Fentanyl: Cut Heroin and Counterfeit Pills

An analysis of millions of American's medical claims showed diagnoses of opioid addiction has surged nearly 500% over the past seven years, according to a review by the Blue Cross Blue Shield Association (1). Exacerbating the opioid and overdose crisis, cut batches of heroin containing deadly amounts of fentanyl have been introduced into U.S. drug markets (2). Fentanyl, a powerful synthetic painkiller about 50 times more potent than heroin and 100 times stronger than morphine. Cheaper and easier to manufacture than heroin, fentanyl has quietly replaced other opioids in the illicit drug trade (3).

Starting in late 2013, several states reported spikes in overdose deaths due to fentanyl. Most of the areas affected by the fentanyl overdoses are in the eastern United States, where white powder heroin is used. Fentanyl is most commonly mixed with white powder heroin or is sold disguised as white powder heroin (4). This phenomenon of cutting heroin with fentanyl isn’t prevalent in the western half of the U.S. where black tar heroin is common. Three weeks ago we made a map displaying the number of overdoses occurring across the country (Where the Opiate Epidemic is Spreading And Why). It was shown that the highest rates of overdose are occurring in the Eastern half of the U.S. These are the same states and regions with increased incidences of fentanyl.

But fentanyl is also being found in hundreds of thousands of counterfeit prescription pills. In two extreme cases in early 2016 counterfeit pills containing fentanyl led to nine deaths in Pinellas County, Florida, and authorities recorded 52 overdoses and ten deaths due to fentanyl in Sacramento, California (5). Counterfeit pill operations with little experience with fentanyl’s extreme potency are creating lethal batches of the pills, disguising them as Norco, Xanax and OxyContin.

So how is fentanyl finding its way into the U.S.?

China is a global source of fentanyl and other illicit substances because the country’s vast chemical and pharmaceutical industries are weakly regulated and poorly monitored. Chinese chemical exporters utilize various methods to covertly ship drugs to Northern and Central America, including sending illicit materials by mislabeling and disguising shipments and creating new versions of chemicals that are not listed and controlled by the United States (2). As we discussed last week in How Big is the Dark Net’s Drug Market, fentanyl is being shipped directly to the U.S. from dark net websites. While sales on the sales on the dark net do not represent a large portion of total illicit drug sales, they represent a disproportionately large percentage of fentanyl. Unlike heroin and prescription painkillers, which are relatively bulky, enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope (6).