The street names say it all — Goodfellas, Murder 8, Poison, Drop Dead, Serial Killer, TNT, among others.Fentanyl. It’s insidious and it’s a killer. In New York State, fentanyl has surpassed heroin as the drug of choice, leaving a trail of bodies from Suffolk to New York City, from Oneida to Erie. Identifying fentanyl abuse can be a matter of life and death.
Nurses know the signs all too well. Fentyanyl users exhibit a false sense of well-being, feelings of euphoria and relaxation, extreme happiness that quickly dissolve into pinpoint pupils, difficulty thinking, speaking or walking, confusion, dizziness, slowed heart rate, difficulty breathing, coma and worse—all classic symptoms of a fentanyl overdose. Without immediate treatment by trained professionals, death comes swiftly—in minutes.
A grain of salt
The body count is staggering. Between 2015 and 2016, according to the New York State Department of Health, fentanyl-related deaths rose by 124 percent (excluding New York City) and another 28.3 percent the following year. Those counties most affected are Suffolk, Erie, Monroe, Nassau, Onondauga, Orange, Dutchess, Westchester, Oneida and Niagara.
In New York City, where a lethal drug overdose occurs every six hours, fentanyl was responsible for 57 percent of drug-related deaths in 2017.
Make no mistake. Fentanyl is toxic. “The dose you require is minuscule, like a grain of salt,” Dr. Nora Volkow, Director of NIH National Institute on Drug Abuse (NIDA) told Rolling Stone Magazine. “A tiny difference in your content can mean someone dying.”
Stronger drugs, less money
Deadly and cheap, with some pills selling for as little as $10, street fentanyl often comes from Mexico and China and is made in labs. According to NIDA, it “is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.” It is often cut with heroin, cocaine, methamphetamine or MDMA.
“Fentanyl is a problem because the dealers who supply heroin and off-market drugs keep lacing everything with it, thanks to the fact that it's both significantly cheaper and 50 to 100 times more potent than heroin. In short, it allows suppliers to make stronger drugs for less money. And the knock-on effects are drastic. The CDC reported that out of 5,152 opioid-related deaths in 10 states, fentanyl was a factor in 3,700 of them,” according to public TV station KQED.
But despite its toxicity, nurses know that fentanyl—when administered properly—can provide a life-enhancing service. It was first used in 1959 to bring pain relief to cancer patients post-surgery, and is prescribed today judiciously by medical professionals for end-of-life care and to those struggling with severe and unrelenting pain. Introduced by shot, patch or lozenge, pharmaceutical fentanyl such as Actiq, Duragesic and Sublimaze has been known to significantly relieve suffering and improve a patient’s quality of life.
Death toll climbing
Even so, nurses know that fentanyl in all its forms is highly addictive and illegal fentanyl is the worst offender. It has surpassed heroin abuse not only in New York but nationwide. In 2017, according to NIDA, 59.8 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.
The death toll is climbing, and by all indicators, will continue to climb. A kilo of fentanyl that wholesales for about $80,000 will bring nearly $1.6 million on the street, the DEA estimates, making fentanyl a go-go business on the black market. And for now, hospital emergency rooms remain the last line of defense for a growing number of users whose lives may one day hang in the balance.