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Men die after an overdose of opioids at a rate almost three times higher than that of women in the United States. Overdose deaths increase more rapidly among blacks and Latin Americans than among whites. And the number of young adults aged 25 to 34 whose death certificates include a version of fentanyl is particularly high.
These findings, released Thursday in a report by the Centers for Disease Control and Prevention, highlight the beginning of the third wave of opioid epidemics in the country. The first was prescription pain medications, such as OxyContin; then heroin, which replaced the pills when they became too expensive; and now fentanyl.
Fentanyl is a powerful synthetic opioid able to stop breathing in less than a minute. Its popularity in the United States began to skyrocket at the end of 2013. Each year, fatal overdoses involving fentanyl have doubled. exponential rate, "says Merianne Rose Spencer, CDC statistician and author of the study.
Spencer's research shows an average annual increase of 113% from 2013 to 2016 (age-corrected). This total was first announced at the end of 2018, but Spencer has deepened, with this report, the demographics of people who died from an overdose of fentanyl.
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Increased drug trafficking and increased consumption both fuel the surge in fentanyl deaths. For drug traffickers, fentanyl is easier to produce than some other opioids. Unlike poppies needed for heroin, which can be spoiled by bad weather or by a poor crop, the ingredients of fentanyl are easily provided; It is a combination of synthetic chemicals, often made in China and packaged in Mexico, according to the US Drug Enforcement Administration. And since fentanyl can be 50 times more potent than heroin, smaller amounts translate into higher profits.
Jon DeLena, deputy special officer in charge of the DEA's New England Division, says that a kilogram of fentanyl, driven across the southern border of the United States, can be mixed with fillers or d & # 39; 39 other drugs to create six or eight kilograms for sale.
"I mean, imagine this business model," says DeLena. "If you're talking to a small business owner and you're telling him," Hey, I have a way to make a product eight times larger than yours, "there's a tremendous windfall there."
For drug addicts, fentanyl is more likely to cause an overdose than heroin because it is very potent and its effect decreases more rapidly than that of heroin. Drug users report injecting more frequently with fentanyl because the high dose does not last as long – and more frequent injection increases the risk of overdose.
Fentanyl also appears in some supplies of cocaine and methamphetamine, which means that some people who do not even know that they need to worry about an overdose of fentanyl are dying.
Fentanyl can be absorbed by another drug in several ways. The mixture can be intentional, because a person is looking for a type of high more intense or different. This may be due to accidental contamination as resellers pack their fentanyl and other medications in the same place.
Resellers can also expressly add fentanyl to cocaine and methamphetamine, in an effort to expand their customer base of fentanyl users.
"It's something we need to consider," said David Kelley, referring to the intentional addition of fentanyl to cocaine, heroin, or other drugs by dealers. Kelley is Deputy Director of the New England High Intensity Drug Trafficking Zone. "The fact that we have had cases where he has been present with different drugs suggests that this could be a possibility."
According to Kelley, the situation is complicated, as dealers develop new forms of fentanyl, even more deadly. The new CDC report shows dozens of varieties of the drug currently on the streets.
According to the study, the highest rates of fentanyl-related overdose deaths were observed, followed by mid-Atlantic central states and the Upper Midwest. However, the number of deaths from fentanyl had barely increased in the West – including Hawaii and Alaska – by the end of 2016.
Researchers have no clear explanation for these geographic differences, but some observers of trends have theories. The first is that it is easier to mix some white fentanyl crystals with heroin powder, which is more common in Eastern states than in black tar heroin, which is more commonly sold. West. Another hypothesis argues that drug cartels have used New England as a test market for fentanyl, as the region has a strong and long-standing market for opioids.
Lead author of the study, Spencer, hopes that some of the other features of the fentanyl wave highlighted in this report will help shape public reaction. Why, for example, did the influx of fentanyl increase the overdose mortality rate among men, which is almost three times higher than the rate of overdose deaths among women?
Some research indicates a particular factor: men are more likely to use drugs alone. According to Ricky Bluthenthal, professor of preventive medicine at the Keck School of Medicine at the University of Southern California, this increases the risk of overdose and death in a man.
"Your drug use is stigmatized, so you hide it," says Bluthenthal. "You use yourself in an unsupervised setting. [If] there is fentanyl in it, so you die. "
Traci Green, Assistant Director of the Injury Prevention Center at the Boston Medical Center, offers other reasons. Women are more likely to buy and consume drugs with a partner, says Green. And women are more likely to call for help – including 911 – and ask for help, including treatment.
"Women go to the doctor more often," she says. "We have health problems that bring us more to the doctor, so we have more opportunities to help."
Green notes that every interaction with a health care provider is a chance to bring a person into treatment. This finding should therefore encourage more awareness, she says, and encourage health care providers to find more ways to connect with active drug users.
To explain why fentanyl seems to hit blacks and Latinos disproportionately compared to whites, Green mentions higher incarceration rates for blacks and Latinos. People who had previously used opioids are at particularly high risk of overdose when they leave the prison or inject fentanyl, she notes; they have lost their tolerance to high levels of drugs.
It has also been reported that African Americans and Latinos are less likely to call 911 because they do not trust first responders, and medication may not be effective. as available for racial minorities. Many Latinos say that bilingual treatment programs are hard to find.
Spencer says the deaths attributed to fentanyl in his study should be considered a minimum number – there are probably more that have not been counted. In some states, coroners do not test the drug or have equipment that can detect one of the dozens of new fentanyl variants that appear if sophisticated tests are more widely available.
There are signs that the fentanyl surge continues. Kelley, from New England's high-intensity drug smuggling zone, notes that seizures of fentanyl are increasing. And in Mbadachusetts, one of the hardest hit regions, state data show that fentanyl is present in more than 89% of fatal overdoses until October 2018.
Even so, even though the number of overdoses in Mbadachusetts continues to increase, deaths badociated with them dropped by 4% last year. Many public health experts attribute the decline in deaths to the growing availability of naloxone, a drug that can reverse an opioid overdose.
This story is part of the relationship partnership between NPR and WBUR and Kaiser Health News.
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