(CNN) As the nation struggles with an epidemic that includes both prescription opioids and heroin, officials are alarmed by a new front in the war against opioids: illicit fentanyl.
Law enforcement agencies submit drug products to the Drug Enforcement Administration for testing. From 2013 to 2014, 426% more products tested positive for fentanyl, according to new numbers from theCenters for Disease Control and Prevention. In the same time period, deaths from synthetic opioids increased by 79%.
But that 79% might actually underestimate the number of deaths from synthetic opioids; the CDC was able to evaluate only the 27 states that had consistent death certificate reporting of the drugs involved in overdoses. The analysis did not include New Mexico, Rhode Island, Pennsylvania or Delaware, states that respectively had the second-, sixth-, eighth- and ninth-highest rates of overdose in the country.
The CDC estimates that the 27 states evaluated represent 75% of the synthetic opioid deaths in the country. In its analysis, it further drilled down on the states that have had the biggest rise in fentanyl-related deaths and seizures, hoping to better understand how illicit fentanyl is making an impact.
Though the number of heroin-related deaths is still greater than those from fentanyl, CDC behavioral scientist Matthew Gladden said, “the issue [of fentanyl] seems to be spreading and growing. The number of samples law enforcement submits for testing is still increasing and spreading.”
What is fentanyl?
Fentanyl is most commonly prescribed to cancer patients for relief of pain. It is 50 to 100 timesmore potent than morphine and 30 to 50 times more powerful than heroin.
According to the DEA, illicit fentanyl is not being diverted from hospitals, but rather being sourced from China and Mexico and making its way into street drugs in the United States. Often, it is passed off as heroin or some other pill and users have no idea that they are taking the dangerous drug. Dealers are also cutting heroin and other drugs with it, because illicit fentanyl is cheap and allows them to stretch their supply.
This year in California, fentanyl was passed off as the prescription drug Norco and sold on the street. In just 10 days, one batch was responsible for at least 10 deaths and 48 overdoses.
Most recently, an outbreak of nearly 90 heroin overdoses in just five days in western Cincinnati was linked to illicit fentanyl.
After his death in April, pop star Prince’s toxicology report found fentanyl in his system. Investigators seizedpills from his Paisley Park compound that were labeled as hydrocodone, but actually contained fentanyl.
Little data to track fentanyl
It’s difficult to determine just how much illicit fentanyl is out there because there are so many newly emerging variants or analogues, and many medical examiners and toxicologists are just beginning to test for it.
Deaths from fentanyl itself are not reported in national data. Just six of the states evaluated by the CDC actually track deaths from the drug: Florida, Maine, Maryland, Massachusetts, New Hampshire and Ohio.
When totaling those states’ numbers, there was an increase of 1,008 fentanyl-specific deaths between 2013 and 2014. In the same time period, there were 966 more deaths from other synthetic opioids, indicating that illicit fentanyl is driving much of the increase.
Ohio has been one of the places hardest hit by the epidemic. In 2014, it had the second largest number of opioid-related deaths in the country and the fifth highest rate of overdose. In Ohio between 2013 and 2014, fentanyl submissions to DEA labs by law enforcement increased by 1,043%, while fentanyl-related deaths increased by 526%. Yet in the same time period, prescriptions for fentanyl actually dropped by 7% in the state.
The growing presence of fentanyl, combined with its potency, is causing public health experts to sound the alarm. Bertha Madras, formerly a director in the White House Office of National Drug Control Policy and currently a professor of psychobiology at Harvard Medical School, likened illicit fentanyl to crack cocaine.
“It enters the brain much more quickly,” she said. But unlike crack, which is three times stronger than cocaine, some fentanyl analogues are 100 times more powerful than regular fentanyl.
“I would say it’s like crack on steroids,” Madras said.
Gladden added, “The key message to the rest of the country is for states that haven’t seen illicitly made fentanyl, they need to be vigilant.” He said states need to be ready with plenty of naloxone, a drug that can counteract opioid overdose, and make efforts to reach out to harm-reduction groups to help counter the impact of illicit fentanyl.