91,799. This is the number of people who died in 2020 from a drug overdose. And more than 932,000 people have died since 1999. About 75% of the deaths in 2020 can be attributed to opioids. Synthetic opioids, mainly fentanyl, account for most opioid deaths.
There was a time when individuals seeking heroin could obtain heroin. Not so much these days. Now, most illicit opiates contain fentanyl which is about 50 times more potent than heroin and 100 times more potent than morphine. When someone unknowingly takes fentanyl, the difference in the potency is critical. A few milligrams of fentanyl is not the same as a few milligrams of heroin.
Two milligrams of carfentanil, another synthetic opioid 10,000 times more potent than morphine, is enough to take down an elephant—or kill about 50 people. Unfortunately, street drugs do not come with equivalency labels, and overdoses are common.
‘Harm reduction’ describes strategies that help reduce the negative consequences of substance use. This could include providing sterile, safe injection supplies, supervised injection sites, availability of naloxone (a drug used to reverse the effects of an opioid overdose), connections to medication-assisted treatment, and drug checking services. Some Harm Reduction sites test drugs to determine if they contain fentanyl (and/or fentanyl analogs) and other compounds. Potentially dangerous drugs and drug contaminants can also be picked up by more elaborate laboratory testing.(1)
One such contaminant of illicit fentanyl is xylazine, a veterinary tranquilizer. Symptoms from xylazine overlap with those from opioids but do not respond to naloxone. These include sedation, vomiting, low blood pressure, and respiratory depression, and when combined with drugs such as fentanyl or benzodiazepines, there is an increased chance of overdose and death.
Unfortunately, the Covid-19 pandemic placed the opioid epidemic on the back burner. Initially, during the pandemic shutdown, individuals with substance use disorders were unable to access their support groups and avoided seeking medical care, worried about contracting the virus. But the opioid epidemic did not disappear; if anything, it’s gotten worse.
Substance use disorder is a disease that affects a person’s brain and behavior. Imagine what we could do if science, and dollars, came together to fight this disease. Every number is a life. 91,799. That’s one death every 5 minutes.
For more on opiates, see my May 2022 Poison blog Magic and Misery—Poppies Will Make You Sleep (bjmagnani.com)
1.Delaney, S and Beriault, D, Clinical Laboratory-Based Drug Checking Services and the Overdose Crisis, Clinical & Forensic Toxicology News, June 2022.