Fentanyl is an extremely powerful opiod pain medication. It is said to be 50-100 times more powerful than heroin or morphine. Fentanyl exists in two basic flavors, pharmaceutical fentanyl and illicit fentanyl. Pharmaceutical fentanyl has been around since the 1960s. It is used in a hospital setting as an injection during surgery. It is also prescribed to cancer   patients for use at home, where it is usually in the form of transdermal patches or nasal sprays. A couple of other forms are also available, but these are less common. Pharmaceutical fentanyl can be extremely dangerous if not used properly. Pharmaceutical fentanyl is abused by some and this abuse has resulted in many deaths.


In recent years, illicit drug suppliers have learned to create and make another form of fentanyl, the illicit fentanyl. There are a number of different versions, called analogues, of this fentanyl, depending upon how it is made. One of the illicit analogues of fentanyl is said to be 600 times more potent than morphine, making it vastly more powerful than pharmaceutical fentanyl. Street names for illicit fentanyl include "China White", "Apache", "China Girl", "Dance Fever", and a few others, including, perhaps its most appropriate name, "MURDER-8". The effects of fentanyl are greatly enhanced with the presence of other drugs or alcohol.

Within the last few of years, illicit drug makers and dealers have been mixing fentanyl with other drugs, primarily heroin. This mixture of fentanyl and heroin has been around in Georgia for a few years and has caused a large number of deaths. A couple of reasons for mixing the drugs have been suggested. One is simply to give an "edge" over the competition by supplying a more powerful product. Another speculation is that ingredients for some of the other drugs have been harder to get due to government crackdowns. A third speculation is that it is cheaper. Since it is so powerful, a much smaller amount is needed, making smuggling much easier. I don't know which one of these is correct. Perhaps it is a combination of these factors.

The problem is that fentanyl is so extremely powerful. I read somewhere that an amount the size of a couple of grains of salt can be fatal. If it is not measured accurately and mixed thoroughly there will be a problem. Considering that most of this "manufacturing" is done in a shack deep in the jungle, one has to assume that crude methods are used. It is also highly unlikely that those involved in this craft are trained pharmacists. When a heroin/fentanyl death occurs, we never know if the victim was aware that the heroin contained fentanyl. Even if he or she did, it is for certain that they were unaware of the quantity and strength. Every batch of this mixture will have a different strength. There are many cases of deaths of long-time heroin addicts after consuming heroin mixed with fentanyl. They knew what they were doing with heroin.... but the fentanyl took their lives.

Where is this stuff coming from? Most of it is being made in China, where it is then smuggled into the U.S., Canada, and Mexico. Then it is often mixed with other drugs, primarily heroin,  or pressed into pills. Likely most of the fentanyl found in the South is coming from China via Mexico. It is interesting to note that there is evidence that some Chinese fentanyl has come into the US through the port of Savannah.


FENTANYL ALERT CLICK HERE                      



                                           The New Problem - Counterfeit Drugs  
In the last couple of years, a new tragedy-waiting-to-happen has unfolded under the radar. By all accounts, in the South, this problem first appeared in mid 2014. Druggers are creating counterfeit, fake replicas of several common pharmaceutical pain medications. The ingredient? FENTANYL. Pills have been discovered that look identical to several brand-name formulations of hydrocodone, oxycodone, and alprazolam (Xanax). 

In February 2015 there were at least two known deaths in Georgia from these fake pills. It is certain there are more. In one of the cases, the young victim still had a couple of the pills in his pocket. They were the correct shape and color for pharmaceutical oxycodone. 

The pills even had the correct numerical identification stampings on them. These pills were tested by authorities and contained no oxycodone at all but contained fentanyl. The second case I mentioned was that of my own son. Imagine if you will, an infrequent "recreational" user. They have no idea that they are taking anything other that the relatively mild dose of oxycodone. It is said that illicit drug dealers are making these fake pills because government crackdowns have made the genuine pharmaceutical pills more difficult to acquire, resulting in a limited supply and extremely high prices. The demand is still there, so they just make their own.. from fentanyl. Illicit fentanyl is cheap.

The pictures below are look like oxycodone, hydrocodone, and percocet. They are not. They are fake and made from fentanyl.                   



Police, Medical Examiners, and Enforcement              

I have seen first hand that there are several problems fighting fentanyl trafficking and investigating fentanyl deaths. First of all, there is an attitude among some in law enforcement that the victim is "just another drug user." The attitude is that this situation is self induced. Add to that the fact that it takes 3 months to get toxicology reports back from the GBI forensics lab. If a detective has a case, not much can be done when the cause of death is unknown. Three months later, when toxicology test results are available, several other (fentanyl) cases have accumulated, in addition to the other case load. I believe that, in most cases, the investigators never go back and take a second look at these cases. Then there are the medical examiners' offices. I have read of cases where oxycodone pills that were found with the victim were sent in to the GBI for disposal. They were not tested but simply discarded. Three months later, it is learned that the victim died from fentanyl, with no trace of oxycodone in their blood. Unfortunately the pills were destroyed, so we will never be able to determine the source of the fentanyl.

It seems that with fentanyl overdose cases, unanswered questions are the norm, and, sadly, acceptable. Many cases are reported where no fentanyl was found. So the number one question is, what is the source of this drug? Obviously the second question is, where (or from whom) did the victim obtain the drug? It appears that very little effort is made to answer these questions. If the death in question had resulted from stabbing, shooting, or any other means, it would be a very different story.

It is unfortunate that, in most cases, we will never know for sure if the victims were aware they were consuming fentanyl, but it is for certain that most were not aware. Still today the average person is unaware that common pain pills are being sold that are fake and contain fentanyl. These cases should be treated as murders, not just overdoses. In 2014 and 2015, out of an estimated 500 deaths, there has been only one case in Georgia where a drug supplier has been prosecuted for the death of another after supplying drugs containing fentanyl.

Another situation worth discussing here is a general lack of information. In searching the internet one will find numerous stories and warnings from government entities in Canada warning of fentanyl dangers and death. Mostly these are press releases which are published and broadcast by print, radio, television, and internet outlets all over the country. In the US, however, there have been very few announcements of any kind. Most people have never even heard of fentanyl. So this raises a question. Is the fentanyl situation in Canada many times worse that in the US? I don't think so. For some reason, government officials in the US are too cheap, too busy, or simply don't care enough about the citizens to try to inform and educate them. In Georgia, there has not been a single press release warning of fentanyl by the State or by the GBI, the agency that performs nearly all of the toxicology testing of drug death cases. Are they hiding something?



How Did We Get Here?             

As mentioned earlier, fentanyl has been around for nearly 70 years.. It is a useful drug, as long as it’s pharmaceutical-grade fentanyl, prescribed by a trustworthy physician, and, of course, taken as directed. For the most part, misuse of pharmaceutical fentanyl has not been a big problem. The fentanyl that is causing so many deaths is illicit fentanyl, usually manufactured in China. 

In the 1990’s and 2000’s several less-than-ethical drug manufacturers began to promote opiate pain drugs such as hydrocodone and oxycodone. Doctors were told that these relatively new drugs were safe and not habit-forming and were encouraged to prescribe them. Some physicians were even paid ‘bonuses’ for prescribing these drugs. Some, less-than-ethical doctors even set up ‘pain clinics’, sometimes called pill mills, simply to hand out prescriptions for these pain killers. As a result, a generation of opiod addicts was born. Some were addicted just for the euphoric effect. Many others became addicted as a result of a legitimate medical procedure. 

After several years, the government began to take notice. The CDC and the FDA took steps to reduce the flow of these drugs. Many of the so-called pill mills were shut down; and new, more stringent prescribing guidelines were forced upon doctors. A few of the drug companies were investigated. The government achieved its goal of reducing the availability of these drugs by making them more difficult to obtain. As usual, however, they failed to consider the potential 'unintended' consequences.

As a result, there were many people addicted to these drugs but they could no longer get them. Addiction to these substances is extremely powerful. Users and addicts were forced to turn to street drugs. As pain pills were now in short supply, the prices for street pills skyrocketed. This caused many of those pill addicts to turn to heroin because it was easier to find and less expensive. The large numbers of new heroin users subsequently put a strain on available heroin supplies. This, in turn, caused heroin prices to increase, too. One thing about heroin,
it is labor-intensive and expensive to produce 
because it depends on the cultivation and processing a crop of poppy plants. 

Along this time, China, well-known for it’s cheap, counterfeit goods, steps up with their illicit fentanyl. The fentanyl is created in a ‘lab’ with relatively little labor. It is much cheaper and can be produced much more quickly. It is also much more powerful so less is needed. This makes smuggling much easier. It is easier to obtain as it is being sold on the internet and delivered to the dealer’s door by one of the major parcel services. (as one reporter wrote, “delivered like a pizza”) Dealers / distributors began buying fentanyl and mixing it with their heroin, along with some fillers, to make the heroin go further. They also mixed fentanyl with heroin in stronger concentrations and proudly boasted that it was much better ‘stuff’ than what most are accustomed to.

Meanwhile, there was still a demand for hard-to-get oxycodone and hydrocodone. These dealers obtained inexpensive pill presses and began to press pills containing fentanyl. Cleverly, they were able to press pills that look identical to a variety of the more popular brand name pills, such as Roxycodone, Percocet, Xanax, and others. They also cut fentanyl into cocaine and a few other drugs. There was at least one official report of fentanyl-laced Spice, a synthetic marijuana popular with young teens, and, in Australia, there was a report of fentanyl-laced candies.

People would buy these drugs on the street. Most were unaware that they contained fentanyl. Likely many had never even heard of fentanyl. The danger with these home-brew drugs is that fentanyl is so powerful and it is being mixed with crude methods (one bust in the US involved a cement mixer) so there is no way for the dealer to insure the potency, nor is there any way for the user to know the potency. 

Ironic thing about the fentanyl problem. It was born of greed by the pharmaceutical companies, bolstered by incompetence of the government, and acknowledged by neither.



How Fentanyl Causes Death               

In a nutshell, death is usually a result of the victim having stopped breathing. Fentanyl interrupts the body's automatic breathing processes and the victim suffocates. Fentanyl sometimes causes cardiac arrest or other issues, too, but respiratory arrest is the most common factor. The majority of the victims consumed the drug, went to sleep, and died during their sleep.

 People have asked how much fentanyl does it take to be fatal? Like anything else, there is no clear answer since everyone is different. Persons 

with breathing-related disorders such as sleep apnea or asthma are more susceptible than someone without these conditions. Age, general overall health, and the presence of other drugs or alcohol are also big factors. To answer the question, a couple of studies were done and it has been determined that a blood concentration level of 2.2 micrograms or more per liter of blood can be fatal. To put this in native Georgia speak, that ain't much at all.


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