NEW YORK–(ENEWSPF)–June 2, 2016
By: Kevin Franciotti
The toxicology results from music legend Prince’s tragic death last month are now public, and the media are focusing on what for many is a new word – fentanyl. It appears likely that Prince ingested it and tragically died some time later.
So what is fentanyl?
Fentanyl is a potent painkiller originally synthesized in the 1960’s as part of a class of novel opioids. At first, fentanyl was used only in surgery, but when new forms of administering it were developed decades later, including skin-patches and under the tongue sprays, it quickly became one of the most common treatments for chronic pain and palliative care.
What is important to know when talking about fentanyl?
Recent media coverage claims fentanyl is ’50 times stronger than’ heroin and ‘100 times stronger than’ morphine and is an ‘instant killer.’ It is true that fentanyl is more potent than heroin and morphine, but this simply means that it is active at lower doses. Words are important here – while chemists and pharmacologists can weigh a drugs’ potency by the amount it takes to produce effects, this can be a distraction to what the real issues are with fentanyl and why people are dying from it.
Why do people take fentanyl?
Meeting the need for relief in chronic pain patients is a legitimate medical practice, and when patients on painkillers long-term develop tolerance to their medication, stronger and more effective drugs are often needed. This need is sometimes challenged when attention is brought to problems associated with the illicit use of prescription medication, but when access to painkillers is restricted, patients often resort to the illicit market.
Why are people dying from fentanyl and what can we do about it?
People who use fentanyl often don’t know they’re taking it. In general, fentanyl used to cut heroin is not being diverted from medical facilities but comes from clandestine labs often in other countries, synthesizing large quantities of cheap, pure fentanyl. Fentanyl has become an attractive cutting agent, since its increased sedative potency can be perceived as strengthening a batch of heroin. Therefore risk of fentanyl overdose is particularly greater for opiate-naïve users, and even in those with a tolerance for heroin.
While synthetic opioids are invaluable to medicine, our failed drug prohibition policy is actually creating the scenario where cutting heroin with fentanyl makes sense to sellers because there is a demand for a cheap and strong high.
What’s a better approach to fentanyl?
A law enforcement crackdown on fentanyl and restricting doctors’ prescribing ability to treat legitimate pain patients has been tried already, and it only makes things worse. Proposed solutions that can prevent deaths and create a safer environment for opioid users, like expanding access to the overdose antidote naloxone and creating supervised injection facilities, are necessary.
Stigma prevents people from seeking help.
The harms associated with drug use, including fatal overdoses from opioids, need to acknowledge the role of stigma surrounding people who use them. Prince was known as an advocate for clean living, and if fear of being stigmatized as a drug addict was a contributing factor to his untimely death, just like it is for many others, serious consideration needs to include an end to the stigma around drug use.
Kevin Franciotti is a Program Associate at the Drug Policy Alliance.
To find out more about the issues surrounding novel psychoactive substance, like fentanyl, on June 9th-10th in New York City, attend a summit on New Strategies for New Psychoactive Substances: A Public Health Approach. The free event is open to the public and will explore alternative legal strategies for drug policy. Registration is required: http://newstrategies4nps.eventbrite.com
We can prevent fatal ODs like Philip Seymour Hoffman’s, By: Ethan Nadelmann and Tony Newman, February 4, 2014
Editor’s note: Ethan Nadelmann is the founder and executive director of the Drug Policy Alliance, the leading organization in the United States promoting alternatives to the war on drugs. Tony Newman is the director of media relations at the Drug Policy Alliance.
(CNN) — People are mourning the tragic overdose death of Oscar-winning actor Philip Seymour Hoffman, who was found Sunday morning alone in his New York apartment with a needle in his arm and empty bags of heroin.
When a beloved celebrity such as Hoffman dies of an overdose, it’s front page news. But his death serves as a reminder that 105 people are dying in the United States every day from an overdose involving heroin or pharmaceutical opioids. With more than 30,000 deaths annually, accidental overdose has overtaken car accidents as our country’s leading cause of accidental death for people 25 to 64.
The hundreds of billions of dollars spent on the drug war did nothing to prevent a dramatic increase in overdose fatalities; indeed, those very policies likely increased the number of people who die from an overdose.
Some people are going to use heroin, or play around with pharmaceutical opiates, no matter what we say and no matter what the government does. The real challenge is to do what we can to help people stay alive.
Here are seven steps that can help:
1. Make treatment available to those who want and need it: It is tragic that so many people who need treatment can’t get it. It is outrageous that we taxpayers spend, on average, $30,000 a year to incarcerate someone with a drug problem, but we skimp on treatment programs that are less expensive and more effective in reducing illegal drug use and other crime. Too many people who want treatment are told there are no open slots and turned away.
2. Offer methadone and bupunorphine to those with opioid addiction: Methadone and buprenorphine have been the gold-standard treatment for opioid addiction for decades. These replacement therapies can allow people to live normal lives without the highs and lows of illegal heroin and other opioids.
We need to remove the obstacles to making these life-saving medications more readily available and end the stigma that discourages people from seeking out the most effective treatment.
3. Honest drug education: We urge young people to stay clear of alcohol, tobacco and other drugs, but the reality is many will experiment with using substances no matter what. We must teach them the risks and consequences of drug use.
Most overdose deaths are a result of mixing opioids and alcohol but most people don’t know that. Anyone who receives a prescription for a pain medication, knows a person misusing heroin or other opioids or who cares about keeping people alive, needs to know the incredible risks of mixing with alcohol.
4. Good Samaritan laws for 911 callers: Most people who overdose don’t die. But the chance of surviving an overdose, like that of surviving a heart attack, depends greatly on how fast one receives medical assistance. Unfortunately people are afraid to call 911 because they don’t know if the police who respond will focus on arresting those present rather than saving someone’s life.
Fourteen states and the District of Columbia have passed “911 Good Samaritan” laws that encourage people to call for help without fear of arrest. Although it appears Hoffman was alone when he overdosed, thousands of others are not. People need to call for help. It should never be a crime to call 911 to help save a life.
5. Make naloxone, the antidote to an overdose, more available: Naloxone is a safe, generic, inexpensive, nonnarcotic drug that works quickly and is easy to administer. It has saved hundreds of thousands of lives but could be saving many more.
Many states are just starting to take some great steps to get naloxone in the hands of more people, including law enforcement and emergency responders. Anyone who uses opioids for any reason at all should have naloxone readily available, and friends and family who know how to administer it.
There’s no really good reason, moreover, why this antidote should only be available by prescription. If we really want to save lives, pharmacists should be allowed to sell it to whoever needs it.
6. Supervised injection facilities: Dozens of cities around the world have supervised injection facilities where people can inject their drugs in a clean, safe place with medical professionals on hand.
These facilities eliminate overdose fatalities, reduce dangerous drug consumption practices as well as HIV and hepatitis C, minimize the public nuisance of people using drugs in public places and more than pay for themselves by reducing the need for criminal justice and emergency medical services. It has been particularly successful in Canada.
The scientific consensus demonstrating the benefits of these facilities has yet to result in one such facility being opened anywhere in the United States. It’s time already.
7. Heroin-assisted treatment: Conventional treatments do not work for many people addicted to opioids and want to stop taking them. That’s why more than a half dozen countries in Europe and Canada have developed a second-line option: heroin-assisted treatment.
With this treatment, pharmacological heroin is administered under strict controls in a clinical setting to those who have failed to succeed with other treatment options. Virtually every published evaluation of HAT has shown extremely positive outcomes: major reductions in illicit drug use, crime, disease and overdose; and improvements in health, well-being, social reintegration and treatment retention.
No one can know for sure whether Philip Seymour Hoffman would still be alive if these seven steps had been implemented, but we can be certain that far fewer Americans would die accidentally from an overdose if they were.
While our country continues to mourn his death, we need to educate ourselves about the best policies and practices to reduce these tragic losses. Some of these ideas may make us uncomfortable, but we need to embrace them as soon as possible. Our sons and daughters, brothers and sisters are counting on it.
The cost of a slow learning curve is simply too great.
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