As the opioid epidemic continues, causing US life expectancy to fall for the second year in a row, a new report has shown that the use synthetic opioids is becoming an increasing concern. In fact, the report shows that types of synthetic opioids, like fentanyl, have now overtaken prescription opioids and have become the biggest killer in the epidemic.

The report looked at the number of synthetic opioids overdose deaths in the US between 2010 and 2016, and then compared it to the number of other opioid related deaths. The results show that 46% of all opioid related deaths involved some type of synthetic opioids; this is three times higher than in 2010 when they accounted for 14% of deaths. Prescription drugs were found to be the cause of 40% of opioid overdose deaths.

Christopher Jones, director of the National Mental Health and Substance Use Policy Laboratory at the Substance Abuse and Mental Health Services Administration who led the report said: “It’s certainly concerning. I think that it tracks very closely with the increased availability of illicit synthetic opioids that are coming into the US.”

As pointed out by Lindsay LaSalle, senior staff attorney for the nonprofit Drug Policy Alliance, who was not involved in the report, part of the problem is the strength of synthetic opioids. For example, fentanyl is 50-100 times stronger than other opioids like heroin, morphine and oxycodone. It can be prescribed legally for pain relief, but the majority of overdoses are caused by illegal distribution of the drug.

Lindsay LaSalle said: “Almost all of the increases in overdose deaths are attributed to illicitly manufactured fentanyl, not pharmaceutical fentanyl that has been misused or diverted. And we know that because the number of prescriptions for pharmaceutical fentanyl has remained relatively stable over the past decade, whereas seizures of illicitly manufactured fentanyl has skyrocketed. So it really is due to illicitly manufactured fentanyl that is entering the market and that is essentially being mixed with heroin so that you have an adulterated product that people aren’t aware of, so their risk of overdose increases substantially.”

Another major problem when it comes to synthetic opioids is that they are significantly cheaper to make and easy to mass produce. “Synthetic opioids are significantly easier to manufacture. They’re manufactured in a lab, as opposed to fields of poppies that have to be cared for and cultivated and farmed. Illicitly manufactured fentanyl is almost exclusively made in China. It’s then shipped, broadly speaking, to Mexico, where it’s added to the heroin supply before it enters the United States as a cost-saving measure”, LaSalle added.

Dr. Kevin Hill, director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center in Boston, who was not involved in the recent report said: “Those of us who work in hospital settings are under siege in dealing with the fallout from the opioid epidemic. We have seen the increase in fentanyl first hand, so these findings make sense. Increased potency may mean a more intense high, but it also means an increased risk of overdose. It is likely that potency will continue to rise as dealers and manufacturers try to outdo one another.”

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