Harm Reduction: Experts Call for Urgent Action as Fentanyl-Related Overdose Death Toll Climbs

Submitted by Phillip Smith on (Issue #466)
Consequences of Prohibition

More than 120 medical experts, public health departments, and drug user health advocates have called on the federal government to take more aggressive steps to deal with a wave of overdose deaths caused by heroin cut with fentanyl, an opioid pain medication 50 to 80 times stronger than heroin. The call came in an open letter to US Health and Human Services Secretary Mike Leavitt drawn up by the Harm Reduction Coalition, a national health and human rights advocacy group working to reduce drug-related harm.

[inline:fentanyl.jpg align=right caption="fentanyl"]The ongoing epidemic -- Drug War Chronicle reported on it in June -- has killed more than 750 injection drug users this year from Chicago to the East Coast. Chicago, Detroit, and Philadelphia all have around 200 fatalities.

The actual number of deaths may be far higher because many jurisdictions near these large cities may lack the resources and expertise to monitor overdose trends. "This wave of overdose deaths poses an acute public health emergency and immediate threat to the lives of opiate users, while highlighting persistent weaknesses in health officials' response to the increasing epidemic of both legal and illegal opiate overdose," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition.

The letter makes five recommendations, calling on Secretary Leavitt to ensure that:

  1. The Centers for Disease Control (CDC) create surveillance systems to monitor overdose trends and threats.
  2. The National Institute of Drug Abuse (NIDA) provide emergency funds for research projects to answer urgent questions that will allow jurisdictions to immediately and effectively address the overdose epidemic.
  3. The Substance Abuse and Mental Health Services Administration (SAMHSA) rapidly replicate existing overdose prevention programs, and fully fund them.
  4. The Drug Enforcement Administration (DEA) inform CDC of levels of purity and presence of fentanyl and other hazardous contaminants in local drug supplies so CDC can notify the public.
  5. The Department of Health and Human Services (HHS) prepare an emergency report of the current overdose epidemic for Congress. This report should make emergency recommendations for prevention measures including: Supporting community-based responses to overdose, including the use of naloxone, a legal medication that reverses opioid overdoses, by users and their loved ones; improving police and emergency medical services responses to overdoses; and enhancing the availability of substance abuse treatment.

"A client told us she watched her friend die in front of her and there was nothing she could do," said Corey Davis, legal services coordinator at Prevention Point Philadelphia. "If she had naloxone and was trained to use it, she could have saved her friend's life. We've lost a lot of our people due to fentanyl. This has to stop."

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.


Anonymous (not verified)

The most prevalent and obvious fear going with this latest, panic about fentanyl is that it will assume the proportion of depriving people with legitimate needs of the medication. Typically government forces act before they think, and think before they know what the situation is.
For peole with certain kinds of pain fentanyl is irreplacable and a great blessing. The fear mongers are our worst enemies.

Sat, 12/23/2006 - 3:32pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

I 2nd what you say - Fentanyl is a great blessing and irreplacable for those with severe chronic pain. It is NOT the Fentanyl that is bad - It is how others are using it - But as with MOST drugs if taken improperly will cause problems.

People who need it will suffer and those that abuse it will always find a way.

Sat, 12/30/2006 - 6:49pm Permalink
Anonymous (not verified)

Just trying to find out what the amount of Fentanyl??? in the picture in the article represents...Amount that kills you? Amount added to heroin? I have chronic pain and have only used fentanyl as a patch that absorbs into the skin...It was awkward and did not work as well as Avinza and other pills but that is another story...Just trying to find out about the picture if anyone can enlighten???Thank you.

Thu, 02/01/2007 - 6:44am Permalink
Anonymous (not verified)

Well, most fentanyl comes in 25, 50, 75, and 100 mcg/72 hour patches. this means that these patches will release either 25, 50, 75, or 100 micrograms (1/millionth of a gram) over the course of 3 days. take the 100 mcg patch, devided by 3 days, that's 33 mcgs/day. That's the maximum ammount that most people will ever use therapeutically. Mind you, some people build up tollerance faster than others, and there are people that use 2 patches at a time, so there are exceptions. But given this information, I'd say the ammount in that picture is WAY more than enough to kill someone. Probably enough to kill everyone that has posted on this thread.

Sun, 02/18/2007 - 12:56pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

The fentanyl dose on the patch is per hour, not per day. I maxed my prescribed fentanyl at about a milligram per hour before I had to detox for a medication holiday. If I were to start fentanyl directly again after a month off narcotic painkillers, I would have to start with a single 25 ug/hr patch. But I am more likely to start with a weaker drug. Took me seven years of constant pain and dose increases to get to that much fentanyl plus 80 mg oxycodone for breakthrough - and when that stopped working, it was doubtful that any amount of narcotic would have killed my pain, so I have to put up with pain that makes me want to scream for seven weeks - three weeks of taper, four weeks of allowing my mu receptor count to drop to normal, before I can get pain relief again.

It was a good trade for seven years of fairly low pain.

I agree that if the amount in the picture is pure fentanyl, it probably would be enough to kill all posters - better wear a respirator when working with the pure product in large amounts. The 50 ug/hr and 100 ug/hr patches are labeled so that they won't be used in people who are not already taking significant amounts of narcotic - the worry is, of course, respriatory depression.

The first time I heard of a fentanyl overdose was over three years ago. A fireman had told me about a local junkie who had somehow gotten ahold of a 100 ug/hr fentanyl patch - and had chewed it. A 100 ug/hr patch will deliver about a milligram in ten hours and are supposed to be good for 72 hours - and the old patches still have significant fentanyl in them - the total in the patch is about 10 mg to start. While I have heard that fentanyl has little bioavailability when swallowed, it can be absorbed through the mucus membranes in the mouth. So chewing a 10 mg patch meant an overdose for him, despite regular heroin use. They got him naltrexone at the scene and transported.

At the time, I would occasionally chew a patch when the pain got so bad I could not stand it and I could not get relief from oxycodone. Other than lessening (not completely relieving) my pain, it would not make me high or sleepy.

Sat, 10/20/2007 - 7:29pm Permalink
Anonymous (not verified)

All I know is that the dope is strong, long lasting and cheap. I don't bang anymore, just snort. Unfortunately I found out the dope was laced because I am being charged with possession of both heroin and fentanyl.It is quality stuff, but not for the weak minded. Take a small sample hit to check for potency. If you can hold out that extra 20 minutes you could save your self alot of hassle at the hospital or worse, a quick death.

Thu, 02/22/2007 - 9:22pm Permalink
Anonymous (not verified)

I know this is not what the above article addresses, but I am a stickler for correct drug info. A previous poster said that a 100mcg (microgram, very small) 3 day patch will release 33mcg of fentanyl everyday for three days. This is very incorrect. With a 100mcg patch, 100mcg of fentanyl is released every hour, as opposed to through out the whole day. This goes the same for the other sized pathes too. As a result a 100mcg patch actually has ~10mg (milligrams, much more than micrograms) of fentanyl, which is a huge dose, enough to kill most non-tolerant people. Which is why there are a number of ignorant users who cut open a patch, eat all the gel, then proceed to overdose on the huge dose they unknowingly took. (they should know, everyone should know what they are taking, or they should not take it) Which of course is another problem with fentanyl, but I digress.

Fri, 02/23/2007 - 6:20pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

You're right... My younger brother died 6 weeks ago from just this thing. He had been wearing a patch and took it off (I assume because he was getting too high). He died anyway, sitting on his couch watching TV in the middle of the day. He was 27, suffered from chronic pain and had a tolerance to opiates/narcotics. The coroner said they found nothing more than "theraputic levels", but it killed none the less.

Tue, 08/12/2008 - 11:34am Permalink
Anonymous (not verified)

heh dont know but i think theres something wrong with the weed on the streets dont no what but something aint right

Wed, 03/14/2007 - 3:49pm Permalink
Anonymous (not verified)

Who knows what are they putting in weed these days ... I once read of an internetclub in Thailand where the owner was putting little doses of amphetamine in the customers drinks just to keep them wired to the computer. After one died well it all became very clearly ... people would do anything to make a profit, drug you, drug you better ... anything.

Wed, 04/25/2007 - 9:06am Permalink
Anonymous (not verified)

I have a freind that died because of weed that was laced. he was 15 and when they found high amounts of cocaine in his system they labeled him as an addict and closed the book. I knew he hadn't touched the stuff and when i smoked it with him it felt alot different then regular weed. Everyday i wish i had my freind back and i know that his death is a result of anti-weed propaganda comercials. If i could go back and change anything to get him back i would including smoking weed. I don't care about weed, i enjoyed it emensely but I want it legal not because of that but because if the government does not take control out of the hands of drug dealers more people are going to die from laced weed.

Mon, 10/22/2007 - 12:26am Permalink
Anonymous (not verified)

There has been a lot of heroin going around in michigan that I suspect is laced with fentanyl. I am just wondering what it looks like, because I can't really tell all that well from the small picture from the story. Is it off-white color with a very light tan tint, and when mixed with water, it turns a light brown/tan color; also very very bitter with no smell? I tried it and it took about 0.25grams of doing it I.V. to get me strung-out (I have a somewhat high tolerance). If this is what it looks like, please post the information which you know, so I will know. Thanks.


Thu, 11/08/2007 - 12:24am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

nah the whiter powder is more likley to be laced the shit your describing is just street level heroin. off white brownish powder the fentanyl shit is more white and fine what you got is just dope my man. i'm from trenton new jersey and it's hit the northeast coast the hardest plus cut bags are even smaller than a reg bag instead of a .1 of a gram in a bag they put less and if your doing almost 3 bags ( little more than .25 of a gram ) if it was laced with fentanyl you'd be dead i knew someone with a high tolerance that died off 1 bag I.V.

Sat, 03/22/2008 - 9:39am Permalink
Anonymous (not verified)

I was just simply trying to google how long it took the Fentynal patch to start working. I have been at the hospital with my husband all day. He was supposed to have a cervical epidural injuection, but they could not do the procedure. He was in too much pain and now his only chance of relief is surgery. Thank god he is able to get medication but it is most of the above people who screw it up for us that work forty hours a week and in need of medication! My ex husband is a crack head and unfortunately we share four children together, he is a piece of shit! (He was not a drug addict when I maried him) You are all a piece of shit! Bottom of the barrell, trash!! Which gets me one another subject of child support. He is supposed to pay $315.00 for ALL FOUR KIDS! Maybe if he quit spending all his money on drugs he could pay the state minimum for child support!!

Fri, 01/18/2008 - 8:09pm Permalink
Anonymous (not verified)

i agree with you on how your kid's dad should get his shit straight, but you should know there is plenty of drug addicts who have their shit straight.. so dont go talking shit on a computer because you married a crackhead and chose to have 4 kids with the dude.

Mon, 02/25/2008 - 12:55pm Permalink
Anonymous (not verified)

has this spread to the West at all? I have had a number of friends die in the past two years from heroin OD... and they didn't shoot-up which means that the dose is a bit more regulated in terms of knowing how strung-out you are getting. Of course an OD can happen when smoking black-tar but it takes some work after being addicted for a couple of years already to over-step your boundaries that much. The last friend of mine who died a couple months ago was in the process of cutting-down to then go into detox.

Wed, 02/27/2008 - 3:02am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

no because i'm east coast and i been out west and they have heroin from mexico that nasty bitter shitty black tar shit that isn't powder so they can't cut it the eat or northeast has that asian heroin which is about 3 times as strong in purity and is either off white or brown powder in glassine bags. the real heroin is east coast

Sat, 03/22/2008 - 9:43am Permalink
Anonymous (not verified)

First of all, I can guarantee that no marijuana is being laced with any sort of high potency, ridiculously expensive drug like cocaine, heroin, ecstacy,etc. In some areas methamphetamine is cheap, but can sell itself without masquerading as weed. LSD cannot be smoked, so that is out the window. The only type of weed that is (rarely) laced with anything is dirty ass schwag, and (said dirty ass schwag) is usually laced with formaldehyde (embalming fluid){yes, some idiots do smoke embalming fluid}, or at worst, PCP(which is also extremely, extremely unlikely, as PCP is extremely rare). Glass is highly unlikely to end up in any marijuana, and as it doesn't burn, it probably wouldn't hurt anyone (unless they ate it in a brownie, space cake, etc.). I think if I saw a shard of glass amongst the ashes in my pipe, I'd kick my dealer's ass.
Lastly, I remember when I first started smoking weed, I got really high. It even made me puke once. That was because it was extremely good sinsemilla, and undoubtedly very high in THC. So many unexperienced pot smokers will smoke something really good, and think it was laced because they were unprepared for its effects. My friends have made really great brownies, and people thought they were laced because they got really messed up. Marijuana is a crazy drug, especially for novice smokers. It can have a multitude of different effects, unique to the individual and their particular setting.
As for adulterated heroin, so what? A. It wouldn't be a problem if Heroin(and all drugs) were legal and regulated. The societal harm of drugs is maximized by a biased, revolving-door "Justice" system and their ridiculously high price and varying quality.
B. The heroin is being singled out by the media/law because it is so high in potency, although this is what the addict wants(as fentanyl and heroin are both highly desired/prized by addicts). Almost every dealer will warn their customers if it is good(especially if it is really good, as this is a selling point.), or to stop them from OD'ing. An OD loses a customer and can land a dealer in jail(not at all good, businesswise)
C. This leads me to conclude that most of the addicts who OD'd did so because they did not take a small dose to "test it" as a smarter junkie would (yes, that's a bit oxymoronic), and I doubt they were ignorant of its quality. Most of them were just stupid enough to take the big shot. Also, I bet most all the deaths were caused by intravenous administration, which is much more dangerous than insuffalation. Personally(as an on-again off-again user) I would be thrilled to obtain something so potent, and I'm sure most all of the dead users were happy to have obtained something highly potent as well, until it killed them. Users are responsible for their own actions. H might be illegal, but you don't pillory a bartender whose patron kills himself and a cute family while driving drunk. In fact, I would regard the drunk driving to be a much more serious moral infraction than selling someone heroin who (may) die from it, as that person does not "kill" the person who OD's. However, the drunk driver is responsible for their actions, as is the heroin user who choses to take too much. However flawed my reasoning may be, I think that the above article sends the wrong message. Those addicts undoubtedly sought out that particular "brand" of smack, perhaps even more fervently after they heard people had died from it. If I OD'd one day, it'd be nobodys fault but my own. So lets not point fingers.

Sat, 03/08/2008 - 11:32pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

as a ultra experineced drug user esp. heroin and marijuana being my favorite i would have to say the above article is most accurate ui have seen on this site. nobody laces weed with anything but PCP or embalming fluid and usually they are mixed together and called somehting like ( dippy, wacatah ( only in Philladelphia ) , wet, boat, and many others. They would not lace weed with heroin because heroin doesn't burn at the same temp. they also would not lace it with coke because coke you can't smoke that is what we call crack smokable coke and for that to be in weed it would be noticible size rocks of little pieces of cocaine, you would relize right away. and yes the guy above is right about having super potent weed i'v seen at least 20 people say they smoked laced weed when in fact it wasn't at all. any heroin you obtain or coke in U.S. is cut with something and yes all those dead addcits went looking for the laced heroin more bang for thier buck. heroin comes in glassine bags okay with a colored stamp on it like " diesel " "superman" "sudden death" ect. ect. if a junkie knows the brand name of dope cut with the good shit he;ll look for it until they find it and think they are can't die and don't test it and shoot the whole bag or maybe 2. goodbye

Sat, 03/22/2008 - 9:53am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

As far as your comment "I can guarantee that no marijuana is being laced with any sort of high potency, ridiculously expensive drug like cocaine, heroin, ecstacy,etc" I actually can guarantee that you are incorrect. I worked in our local juvenile court system for about 10 years (before I got fed up with the prejudice and hypocrocy)and for about 4 years of that I worked in the drug lab. You would be surprised how many young kids would come in to drop as part of their probation and be absolutely shocked to find out that thier urine included things like coke, heroine, etc in trace amounts (or sometimes more, depending on the frequency of the use of pot). Most of the kids realized that their probation officers weren't gonna do a whole lot about them smoking a little weed so they took their chances.
What you need to realize is that most drug dealers do not just sell pot. They are not against lacing a little inexpensive pot with something more potant and addictive to get a "new" customer for a different more expensive drug..
Wake up and smell the coffee, drug dealers are not exactly known for their honesty and morality.

Mon, 05/26/2008 - 11:30pm Permalink
Anonymous (not verified)

"I worked in the drug lab. You would be surprised how many young kids would come in to drop as part of their probation and be absolutely shocked to find out that thier urine included things like coke, heroine, etc in trace amounts (or sometimes more, depending on the frequency of the use of pot)"

Hehe no offense but I honestly think your the gullable one my friend =) I think youd be suprised as to how many young kids ACT absolutely shocked to see those things in their urine meanwhile they just did this or that with a friend or two ;P lol.

I also agree with you in some ways, im sure marijuana is very very rarely laced with something odd but its deffinetly not something common at all. Not even something id worry about regularly actually, 99% of the time people say weed is laced its just them having a panic attack or something of the sort, but yes im sure occasionally somebody gets some fucked laced weed lmao and yous I feel sorry for =D.

Sat, 05/31/2008 - 12:44am Permalink
Anonymous (not verified)

My brother died from using one of these patches 6 weeks ago. They did not find a high dose in his body, just enough to make him stop breathing. Relief from chronic pain is a blessing (my brother had it), but not worth dying for. If it kills a relatively healthy 27 year old man, it's dangerous and needs to be reevaluated. By the way, I'm active in NORML activities/support and I'm all for de-criminalizing drug use in this country, but this destroyed my family and left us all in pieces. My brother wasn't a junkie with nothing to lose.

Tue, 08/12/2008 - 11:20am Permalink
Anonymous (not verified)

Do any of you abuse and addiction advocates realize how absolutely irrational and irresponsible you sound/act? As the mother of two sons who have ruined their lives and are now working on their children's lives, I can assure you that we need your healthy brain cells. Please get some help. For every one of you who behave so abnormally, you devastate five of those of us who love you.

Sun, 01/11/2009 - 7:21pm Permalink
Anonymous (not verified)

My husband [age 58 ] has just commenced taking fentynol [patch-lowest dose] Is he at risk of serious problems as a consequence of taking this medication

Fri, 01/23/2009 - 9:56am Permalink
Anonymous (not verified)

I would say anyone that uses it, regardless of legal or illegal, is literally gambling with their own lives. This drug is lethal. Even if it doesn't kill you, it is not compatible with really any other drug, has a higher potency and propensity for abuse than heroin, and is steadily killing people across the country. The FDA has recalled a massive amount of patches that were distributed damaged and possibly have killed people. What then? The pain is bad enough that bargaining with the devil is warranted? I think not. This drug needs to be taken off the market, period. The patient insert is 18pages long-in regular page format-and it is full of warnings. Don't take with benzos, don't use with heat, don't take with respiratory depressants, don't touch it, don't throw it in the trash, but instead flush into the water supply, via your toilet, don't give to children under 2, don't allow anyone not prescribed to touch it, don't take if you have not been taking other opiates for at least 2weeks, don't dispense if there is a suspicion of abuse, don't dispense without medical history, don't dispense without close monitoring for abuse or addiction. I have never read a patient insert that had more BOLD print, CAPITAL letters, WARNINGS, SIDE EFFECTS, or COMPLICATIONS. So its a great drug huh? You think so? Have you known someone who has died from using it-properly? I have. And let me tell you, there is no amount of pain that he may have been in that would justify his dying from trying to correct it. None. Its not a wonder drug. Its lethal. You use it, you need to understand you have a high risk of death. Got pain? Smoke some marijuana. Its got excellent medicinal qualities including destroying cancer cells and dulling nerve pain. And you can't overdose on it, you can't get addicted to you, its less expensive, easier to get, and IT WON'T KILL YOU. PLEASE! Think clearly about how much you may value your life before you ingest or apply a fentanyl patch. You may be loved and your loved ones may not recover from losing you. Period.

Sat, 04/18/2009 - 3:44am Permalink
I KNOW SO (not verified)

In reply to by Anonymous (not verified)


Thu, 05/20/2010 - 11:45pm Permalink

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