Opioids are found in the opium poppy plant. Some prescription opioid medications are made in a lab by scientists or from the plant directly. The drugs are created to use as medicine to relieve pain and relax the body. The prescription form is used to treat moderate to severe pain, diarrhea or painful coughs. Common prescription opioids include:
Opioid drugs are misused for nonmedical reasons because they give users a high. The opioid crisis has become a severe epidemic, and heroin overdoses are on the rise. Fentanyl abuse in particular has become prevalent in places like Philadelphia.
What Is Fentanyl?
Fentanyl is a synthetic opioid that is 100 times more potent than morphine. Physicians use the drug to treat patients who are experiencing severe pain, usually after surgery. Recognized as a schedule II prescription drug, it can also be used for patients who are tolerant to other opioids. Fentanyl goes by the name Duragesic, Actiq or Sublimaze in prescription form. On the streets today, synthetic opiates like fentanyl are sometimes laced with heroin and can be very dangerous. Synthetic opioids are highly addictive due to the euphoric effects. Misuse can also cause adverse effects such as vomiting, nausea, dizziness, confusion, urinary retention and respiratory depression. The drug can be snorted, sniffed, taken orally, smoked, injected or taken through a patch.
How Do People Misuse Prescription Opioids?
When used in the short term, prescription opioids are safe to ingest when prescribed by a doctor. People may begin to misuse their prescription by:
- Taking a higher dose than prescribed
- Taking someone else’s prescription
- Taking the drug solely to get high
The Synthetic Opioid Epidemic
Americans should be aware of the increasing production of fentanyl and how dangerous the drug is becoming. In January of 2018, the DEA seized over 45 kilograms of fentanyl from traffickers in New Jersey. According to law enforcement, that amount of drugs could cause fatal overdoses for nearly 20 million people.
Synthetic opioids are rapidly spreading around the United States thanks to their high profit margin for drug traffickers. The DEA reports that fentanyl pills are being sold illegally at $10 to $20 per pill. Typically, synthetic opioids are manufactured overseas and then either sent discreetly through the mail or transported across the American Southwest’s border. Today, drug traffickers who would only purchase heroin are purchasing fentanyl at the same time. Synthetic opioids that are made from a variety of formulations make them extremely dangerous when used illicitly.
Drug dealers in Pennsylvania are combining crack cocaine with fentanyl for the purpose of “speedballing.” This is a dangerous combination as the cocaine acts as a stimulant while the fentanyl depresses the nervous system. At first, it appeared as if the production of fentanyl-laced cocaine was as a result of an accident. However, because of the spike in overdoses thanks to the fentanyl-laced cocaine, authorities now believe the production is intentional. They think that this is a devious way for the drug cartels to use cocaine to expand the market. Synthetic opioids are a more addictive drug than cocaine, and the goal of the dealers is to make users need the product. Opioids are also cheap and easier to mix with many other drugs.
The city of Philadelphia is seeing a spike in opioid addiction. In just one week, 20 people entered an emergency room in West Philadelphia. At first, doctors suspected heart attacks. Within minutes, they realized the patients were experiencing overdoses from opiates. Two of the patients died while others suffered brain injury from lack of oxygen. Some patients were shocked after finding out their urine tests were positive for fentanyl after stating that they only used cocaine. Authorities investigated and soon realized that these people who were trying to purchase crack cocaine were being given fentanyl instead. This particular incident put the community on high alert. Even those who were abusing cocaine were fearful that they would somehow ingest fentanyl instead. A typical cocaine user does not have a tolerance for opioids, making fentanyl especially dangerous.
The majority of the victims in West Philadelphia were African-Americans between the ages of 40 and 55. Over the years, illegal opioid abuse has been stereotyped as happening to mostly white Americans. However, since 2016, the death rate among African-American opioid users has spiked. The overdose rate in Philadelphia has outpaced other areas of the country.
Especially in the Kensington area, deaths related to fentanyl have increased. The Philadelphia division of the Drug Enforcement Administration has been monitoring this area for over two decades. Kensington is starting to see over 800 overdoses each year. Sadly, those who are expecting crack but are getting it laced with something else have the highest risk of death. Fentanyl is unlike any other opioid when snorted. One dose taken through the nose or via a needle can result in immediate death.
Kensington is becoming a focal point for the opioid crisis in the United States. Even people from out of town are going there to seek out drugs that are easy to acquire. Kensington reportedly draws drug addicts in because the East Coast is believed to have the purest drugs. This is becoming a massive problem for the U.S. DEA. During such a crisis, researchers and emergency responders usually fall behind when it comes to identifying drugs. With so many new drugs coming out, labs may not be equipped to recognize them all.
The Deadly Risks Philadelphians Face With Opioid Addiction
Opioids bind to receptor cells in the brain, spinal cord and other organs inside the body. Once attached, they release dopamine in large amounts throughout the body while blocking pain signals. This is what makes these opioids so addictive and motivates the user to repeat the experience.
When one misuses opioids, it can cause slowed breathing due to the lack of oxygen reaching the brain. This can lead to long-term neurological and psychological effects, including permanent brain damage or coma. Even death can occur. Older adults who have chronic diseases and multiple prescriptions are more likely to abuse drugs like opioids. Addiction can increase the risk of contracting infectious diseases from sharing needles. Opioids are control-release drugs, meaning they gradually release into the bloodstream over time. When used as prescribed, one would only need to take the medication once every 12 hours. Addicted individuals, though, might snort the medication to get the effects instantaneously. When the drug is snorted, the nasal membrane absorbs it quickly, passing it through the GI tract and sending it directly into the bloodstream. Side effects from snorting opioids include:
- Drop in blood pressure
- Cardiac arrest
- Respiratory distress
- Chest tightening
- Trouble breathing through the nostrils
- Erosion of the nasal passages
It is estimated that a large number of drug abusers in Philadelphia start using heroin after abusing prescription painkillers. Doctors may stop issuing prescription opioids to a patient suspected of misusing them, so a desperate user may turn to street drugs and dangerous synthetic combinations to get their high.
How the Community in Philadelphia Is Fighting Back
Officials in Philadelphia are hoping to implement a strategy that has never been tested before in the United States but has been used in some European countries such as Portugal. Local officials are looking into opening medically supervised safe injection sites where users can inject opioids without fear of being arrested. While this may seem like a radical approach, the injection sites could potentially prevent up to 75 deaths and 20 cases of HIV infection every year. City officials seem to agree on this tactic to try and combat the increasing prevalence of fentanyl in Philadelphia. In 2016 alone, the drug accounted for 412 deaths. Through this plan, users will be offered the overdose-reversing drug naloxone as well as sterile needles.
Officials in Philadelphia can look overseas for some positive signs. Safe injection sites have been operating in some European countries since the 1980s, and the results indicate fewer deaths from overdose and an increase in participation in drug treatment services. The city of Seattle is planning on opening up two of these sites on a pilot basis. Officials in Philadelphia have also asked doctors to prescribe fewer opioids. Health department officials are advising health care providers to stay on top of signs of overdose even if the patient insists they took a non-opioid. Officials are also asking that toxicology tests be done for opioids when a drug user reports that they only took cocaine.
Allison Herens is the harm reduction coordinator in Philadelphia who is one of many who are encouraging street drug users to carry Narcan. Herens believes that Narcan should be carried even among those who only use cocaine. Narcan is a nasal spray that is an opiate antagonist. It can revive someone who overdoses on opioids by blocking the opioid receptors in the brain. It has been used by first responders and in emergency rooms for years and is carried by EMTs and the police. Should first responders encounter an individual suffering the symptoms of an overdose, administering Narcan may prevent death. Many people are skeptical about Narcan being the answer to ending the epidemic, but it may be useful in preventing fatal overdoses until Philadelphians can find a better solution. The key to reducing opioid use in the city may be a combination of doctors and law enforcement officials working together to educate the public about the dangers of prescription drug abuse.
Local officials have been conducting training on how to use Narcan and helping get it into the hands of every Philadelphian. The Pennsylvania physician general signed a standing order allowing anyone to obtain the medication without a prescription. The generic form naloxone costs as little as $20. Since the effects of fentanyl happen immediately and intensely, it is incredibly easy to overdose compared to heroin. Withdrawal can be long and extremely uncomfortable with dependence escalating quickly. The drug is so powerful that if the user overdoses, they can even slip back into unconsciousness after an overdose-reversing medication wears off.
Philadelphia typically sees four times as many overdoses every day as homicides. Organizations that provide health services to drug users in the city hand out four to five opioid antidote kits per day. Synthetic opioids give the user a rush that goes away quickly and then causes illness. These drugs are more serious than heroin when it comes to the withdrawal process. Heroin withdrawal takes only five to six days while synthetic opioids can take up to 60 days. All of this indicates the importance of making a medication like Narcan widely available.
The city of Philadelphia is recognizing that this is a very serious time for anyone who is struggling with substance abuse. Luckily, law enforcement is joining the fight and working with the public to help combat the opioid crisis and save thousands of lives.