This potentially deadly scenario isn’t farfetched for some people with OUD, finds study
By William WagnerSeptember 15, 2020
Illicitly manufactured fentanyl has emerged as a particularly dark villain during the opioid epidemic, which makes a recently published study in The American Journal on Addictions all the more chilling.
The study, funded mostly by the National Institute on Drug Abuse of the National Institutes of Health and conducted from 2016 to 2019 in New York City, sought to determine the extent to which people suffering from opioid use disorder (OUD) are unknowingly using fentanyl. The answer? Potentially to a large extent.
Of the 1,118 urine samples from 316 participants in the study, 34.6% tested positive for fentanyl. Researchers “found all participants had pre-existing knowledge that drugs may be adulterated with fentanyl, yet 67% [of those who tested positive for fentanyl] were surprised by their own fentanyl-positive test result.” Considering fentanyl is estimated to be 80 to 100 times more powerful than morphine, this was vital information to glean.
‘67% were surprised by their own fentanyl-positive test result.’ …Fentanyl is estimated to be 80 to 100 times more powerful than morphine.”
The use of illicitly produced fentanyl has risen sharply over the past decade. From 2014 to 2017, according to the Drug Enforcement Agency (DEA), there was a 1,000% increase in fentanyl-related drug seizures. Jason Schwartz, director of behavioral medicine at St. Mary Mercy Hospital in Livonia, Mich., and creator of the addiction-oriented blog Recovery Review, has seen with his own eyes the normalization of fentanyl among individuals with OUD.
“Most of my career has been spent with patients who are not naïve when it comes to opioids,” Schwartz says. “And my patients in recent years expect and assume that they’re using fentanyl. We’ve seen more and more patients actually express a preference for fentanyl.”
The findings in this new study point to an insidious twist in the evolution of fentanyl use. Consider the sheer lethality of the drug: In a yearlong period ending in February 2019, almost half of all overdose deaths (47%) involved fentanyl or other synthetic opioids, reported the Centers for Disease Control and Prevention (CDC). Now consider the outsized OD vulnerability of users who aren’t aware that the opioids, or even the psychostimulants like cocaine, they’ve scored are adulterated with fentanyl.
My patients in recent years expect and assume that they’re using fentanyl. We’ve seen more and more patients actually express a preference for fentanyl.”—Jason Schwartz, director of behavioral medicine at St. Mary Mercy Hospital in Livonia, Mich., and creator of Recovery Review
“For people who are in earlier stages of opioid use disorders and maybe are less experienced, it’s probably true that they’re unknowingly using fentanyl,” Schwartz says. “Everyone is at greater risk when they’re using fentanyl, but [the less experienced users are] probably at an especially heightened risk. It’s just the potency and the inconsistency of the mix from dose to dose. The range of potency is much greater today than it was years ago due to fentanyl.”
Schwartz’s assessment jibes with the study’s conclusion that more needs to be done in the way of education.
“Like previous studies,” state The American Journal on Addictions authors, “our data indicate the high prevalence of fentanyl exposure and low perception of fentanyl-related risk among individuals with OUD, respectively, suggesting that opioid overdose harm reduction efforts may need to focus more on drug users’ understanding of risks related to fentanyl use and adulteration of drugs.”
Photo: Jon Tyson