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Stop Demonizing Synthetic Opioids

While it’s true that fentanyl is a synthetic opioid, writers and reporters have widely placed undue blame on fentanyl’s synthetic nature for causing the opioid crisis.

Two-dimensional chemical structure of fentanyl, a synthetic opioid.
Chemical structure of fentanyl

We’re all familiar with the rash of opioid overdose deaths currently plaguing the United States. You may also know how that fentanyl is often to blame for these fatal overdoses. While it’s true that fentanyl is a synthetic opioid, writers, reporters, and news agencies have widely placed undue blame on fentanyl’s synthetic nature for causing the opioid crisis.

Demonizing synthetic opioids will restrict access to other synthetic opioids that are valuable in treating opioid use disorder or managing chronic pain. It also encourages Americans to support causes that won’t reduce opioid overdose deaths, reduce the incidence of opioid use, or improve long-term treatment outcomes.

Fentanyl isn’t bad because it’s synthetic. Fentanyl is single-handedly responsible for more deaths than any other opioid right now because consumers never know whether fentanyl or fentanyl analogues are present, in what amounts fentanyl or its analogues are present, or if their street heroin is mixed evenly.

Most Americans don’t know that fentanyl is here to stay. Here’s why:

  • The primary issue is that the American opioid market is unregulated. Legalization and subsequent regulation is the only way for users to know without fail what they’re consuming.
  • Fentanyl’s synthetic nature means that manufacturers can create the drug in labs as opposed to growing vast fields of opium poppies. Laboratory synthesis is easier, quicker, and less risky.
  • Fentanyl is cheaper to produce than heroin and other opioids (e.g., oxycodone, morphine).
  • Dealers can selectively add more fentanyl to batches of street heroin to drastically increase the likelihood of an overdose. News regarding the opioid’s source spreads like wildfire among local users, often boosting business for dealers in the short-term. What profit-minded entrepreneur would give up this valuable marketing tool?
  • American illicit opioid users have grown accustomed to fentanyl. If, overnight, all fentanyl left the American illicit opioid supply, consumers would likely not feel satisfied at their current doses (i.e., 500 milligrams of fentanyl-free street heroin might not hold a flame to 100 milligrams of fentanyl-positive street heroin).
  • Fentanyl is relatively easy to source. Through Tor-based online markets, it’s easy to find reputable vendors selling high-quality fentanyl at low costs. While few people have access to high-quality heroin from high-level distributors or manufacturers, virtually anybody who purchases fentanyl online can compete with local low-level dealers.

Synthetic Opioids Aren’t Inherently Deadly

Methadone

Bottle containing bright pink oral methadone solution.
Oral methadone solution

Methadone is a popular opioid replacement drug in the United States. It’s also a synthetic opioid. Methadone has a strong binding affinity to the brain’s opioid receptors. Put simply, this means that users can’t take other opioids (e.g., heroin, oxycodone, morphine) and get high; this blocking effect lasts anywhere from a few hours to upwards of two days after dosing.

Patients who are prescribed methadone for opioid use disorder won’t ever feel withdrawal symptoms unless they stop taking the drug as prescribed. This withdrawal-fighting quality reduces the likelihood of methadone-maintained patients of missing work or other obligations; as opioid withdrawal syndrome is often compared to the flu — illicit opioid users like me often call it being “dopesick” — it’s easy to understand how methadone helps opioid-dependent persons stick to schedules.

Tramadol

Tramadol tablet with the markings "AN 627"
50-milligram tramadol tablet

Although opioids are considered by many chronic pain patients to have high utility as a pain management tool, physicians across the United States have become considerably reserved in terms of prescribing opioids, even for patients with easily-diagnosed, legitimate, well-documented issues that cause chronic pain.

Opioid prescriptions have decreased in number, quantity of tablets prescribed, and dosage because they have a high potential for abuse. Although the vast majority of patients who are prescribed them don’t end up addicted to them, opioids are more frequently abused than other medications used to manage pain.

Tramadol is a synthetic opioid that has significantly less potential for abuse than other opioids (e.g., oxycodone [Percocet, OxyContin], hydrocodone [Lortab, Norco], hydromorphone [Dilaudid], morphine). Although it’s not ideal for all types of pain, modern research shows that tramadol “is now regarded as the first-line analgesic for many musculoskeletal indications.”

Fentanyl

Generic transdermal fentanyl patch.
75 microgram/hour transdermal fentanyl patch

Although fentanyl is responsible for more opioid overdose deaths than any other opioid in modern America, pharmaceutical fentanyl isn’t to blame; rather, illegally-manufactured fentanyl is found in essentially all fentanyl-positive counterfeit opioid tablets and street heroin.

Fentanyl is, again, a synthetic opioid that isn’t used very often to manage pain. The drug should only be prescribed to opioid-tolerant patients who exhibit a well-documented need for such a potent analgesic. Physicians sometimes use fentanyl to manage acute pain in hospital settings.

The drug is also used in combination with midazolam to sedate patients via general anesthesia — however, fentanyl is only for analgesic (pain relief) purposes, not for actually putting patients under.

Although I struggle to find facts or statistics about how infrequently physician-prescribed, pharmaceutical fentanyl causes death in patients or diverted for illicit use, as a long-term opioid user who’s been around the block, I know that pharma fentanyl isn’t commonly found on the streets. I also know that people don’t isolate fentanyl from prescribed formulations of fentanyl (e.g., transdermal patches, nasal sprays, buccal tablets) to go on to adulterate street heroin or manufacture counterfeit opioid tablets.

Restricting the prescription or dispensing of pharmaceutical fentanyl in the U.S. won’t reduce the incidence of fentanyl-involved overdoses.

What’s the Problem With Suggesting That Synthetic Opioids Are Inherently Bad?

Laypeople aren’t that interested in illegal psychoactive drugs like opioids. It’s easy to understand why the public doesn’t have a good understanding of them. When people are told anything about opioids or other illicit drugs by the news, they often blindly take what they hear at face value.

Even those who support the criminalization of all drugs — throwing non-violent users in jail and all that jazz — know friends, family members, classmates, coworkers, local community members, and others who have struggled with drug addiction.

We — you and me both — all know people affected by the opioid epidemic. This fuels Americans to want to improve long-term outcomes for people suffering from opioid use disorder, reduce drug consumption rates, and cut down on opioid-related deaths.

Here’s the Issue

Most of us support ineffective methods of dealing with drug use, namely the ongoing opioid crisis. When we don’t understand why the opioid crisis has claimed so many lives, we similarly don’t understand how to respond to it.

Local news agencies, their national counterparts (e.g., CBS, NBC, CNN, FOX), and non-news writers alike need to make clear that fentanyl’s synthetic nature isn’t responsible for the opioid crisis, the rash of fatal opioid overdoses, or any other problems. The problem isn’t synthetic opioids. The problem is that illicit opioid consumers never know what active ingredients are present in the opioids they use or in what amounts; they also can’t be confident that an entire bag’s contents are evenly mixed, which ensures that one part of the batch won’t have a disproportionate amount of active ingredients. These discrepancies — illicit opioid users like me often call them “hot spots” — are the reasons why the modern American illicit opioid market has churned out so many fentanyl-related overdoses in recent years.

One thing’s for sure: if we don’t change our approach — and quickly — the opioid epidemic will keep on truckin’.

By Daniel Garrett

I'm a self-employed writer, long-term drug user, and resident of rural Tennessee. Find me on Twitter at @DanielGarrettHR or email me at danpgarr@ut.utm.edu.

2 replies on “Stop Demonizing Synthetic Opioids”

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