The toxicology results from music legend Prince’s tragic death last month are now public, and the media are focusing on what for many is a new word – fentanyl. It appears likely that Prince ingested it and tragically died some time later.
Fentanyl is a potent painkiller originally synthesized in the 1960’s as part of a class of novel opioids. At first, fentanyl was used only in surgery, but when new forms of administering it were developed decades later, including skin-patches and under the tongue sprays, it quickly became one of the most common treatments for chronic pain and palliative care.
Recent media coverage claims fentanyl is '50 times stronger than’ heroin and ‘100 times stronger than’ morphine and is an ‘instant killer.’ It is true that fentanyl is more potent than heroin and morphine, but this simply means that it is active at lower doses. Words are important here – while chemists and pharmacologists can weigh a drug's potency by the amount it takes to produce effects, this can be a distraction to what the real issues are with fentanyl and why people are dying from it.
Meeting the need for relief in chronic pain patients is a legitimate medical practice, and when patients on painkillers long-term develop tolerance to their medication, stronger and more effective drugs are often needed. This need is sometimes challenged when attention is brought to problems associated with the illicit use of prescription medication, but when access to painkillers is restricted, patients often resort to the illicit market.
People who use fentanyl often don’t know they’re taking it. In general, fentanyl used to cut heroin is not being diverted from medical facilities but comes from clandestine labs often in other countries, synthesizing large quantities of cheap, pure fentanyl. Fentanyl has become an attractive cutting agent, since its increased sedative potency can be perceived as strengthening a batch of heroin. Therefore risk of fentanyl overdose is particularly greater for opiate-naïve users, and even in those with a tolerance for heroin.
While synthetic opioids are invaluable to medicine, our failed drug prohibition policy is actually creating the scenario where cutting heroin with fentanyl makes sense to sellers because there is a demand for a cheap and strong high.
A law enforcement crackdown on fentanyl and restricting doctors’ prescribing ability to treat legitimate pain patients has been tried already, and it only makes things worse. Proposed solutions that can prevent deaths and create a safer environment for opioid users, like expanding access to the overdose antidote naloxone and creating supervised injection facilities, are necessary.
The harms associated with drug use, including fatal overdoses from opioids, need to acknowledge the role of stigma surrounding people who use them. Prince was known as an advocate for clean living, and if fear of being stigmatized as a drug addict was a contributing factor to his untimely death, just like it is for many others, serious consideration needs to include an end to the stigma around drug use.
Kevin Franciotti is a Program Associate at the Drug Policy Alliance.
To find out more about the issues surrounding novel psychoactive substance, like fentanyl, on June 9th-10th in New York City, attend a summit on New Strategies for New Psychoactive Substances: A Public Health Approach. The free event is open to the public and will explore alternative legal strategies for drug policy. Registration is required: http://newstrategies4nps.eventbrite.com
Photo via Scott Penner