The What, When, and Where of Fentanyl: Part 1
There were 112,000 overdose deaths in 2023—the highest in recorded history. Synthetic opioids, such as fentanyl, were the primary driving factor for overdoses, according to the CDC.
Overdose Deaths Down by Ten Percent
Now, for the first time in decades, the numbers so far from the CDC indicate that the final tally of 2024 overdose deaths will show a 10% decrease. The fact of reversal is significant, given that there have been double-digit percentage increases in overdose deaths every year since 2019. But 100,000 overdose deaths are still too many. As Dr. Rahul Gupta, the White House drug czar, has so poignantly stated, “We can’t treat dead people.”
Thus, it is incumbent for stakeholders to research what elements contributed to the decline in overdose deaths and bolster those. But more importantly, the role of fentanyl and the associated factors that propelled the skyrocket in overdose deaths from 2015 to 2023 should be reviewed. A thorough study and analysis could lead to establishing sensible public policies—policies that could accelerate a decline in fentanyl-related deaths commensurate with the 2015–2023 incline.
A Review of Fentanyl’s Path to Lethality
Fentanyl is a lethal drug with a confusing history. The manufacturing sources and distribution lines are murky. Therefore, extensive research would be required to develop effective programs for significant reduction.
This series is simply an overview and suggests areas for researchers to look.
The Early History of Fentanyl
Dr. Paul Janssen, a Belgian chemist, is credited with being the first to synthesize fentanyl in 1959. It was patented that same year by his company, Janssen Pharmaceuticals.
Dr. Janssen and his team began research in 1953 to create a potent, rapid-acting, and effective analgesic, a compound more effective than morphine. Toward that end, the development team worked with simpler molecules that were easier to manipulate. Paradoxically (as it turns out), they hoped simpler molecules would have higher safety margins and fewer unwanted side effects than traditional morphine compounds.
The team also determined that synthesizing a more fatty-soluble compound would give faster absorption rates than morphine, thereby increasing potency and analgesic onset.
And thus, after continuing research throughout the late 50s, fentanyl was born—a drug 100 to 200 times more potent than morphine.
Fentanyl Approval In the United States
Fentanyl wasn’t approved for use in the United States until 1968. The Janssen Company initially had difficulty getting approval from the FDA, partly due to the objections of Dr. Dripps, a well-respected professor of anesthesiology at the University of Pennsylvania. He felt the potency of the drug deemed it unsafe and potentially addictive (to put it in layperson’s terms).
The drug was approved after a compromise was reached that fentanyl would be combined with droperidol. The new compound drug was called innovar.
Four years later, fentanyl, as a stand-alone drug, was approved in the United States, but only in small dosages.
Fentanyl stayed in the hospitals for decades, though delivery methods, dosages, and uses changed.
From Analgesic to Killer
To track how fentanyl was averted from its intended purpose of alleviating chronic or severe pain to killing people on the streets, it is necessary to follow the trend of opioid abuse in general. Fentanyl falls at the tail end of that trend, though the number of Fentanyl-associated deaths far surpasses earlier decades of opioid abuse.
From the mid to late 90s, a prescription opioid crisis started in the United States, relatively unnoticed at first but steadily growing. Coincident with and contributing to this increase in prescription opioid abuse were two factors: The prescription opiate narcotic Oxycontin was approved by the FDA in 1995. And the “Pain as the 5th vital sign” campaign was launched. (Unlike other vital signs like temperature and pulse, this “vital sign” had no empirical method of measurement.)
Overdose Epidemic
Both factors mentioned above led to increased prescribing of opioid painkillers by medical practitioners from the late 90s to 2010. In fact, from 2000 to 2010, opioid analgesic prescriptions increased by an estimated whopping 104%.
With the increase in opioid prescriptions came a rise in overdose deaths. The public started noticing, and the elephant in the room could no longer be ignored. So, in 2011, the CDC declared the deaths from prescription opioid overdoses to be an epidemic.
Subsequently, the legal and medical community made efforts to rein in the high numbers of opioid prescriptions. It was harder to get opioid prescription drugs, and associated overdose deaths leveled off.
The Move to Heroin
In 2011, addicts, no longer able to get prescription opioids as easily, turned to heroin. Illicit suppliers happily stepped up to fill the demand. For the next few years, heroin deaths increased.
Opioid addicts were now at the mercy of the illicit suppliers and dealers.
The Business of Fentanyl
As in any business, profits matter, and fentanyl turned out to be better for the dealers than heroin. It is easier to produce in large quantities and has a higher potency. Fentanyl is also easier to smuggle than heroin.
The customers were there—they took what opioids the dealers had to offer. And what dealers have had to offer in abundance since 2014 has been fentanyl.
The Downside of Business
Deaths from heroin decreased, and fentanyl-related deaths have continued to dramatically increase at higher rates than other opioids. Thus far, 2024 is the only year with any decrease in the death toll, slight as it might be.
Perhaps the slight decrease in overdose deaths in 2024 is a fluke, or maybe it was caused by some undetermined factors.
Regardless, fentanyl continues to take too many lives and ruins even more.
We Must Do Better
It would be of significant public benefit to commission a task force to research all aspects of the current opioid epidemic. From there, comprehensive policies could be implemented toward the end of reducing addiction nationwide.
But that day may be far in the future.
Right now, too many families have loved ones who have become hopelessly addicted to opioids. Help is needed NOW. If you are looking for a program for a loved one and would like to learn more about the Narconon drug-free approach, give us a call at.
Effective drug treatment is our passion.
Read Next: Part 2
Sources:
- “Facts About Fentanyl” DEA.gov
- “PROVISIONAL DRUG OVERDOSE COUNTS” CDC National Center for Health Statistics https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- “Remarks by ONDCP Director Dr. Rahul Gupta at the National Conference of State Legislatures 2023 Summit” The White House
- “The Fentanyl Story” Theodore H. Stanley, American Pain Society, The Journal of Pain, Vol 15, No 12 (December), 2014:
- “The Opioid Epidemic in the United States” State Health Access Data Assistance Data (SHADAC)
- “Increases in the Use of Prescription Opioid Analgesics and the Lack of Improvement in Disability Metrics Among Users” NIH National Library of Medicine.
- “Fentanyl Flow to the United States” DEA INTELLIGENCE REPORT 2020
