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Fentanyl: Actually As Dangerous As They Say

By iHeartPodcasts

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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Fentanyl: Actually As Dangerous As They Say

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Fentanyl: Actually As Dangerous As They Say

1-Page Summary

The Origin and Development of [restricted term]

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.

The Deadly Effects and Potency of [restricted term]

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].

[restricted term]'s Introduction Into the Illicit Drug Supply

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.

Waves of the Opioid Crisis Driven by [restricted term]

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].

Harm Reduction: Law Enforcement vs. Public Health Debate

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

Additional Materials

Actionables

  • Educate yourself on the signs of an overdose and how to respond, including the administration of [restricted term], to be prepared in case you encounter someone in need. By understanding the symptoms, such as difficulty breathing, extreme drowsiness, or unresponsiveness, you can act quickly to potentially save a life. You can obtain [restricted term] from many pharmacies without a prescription, and many community organizations offer free training on how to use it.
  • Start a conversation with friends and family about the risks of illicit drug use, emphasizing the prevalence of [restricted term] in the drug supply. Use the information about [restricted term]'s potency and the risk of it being mixed with other substances to highlight the dangers. This can be as simple as sharing what you've learned in casual conversation or sending an informative text or email to raise awareness.
  • Support local organizations that focus on harm reduction by volunteering or donating. Look for groups in your community that provide services like distributing [restricted term], offering medication-assisted treatment, or advocating for Good Samaritan laws. Your involvement can help these organizations reach more people and reduce the stigma associated with addiction and overdose.

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Fentanyl: Actually As Dangerous As They Say

The Origin and Development of Fentanyl

[restricted term]: A Potent Synthetic Opioid Anesthetic From the 1960s

[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.

[restricted term], Created by Paul Janssen In Belgium, Offered a Safer, Faster-Acting Alternative to Opioid Painkillers

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.

[restricted term], Approved For Medical Use In the 1960s, Became Widely Available as Restrictions Lifted

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 ...

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The Origin and Development of Fentanyl

Additional Materials

Actionables

  • Educate yourself on the evolution of pain management by comparing [restricted term]'s development with current alternatives to understand its significance in medical history. You can start by researching the latest advancements in opioid alternatives and their safety profiles, then create a timeline to visualize how pain management has evolved since the 1960s. This will give you a better appreciation of the medical advancements and the importance of ongoing research in pharmacology.
  • Develop a personal medication safety plan by learning from [restricted term]'s therapeutic index and application forms. Gather information on the medications you or your family members are prescribed, focusing on their therapeutic indices and side effects. Use this information to discuss with your healthcare provider about the safest and most effective pain management options for your specific needs, considering both the benefits and risks of each medication.
  • Advocate for responsible prescription pract ...

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Fentanyl: Actually As Dangerous As They Say

The Deadly Effects and Potency 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]: An Opioid 100x More Potent Than [restricted term], 50x Than Heroin

[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.

[restricted term]'s Potency and Speed Increase Addiction and Overdose Risk

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 Dangerous Side Effects: Respiratory Depression, Sedation, Confusion, Nausea, Heart Failure, Death

[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 ...

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The Deadly Effects and Potency of Fentanyl

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Actionables

  • Educate your peers on the dangers of [restricted term] by creating simple infographics that highlight its potency and risks, and share them on social media. Use free graphic design tools like Canva to design these infographics, focusing on key facts like the comparison of [restricted term]'s potency to heroin and [restricted term], its short duration of high, and the risks of overdose. Sharing this information can raise awareness among your friends and followers, potentially preventing misuse.
  • Start a personal blog or vlog series discussing the impact of [restricted term] on communities, using storytelling to humanize the statistics. Share stories of how [restricted term] addiction has affected individuals and families, aiming to put a face to the 3.1 million years of life lost. This can be done by interviewing volunteers who have been affected by the opioid crisis or by curating content from news articles and reports, ensuring to respect privacy and sensitivity around the subject.
  • Implement a personal policy to regularly ...

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Fentanyl: Actually As Dangerous As They Say

Fentanyl's Introduction Into the Illicit Drug Supply

The dangerous opioid [restricted term] has swiftly entered the illicit drug market, exacerbating overdose risks as it's often combined with other substances.

[restricted term] Enters Illicit Drug Market, Often Mixed With Heroin or Cocaine Unknowingly

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 Lace Drugs With [restricted term], Boosting Potency and Profits, Causing Overdose Rise

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 ...

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Fentanyl's Introduction Into the Illicit Drug Supply

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Actionables

  • Educate yourself on the appearance and effects of pure substances versus those laced with [restricted term] by using online resources from credible health organizations. This knowledge can help you identify potential risks if you or someone you know comes into contact with these substances. For example, you might learn that certain color or texture changes in a substance could indicate the presence of [restricted term].
  • Create a personal safety plan that includes carrying naloxone, a medication that can reverse the effects of an opioid overdose, and learning how to use it. You can obtain naloxone from pharmacies or local health departments, and many offer brief training on its administration.
  • Start a conversati ...

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Fentanyl: Actually As Dangerous As They Say

Waves of the Opioid Crisis Driven by Fentanyl

The opioid crisis in the United States has developed in waves, with the recent rise of illicit [restricted term] outpacing previous overdose waves.

US Opioid Crisis: Illicit [restricted term]'s Recent Rise Outpaces Previous Overdose Waves

1990s: Prescription Opioid Abuse Rise; Heroin Overdoses Follow

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].

2013 Third Wave Shows Increase in Overdose Deaths From Illicit [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 ...

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Waves of the Opioid Crisis Driven by Fentanyl

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Clarifications

  • The opioid crisis developing in waves signifies distinct phases of the crisis marked by shifts in the primary substances driving overdose deaths, such as prescription opioids, heroin, and illicit [restricted term]. Each wave represents a new stage in the crisis, often influenced by changes in drug availability, prescribing practices, and user behaviors. This wave-like pattern helps to understand the evolving nature of the crisis and the need for targeted interventions tailored to the substances causing the most harm at any given time.
  • The opioid crisis in the United States has unfolded in waves. The first wave began in the 1990s with the rise of prescription opioid abuse. The second wave followed as people turned to heroin due to restrictions on prescription opioids. The third wave, starting around 2013, saw a significant increase in overdose deaths related to illicit [restricted term]. The fourth wave involves [restricted term] mixed with stimulants like cocaine or [restricted term], presenting new challenges in combating the crisis.
  • The relationship between prescription opioid abuse, heroin overdoses, and illicit [restricted term] is interconnected through a progression known as the opioid crisis. It started with the overprescription of opioids like [restricted term] in the 1990s, leading some individuals to turn to heroin when access to prescription drugs was restricted. Illicit [restricted term], a potent synthetic opioid, has now emerged as a major driver of overdose deaths, surpassing heroin in its lethality and contributing to the evolving waves of the opioid crisis.
  • The government pressured doctors and manufacturers to reduce opioid prescriptions and reformulate medications to make them less prone to abuse. This led to a decrease in access to prescription opioids like [restricted term]. As a result, some individuals turned to heroin, contributing to a rise in heroin overdose deaths. The reduction in prescription opioids availability was a response to the escalating opioid crisis and aimed to curb the misuse and diversion of these medications.
  • The significant increase in overdose deaths associated with illicit [restricted term] in the third wave can be attributed to the heightened potency and availability of [restricted term] in the illicit drug market. Illicit [restricted term] is a synthetic opioid that is much more potent than other opioids, leading to a higher risk of overdose. Its introduction into the drug supply has contributed to a sharp ...

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Fentanyl: Actually As Dangerous As They Say

Harm Reduction: Law Enforcement vs. Public Health Debate

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.

Opioid Crisis Leads to Harm Reduction Focus, Providing Overdose Reversal Meds and Safe Drug Testing

Punitive Law Enforcement vs. Public Health Response to Opioid Crisis

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.

Harm Reduction Measures, Such as [restricted term] Test Strips and Supervised Consumption Sites, Show Promise In Reducing Overdose Deaths, but Access Is Uneven

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 ...

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Harm Reduction: Law Enforcement vs. Public Health Debate

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Counterarguments

  • While MAT is considered the "gold standard," some argue that it may create dependency on substitute medications, and there should be more emphasis on holistic and abstinence-based treatments.
  • Good Samaritan laws and policies preventing ambulances from alerting police may inadvertently shield drug dealers or enable environments where drug use is more likely to occur without addressing the root causes of addiction.
  • Harm reduction measures like [restricted term] test strips and supervised consumption sites could be seen as normalizing drug use rather than focusing on long-term solutions to addiction.
  • The effectiveness of supervised consumption sites in reducing overdose deaths is debated, with some arguing that they may concentrate drug-related activities in certain areas, potentially leading to increased crime and social issues.
  • The distribution of [restricted term], while life-saving, does not address the underlying addiction and may give a false sense of security that could lead to riskier drug use behaviors.
  • The focus on harm reduction strategies might divert resources and attention from prevention and education efforts that aim to reduce the i ...

Actionables

  • You can educate your peers on the nature of addiction as a health issue by sharing articles and resources from reputable public health organizations on your social media. By doing this, you help shift the narrative from a criminal perspective to a health-centered one, fostering a more compassionate and informed community dialogue.
  • Start carrying naloxone in your first aid kit and learn how to use it through local training programs or online tutorials. Having naloxone on hand and knowing how to administer it can make you a critical first responder in the event of an overdose, potentially saving lives in your immediate environment.
  • Volunteer with ...

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