Today, in the United States, there are a startling 600,000 heroin addicts. Over 2,000,000 Americans abuse their prescription painkillers. 4,000,000 consume marijuana habitually. More than 2,000,000 addicts are unable to survive a single day without opiates. In sum, there are 22,000,000 people addicted to some variety of drugs 1. These astonishing statistics represent a nationwide epidemic, impacting nearly every American.
History of Heroin
The American opioid crisis began over a century ago. During the mid-1800s, morphine addiction skyrocketed as doctors marketed it as a home remedy and prescribed it to veterans and soldiers, suffering from physical injuries. In response to the mass addiction of morphine, Bayer Pharmaceuticals, a German company, developed heroin. They marketed this new opiate as non-addictive and one that would subdue the more painful withdrawal symptoms of morphine. Incidentally, heroin became readily available, leading to 200,000 addicts by 1910 2.
Following the dramatic increase in heroin dependency, the government enacted the Harrison Narcotics Act, which placed a tax and regulated the importation, production and distribution of opiates, primarily heroin. By 1970, the trade shifted to an illegal one with international narcotics traffickers. Colombian drug cartels were importing 90% pure heroin, leading to 200,000 new addicts in New York alone. Due to the purity of the heroin that was now accessible, drug-induced trips to the emergency room increased three fold, and drug related suicides increased 45% in three years 3 .
The rising rates of addiction were accompanied by only a small increase in treatment facilities. Even in these limited facilities, only 13% of addicts would accept professional help 4. While a large portion of addicts remained without treatment, some tried Methadone. Methadone, a synthetic morphine invented by German doctors during World War II, was introduced to the US as a painkiller in the 1940s 5. In 1964, Dr. Vincent Dole and Dr. Marie Nyswander found that Methadone blocks the withdrawal symptoms of heroin 6. A decade later, there were 32,000 addicts receiving Methadone treatments. However, in 1977, there had been no recorded change in the number of heroin addicts; most people were relapsing into their old habits and becoming addicted to Methadone. In a study commissioned by Mayor Rudy Giuliani in New York, 2,079 out of 2,100 Methadone patients became reliant on Methadone after a five month treatment 7.
The response to rising heroin addiction shows that treating opioid addiction goes beyond introducing a substitute pharmaceutical. The dramatic rise paled in comparison to the swell of Fentanyl addiction.
History of Fentanyl
Today, there is a new war – a war on prescription opiates, which were responsible for almost 17,000 drug-induced deaths in 2014 9. This newfound battle is opening a black market door for more potent drugs such as Fentanyl as the accessibility of heroin and morphine decreases rapidly. A deadly narcotic, Fentanyl is 100 times more potent than morphine and has killed over 30,000 people 10. Compared to heroin, Fentanyl is easy to synthesize and is significantly cheaper to produce. Because of Fentanyl’s deadly nature, it takes four doses of Naloxone, an antidote, to stop a Fentanyl overdose, whereas heroin only required one dose 11.
Due to Fentanyl’s intoxicating qualities, some drug dealers lace heroin with Fentanyl in order to create higher highs for their consumers. Inadvertently, heroin users consume large amounts of what they assume to be heroin and overdose 13. As Fentanyl has been available since the mid 2000s, there have beens tens of thousands of deaths 14. History shows that through increasing the regulation on certain drugs, the market opens to other, more dangerous drugs. Fentanyl follows historical patterns. This crisis demands finding a way to decrease addiction.
How does Fentanyl affect the brain?
Like heroin, morphine, and other opioids, Fentanyl was created to be a strong painkiller. It binds to the pain receptors located in your brain. Fentanyl triggers a release of dopamine, which creates a flood of euphoria and instills a sense of deep relaxation in the user. While these symptoms are similar to those caused by heroin, Fentanyl produces a more powerful high.
So how is this actually dangerous? As Fentanyl increases the dopamine released by the brain, the respiratory system slows down, lowering one’s rate of breath. Consuming minuscule amounts of Fentanyl, four pure milligrams or the equivalent two grains of salt, can stop your breathing, heart rate, and lower your body temperature. Because of the brain’s natural tendency to desire euphoria, it encourages a dependency on Fentanyl, regardless of the risks. This is why Fentanyl is so dangerous 15.
Watch this video to learn more about Fentanyl and the brain! 17
How is Fentanyl obtained?
The increasing number of addicts in the United States is directly influenced by the accessibility to the ingredients needed to synthesize Fentanyl. 40% of Fentanyl is created in China and imported through Latin American countries. The other 60% is cooked up in the United States and distributed through the postal service 18. Cayman Chemicals, a company that distributes products in bulk, sells the two main chemicals in synthetic Fentanyl, N-Phenethyl-4-piperidone (NPP) and 4-Aminophenyl-1-phenyl piperidine (ANPP) for cheap prices. This makes it very easy to synthesize Fentanyl at home 19.
How can the accessibility of Fentanyl be decreased?
Increased regulation on who can distribute NPP and ANPP, along with additional background checks and general security on those who want to purchase these chemicals, will decrease the amount of Fentanyl produced in the US. Also, limiting the amount of product companies are allowed to sell will minimize the amount of Fentanyl that can be cooked up at home, and therefore, the number of addicts.
This was proved an effective method of reducing the amount of methamphetamine created in the US. The base of meth production is pseudoephedrine, an incredibly powerful cough medicine ingredient that was accessible in the early 2000s but due to increased regulation, is no longer easily obtainable. In 2005, 85 metric tons of meth were consumed in the US but after the Combat Methamphetamine Epidemic Act of 2005, pseudoephedrine was practically unobtainable, lowering the consumption to 39 tons in 2008. Clearly, enacting regulation on key ingredients is an effective method of lowering the accessibility of drugs 22.
What are treatment options for opioid addicts?
In the last decade, addiction treatments have been refined. The three most common procedures are as follows: the “cold turkey” method, the professional treatment option, and the at-home detox. The “cold turkey” method involves completely neglecting drugs. Though this is initially effective, there are additional withdrawal symptoms that are considerably more uncomfortable. Also, the chance of death after relapse is higher as the body is no longer used to the highs that the drugs emit 23.
The professional treatment option is less risky but also ineffective. Professional opioid treatment is divided into two stages. Stage One is the first two days in which withdrawal symptoms are the worst. Stage Two is the two weeks following, in which the withdrawal discomfort has decreased but is still present. After being weaned off drugs, ex-addicts are considered “unaddicted”. This treatment is only partially effective but the long term results are less than satisfactory. An important factor of rehabilitation is the psychological treatment. Currently, there is little to no psychological treatment, meaning there are still psychological dependencies and behavioral habits that reenforce drug addiction. 40-60% of rehab patients relapse within two months of their treatment, rendering professional rehab relatively ineffective 24.
Home detox, the third most common rehab treatment, is risky and ineffective but affordable. To elaborate, a home detox is done without the medicines or support systems provided by a rehab center, it takes longer, and the withdrawal symptoms are usually worse. In 2016, only 1.8 out of 21 million addicts attended rehab sessions that lasted two weeks or less. The best professional rehabilitation options include psychological and physical treatments 25.
How can we make professional treatments better?
To improve the rehab treatments for those who want help, shifting the focus from purely physical treatment to a combination of psychological and physical therapy is key. Addressing the psychological treatment is key to minimize the possibility of relapsing. This is going to be more effective than just ending the physical dependency because ending the mental dependency can be changed by altering the emotional attachment associated with addictions, which is controlled by the insula in your brain. Another important part of your brain is the caudate which is in charge of forming habits. To break a habit, one must allot 21 days to altering any habit. In order to more successfully stop addiction, the average treatment time must be increased from 14 days to a minimum of 21 days, the time it takes the caudate to break a habit 26. This is a crucial change that will render treatment more effective.
I recommend a six-week program – two weeks of Stage One type treatment, two weeks of Stage Two treatment, and finishing with two weeks of supervised freedom in the real world. If an addict can accomplish this after undergoing intensive physical and psychological treatment, they, theoretically, should have enough time to break their habit and develop new ones.
So, what’s next?
You have already taken the first step by becoming more informed about Fentanyl. The more people who know about the dangers of synthetic opioids, the more people will know the risks of exposing oneself. Thanks to people like you, we can take the first steps in lowering accessibility to Fentanyl and improving rehab treatment for maximum effectiveness. If you want to help improve the opioid crisis of today and prevent as many overdose deaths, this page was made for you. Share it and leave comments at the bottom! I would love to hear your thoughts, feedback, and answer any lingering questions.
If you or a loved one is suffering from addiction, call 1-877-898-1136 to get help today for a better tomorrow.