- Among the drugs driving the nation's opioid crisis, fentanyl is significantly cheaper and more potent than heroin and prescription opioids, and its analogues – including carfentanil – can be even deadlier, exacerbating health experts' concerns over their escalating role in the epidemic.
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In Wayne County, home to Detroit, researchers detected carfentanil in 27 percent of accidental opioid overdose deaths between July 2016 and February 2017 that did not involve a medical prescription. The spike followed a year in which the substance was detected in zero deaths.
"Fentanyl has almost become a universal thing throughout the heroin supply, at least in the Midwest and the East Coast," says Dr. Andrew King, a professor at the Wayne State University School of Medicine and lead author of the study, which was published Thursday by the American Journal of Public Health.
- Yet carfentanil is "really hard to dose because it's so potent. It requires such a small amount, that any error can really get someone in trouble," says King, who also works with the Michigan Regional Poison Control Center. "I can't say it was causal (of the increase), but it really makes a compelling argument that that's what happened."
- Carfentanil was the only opioid detected more frequently during the eight-month spike in mortality, the report said.
Concerns remain that even if the international supply of fentanyl is cut off, drug dealers and users will find other ways to get it, while others may not even realize their drugs are laced with the lethal substance.
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In Wayne County, for example, cocaine was detected in 29 percent of carfentanil-related deaths, but was not among the most commonly detected other substances in deaths involving different opioids. King says it's unclear whether users purposely mixed the drugs or whether their cocaine was contaminated without their knowledge.
King says local researchers and health officials monitor trends in the drug crisis elsewhere in the country, so they're as prepared as possible when the new drugs and methods inevitably hit Detroit and the rest of Wayne County.
Still, it's difficult to prevent the substances from showing up in the first place.
"We're sort of just stuck with responding to what gets thrown at us, unfortunately," King says.
When the Detroit Health Department detected the increase in carfentanil-related deaths in late 2016, for example, the agency "sent out letters to emergency departments warning them of the dangers," Dr. Joneigh Khaldun, the health department's director, says via email.
Now, the department is prioritizing increased access to naloxone, the opioid overdose-reversal medication, and "will continue to expand efforts in 2019 to connect people to treatment and address stigma associated with addiction," Khaldun says.
Public health experts say a more expansive, coordinated effort at the state and federal levels is needed to significantly reduce the supply of fentanyl and its deadly cousins in the U.S.
Until that happens, King says, "doing heroin is going to be a Russian roulette."