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Fentanyl Isn't About to Go Away. What Can We Do About It? [FEATURE]

Submitted by Phillip Smith on (Issue #1080)

In the most thorough review yet of the powerful synthetic opioid fentanyl, a new study from the RAND Corporation warns that its arrival heralds a new dynamic in illicit drug markets -- and that is going to require new approaches for dealing with the dangerous drug.

a fatal dose of illicit fentanyl (
Last year, the Centers for Disease Control and Prevention (CDC) linked the synthetic opioid, which is roughly 50 times as powerful as heroin, to more than 31,000 overdose deaths last year, a little less than half of all drug overdose deaths registered in 2018, and the most people killed by a single drug in a single year in United States history.

Those fentanyl-linked deaths were 10 times the number of synthetic opioid deaths just five years ago. That's because a reliable supply chain has been established. Whether it's coming via DHL or Fedex packages ordered on the dark web direct from under-regulated Chinese pharmaceutical labs or being cooked up from precursor chemicals in informal Mexican labs and then smuggled across the border, fentanyl is pouring into the country.

In addition to its extreme lethality, what makes the rise of fentanyl different from previous drug epidemics is that very few users seek it out. Only the heaviest opioid users with the highest tolerance levels might seek fentanyl. The drug is here, rather, because it works better for drug dealing syndicates. It is cheap and relatively easy to produce, it does not require the control of extensive territories to produce drug crops, and because it is so potent, massive quantities of the drug can be smuggled in small packages, making it more attractive to traffickers.

"This crisis is different because the spread of synthetic opioids is largely driven by suppliers' decisions, not by user demand," RAND researcher Bryce Pardo, lead author of the study, said in a press release. "Most people who use opioids are not asking for fentanyl and would prefer to avoid exposure."

The fentanyl crisis is largely regional, the RAND researchers found. Deaths related to the drug are clustered in Appalachia, the mid-Atlantic and New England.

"While synthetic opioids have not yet become entrenched in illicit drug markets west of the Mississippi River, authorities must remain vigilant," said Jirka Taylor, study coauthor and senior policy analyst at RAND. "Even delaying the onset in these markets by a few years could save thousands of lives."

While the RAND report said "nontraditional strategies may be required" to address fentanyl, it did not make any specific policy recommendations. Instead, the authors urged consideration of a number of innovative approaches, many of which are tenets of harm reduction. They include:

  • supervised consumption sites (or safe injection sites)
  • drug content testing
  • providing prescription heroin to addicts (heroin-assisted treatment)
  • creative supply disruption

"Indeed, it might be that the synthetic opioid problem will eventually be resolved with approaches or technologies that do not currently exist or have yet to be tested," said Beau Kilmer, study coauthor and director of the RAND Drug Policy Research Center. "Limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths."

In other words, traditional drug war strategies when it comes to fentanyl are not only unlikely to succeed, but people will die. While tough-on-drugs politicians and prosecutors are quick to embrace harsher penalties, the researchers note there is little reason to believe tougher sentences, such as drug-induced murder laws applied to low-level retailers and couriers, will make any difference.

On the other hand, RAND does advocate for short but swift punishments as a deterrent. The one supply-side intervention RAND discussed in this report is efforts to disrupt dark web drug marketing of fentanyl, because the market is driven by suppliers, not users. "It makes sense," they wrote, "to consider supply disruption as one piece of a comprehensive response, particularly where that supply is not yet firmly entrenched."

That's particularly urgent, the researchers explained, because their study, which also examined fentanyl outbreaks in other countries, found that once the drug gains a prominent place in a local drug market, it doesn't go away.

But fentanyl is clearly already entrenched in parts of the US. The RAND report points the way to smarter approaches to dealing with the crisis -- approaches that focus on saving lives.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Permission to Reprint: This content is licensed under a modified Creative Commons Attribution license. Content of a purely educational nature in Drug War Chronicle appear courtesy of DRCNet Foundation, unless otherwise noted.


newageblues (not verified)

  Fentanyl is ramping up the damage done by prohibition. Making the need for a legal alternative to the black market even more urgent than it already was. Lives are slipping through our hands like water, their ghosts are everywhere.

 America's always had a mean streak and they've been taking it out on illegal drug users for a long time, but it comes back and bites society in many ways.

Let people have their illegal drugs at affordable price in return for meeting some standard of behavior. Watch the number of overdoses and crimes fall. And the level of marginalization/alienation. And watch the level of gainful employment rise.

Tue, 09/17/2019 - 7:01pm Permalink
the virgin terry (not verified)

In reply to by newageblues (not verified)

newageblues, i agree america's got a mean streak. i think it comes from 'conservative' christianity with it's dogmatic, puritanical, judgmental, and infinitely punitive god. the whole idea that humans are 'sinners' worthy of eternal damnation. believing in a cruel god as a 'role model'.

Thu, 09/26/2019 - 2:18am Permalink

“If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.” - Alice Bell As fentanyl analogues have no smell, and are much easier to smuggle than plant-based opiates (due to their potency), lotsaluk to the DEA with interdiction. I tried to tell the NC Board of Medicine about this back in 2017. My reward: Loss of my medical licence. Thanks, Prohibition, for another way to kill or maim Americans just for trying to get pain relief. Dr. Jim
Mon, 09/23/2019 - 7:29pm Permalink

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