreme potency—100 times stronger than [restricted term] and 50 times stronger than heroin. The drug's rapid onset and short duration of effects increase addiction and overdose risks. Its primary danger lies in respiratory depression, where it suppresses both voluntary and involuntary breathing, potentially leading to death. The crisis has been further complicated by even more potent variants like carfentanil, which is 10,000 times stronger than [restricted term].
The illegal drug market has seen a surge in [restricted term], often mixed unknowingly with other drugs like heroin or cocaine. Dealers frequently use [restricted term] to cut costs and increase potency, while users remain unaware of its presence. The drug's simple production process, requiring only basic chemicals and equipment, has contributed to its widespread availability. As reported by Univision, cooks in Mexico can produce [restricted term] using rudimentary setups in remote locations.
Chuck Bryant traces the opioid crisis through several waves, beginning with prescription opioid abuse in the 1990s, followed by a surge in heroin use when access to prescription opioids was restricted. The third wave, starting around 2013, saw a dramatic increase in [restricted term]-related deaths, reaching 25 deaths per 100,000 people by 2022—with [restricted term] accounting for 69% of all overdose deaths. A fourth wave has emerged, characterized by [restricted term] mixed with stimulants like cocaine or [restricted term].
Chuck Bryant and Josh Clark discuss the shifting approach to the [restricted term] crisis, with increasing emphasis on public health solutions over punitive measures. Harm reduction strategies include medication-assisted treatment (MAT), Good Samaritan laws protecting those seeking help during overdoses, and the distribution of [restricted term] for overdose reversal. However, societal stigma and misinformation continue to challenge these progressive approaches to addressing the crisis.
1-Page Summary
[restricted term], a synthetic opioid and powerful form of anesthetic, was first introduced to the medical community in the 1960s, marking a significant advancement in pain management and surgical procedures.
Developed by Paul Janssen and his company in Belgium, [restricted term] was crafted to serve as an intravenous anesthetic for surgical use. Aimed at providing a safer and faster-acting option compared to existing opioid painkillers, [restricted term] quickly became valued for its high therapeutic index and reduced number of negative side effects.
Making its first appearance in 1960, [restricted term] spread across Europe by 1963 and landed in the United States by 1968. The U.S. Food and Drug Administration (FD ...
The Origin and Development of Fentanyl
The discussion highlights the dangers and strength of [restricted term] in both medical settings and illicit use, emphasizing its significant role in opioid overdoses and its impact on life expectancy in the U.S.
[restricted term], commonly used as an anesthetic during surgery, poses grave risks on the streets because of its potency and the possibility of uneven dosages, making a toxic dose easily attainable. [restricted term] is 100 times more potent than [restricted term] and 50 times more potent than heroin. It has an alarmingly fast onset due to its ability to quickly cross the blood-brain barrier. The high from [restricted term] has a shorter duration than heroin or [restricted term], generally lasting only an hour or two, which can cause users to dose more frequently and increases the risk of developing an addiction or experiencing an overdose. Overdoses can occur within seconds due to this rapid onset.
Josh Clark points out that while [restricted term] is safe under medical supervision, it becomes dangerous when manufactured and distributed by illicit channels. The drug's intense rush and rapid onset contribute to addiction, with users often seeking repeated doses to maintain the high, significantly raising the odds of an overdose.
[restricted term]'s deadly side effects include intense relaxation and pleasure, but can also lead to nausea, dizziness, confusion, and vomiting. Overdosing primarily causes breathing issues, which is the leading cause of [restricted term]-related death, but it can also result in heart attack, heart failure, mood disorders, and problems with the im ...
The Deadly Effects and Potency of Fentanyl
The dangerous opioid [restricted term] has swiftly entered the illicit drug market, exacerbating overdose risks as it's often combined with other substances.
While some [restricted term] users obtain legitimate forms of the drug, such as patches, the greater threat comes from powders and pills manufactured illegally. These clandestine forms of [restricted term] often make their way into the country or are produced domestically. Notably, there's a pressing concern that cocaine is sometimes cut with [restricted term], leaving users to ingest [restricted term] without their knowledge and significantly elevating the risk of overdose.
Illicitly produced [restricted term], including these powders and pills, is frequently mixed with other drugs like heroin or cocaine. [restricted term] pills are sometimes designed to mimic old [restricted term] pills, further deceiving users about the substance they are taking.
Dealers are known to lace drugs with [restricted term] to cut costs and increase potency. Users are often unaware that their heroin might contain dangerous levels of [restricted term], which has led to an increase in overdose incidents. The variability in [restricted term]'s potency between batches can cause people to overdose simply ...
Fentanyl's Introduction Into the Illicit Drug Supply
The opioid crisis in the United States has developed in waves, with the recent rise of illicit [restricted term] outpacing previous overdose waves.
Chuck Bryant discusses the beginning of the opioid addiction crisis which started in the 1990s with prescription opioids. This period saw an associated rise in fatal overdoses due to the widespread abuse of medication like [restricted term].
As the second wave unfolded, the government pressured doctors and manufacturers to reduce opioid prescriptions and reformulate medications to make them less prone to abuse. Subsequently, when the access to [restricted term] was curtailed, people turned to heroin, resulting in a quadrupling of heroin overdose deaths from 2002 to 2013.
The third wave, which began around 2013, has seen a surge in overdose deaths associated with illicit [restricted term]. Compared to the previous waves, this one has observed a significantly higher death rate. In 1999, there were two opioid overdose d ...
Waves of the Opioid Crisis Driven by Fentanyl
As the opioid crisis evolves, the debate intensifies between those advocating for punitive law enforcement responses and those supporting public health strategies for harm reduction, including the provision of overdose reversal medications and safe drug testing.
The discussion by Chuck Bryant and Josh Clark touches upon the shift in perception of the [restricted term] crisis—viewing it more as a public health issue than solely a criminal one. Emphasizing harm reduction strategies, they mention measures such as medication-assisted treatment (MAT) as the "gold standard" for opioid addiction treatment, with [restricted term] and [restricted term] ([restricted term]) being widely recognized options. Good Samaritan laws acting to protect drug users seeking medical help during an overdose scenario, as well as policies forbidding ambulances from alerting the police, are cited as indicators of a growing focus on health rather than punishment.
While [restricted term] test strips, which can indicate the presence of [restricted term] or its analogs in drugs, are indeed a component of these harm reduction strategies, the transcripts do not specify how these and other measures like supervised consumption sites have impacted the reduction of overdose deaths or address the uneven access to such resources. However, practices like administering smaller doses of drugs and using drugs in groups to facilitate immediate response with [res ...
Harm Reduction: Law Enforcement vs. Public Health Debate
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