Fentanyl
The wave of overdose deaths that swept across the nation in this past year claimed over a hundred thousand lives according to the CDC in a recent statement. Overdose deaths are one of the few things increasing faster than inflation. Drug use is part of the human condition and like everything else it is only getting worse. People have been seeking to expand their mind or numb their pain forever and drugs have always been a popular option for achieving that. Today though it is a much more dangerous game than it once was, the line between potion and poison is blurrier than ever.
The illicit drugs of the previous generation while having the potential to kill you did so far less often. The big reason is there were only a few different things you could be getting and if it were adulterated or cut with something it was usually with something inert that would reduce the potency of the product while expanding the seller's margin. This has always been a problem with powdered substances like cocaine, heroin, methamphetamine mix a little of that with a little of this and one pound of drugs can turn into two or ten. Today potent opiates like fentanyl or one of its derivatives are produced in mass quantities and used to turn one pound of drugs into one hundred pounds or more.
As a prescription fentanyl is normally prescribed as a patch in varying strengths that deliver micrograms over the course of three days. As the potency of these chemicals increases the window of forgiveness decreases. Poorly made street products are not always homogeneous mixtures. The cook measured wrong, his boss did the math wrong, or maybe the product they were starting with was not what they thought it was. Any one of these mistakes can turn profitable street products into powdered Russian roulette. Mistakes happen, we are all human or it could have been intentional, tainting a competitor's product is not unheard of even if it is bad business. Good news though a study using the IMF and DEA database revealed that the price of powdered drugs was down significantly between 2016-2021. Street drugs may be the only thing that is becoming more affordable even if the quality can be suspect.
Legal settlements for the opioid crisis are now so common you can easily get lost in the articles reporting them. Purdue usually gets the bulk of the blame and the largest financial settlement but even Mckinsey the consulting firm paid out 600 million for its role in marketing Oxycontin. While there is plenty of legal liability to go around at the root of it all is a problem that pre-existed any of these corporations or heck even any of these drugs. Preventing opioid overdoses is now a cash cow that can be targeted. The Naloxone nasal spray market has what investors would call growth potential. There is even talk of an opioid vaccine but don’t worry it's still in the animal testing phase but perhaps a decade from now they will be required for college admission.
Historically our current Fentanyl crisis has some striking similarities to the Opium wars. British and American merchants working with Chinese smugglers were moving large amounts of opium into China, the increased availability took what was once a rarely used medicine and turned it into a popular recreational drug. Between 1787 and 1833 the opium trade would grow extensively from 4000 chests annually to over 30,000. The emperor would issue several edicts over this time outlawing opium but their war on drugs was an even greater failure then ours. They would finally get fed up and in 1839 the emperor would command his Viceroy Lin Tse-Hsu to end the opium trade once and for all.
His first action was to seize all the opium in Canton, and this would start a standoff that would last several days until finally Charles Elliot, a representative of the British government would arrive and essentially pay a ransom for the drugs which were immediately then destroyed. By the end of the standoff, it is estimated that about 1300 tons of opium was destroyed. The British government would not take kindly to this action and by 1840 they would authorize troops to impose reparations for the financial losses to English traders. By summer the Royal Navy was shelling the port of Macao. The combination of superior English firepower and a weakened Qing dynasty would result in a lopsided victory resulting in the Treaty of Nanking which opened China up to trade and ceded control of Hong Kong to Britain.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
https://pubmed.ncbi.nlm.nih.gov/35528111/
