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What’s fentanyl, and why have deaths due to drug overdose spiked in the US?

The United States is imposing sanctions and launching indictments against dozens of Chinese companies and individuals it claims are involved in the illegal trade of the highly addictive drug fentanyl.

The charges, brought by the US Attorney’s Office in Florida, and sanctions by the Department of Treasury on Tuesday, have been strongly condemned by China.

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“We know that this global fentanyl supply chain, which ends with the deaths of Americans, often starts with chemical companies in China,” US Attorney General Merrick Garland told reporters.

In this visual explainer, Al Jazeera breaks down the numbers behind fentanyl overdoses in the US.

What is fentanyl?

Fentanyl is a powerful synthetic opioid, often used in the medical field as a pain management medication for cancer patients.

However, as little as 2 milligrams of fentanyl can be lethal.

It is estimated to be 100 times more potent than morphine and almost 50 times more potent than heroin. Although fentanyl is approved for medical use, especially in pain management, more than 150 people in the US die every day from overdoses related to synthetic opioids like fentanyl.

What are the different types of fentanyl?

There are two forms of fentanyl: the pharmaceutical version, prescribed by doctors and used in hospitals and pain treatment centres worldwide for pain management, and illegally manufactured fentanyl.

While both are synthetic opioids, it is primarily the illegally manufactured fentanyl that contributes to the majority of overdose deaths.

According to the Centers for Disease Control and Prevention (CDC), overdose deaths from illegal synthetic opioids were 23 times higher in 2021 compared with 2013.

Illegally manufactured fentanyl can look like any other powdered drug, and it is often mistaken for other illicit drugs, like heroin, cocaine and methamphetamines. With its low-cost production and high potency, drug dealers often mix fentanyl with other drugs to boost the addictive nature of the high.

Fentanyl overdose deaths in the US

More than 106,000 people died of a drug overdose in 2021, with two-thirds (67 percent) of those deaths involving synthetic opioids like fentanyl.

Due to fentanyl’s high potency, low-cost manufacturing, ease of smuggling, and asymmetric tolerance between new and old users, it can have disastrous effects, especially on new users.

Longtime drug users tend to build a tolerance, requiring higher dosages to get the same high. However, when new users unknowingly take fentanyl-laced pills, they often end up in lethal overdose.

Although there are many contributing factors that can lead to a lethal overdose, according to the Drug Enforcement Administration (DEA) 2mg of fentanyl is considered a lethal dose. To put this in perspective, a lethal dose of fentanyl is smaller than the tip of a pencil.

The effects of fentanyl on the body

Fentanyl is the most potent opioid pain reliever available for use in medical treatment. It is roughly 100 times more potent than morphine, the most commonly used prescription medication for severe pain.

Similar to other opioid drugs, fentanyl works by binding to the body’s opioid receptors, affecting the brain’s control of pain and emotion.

After repeated opioid use, the brain undergoes adaptations to the substance, reducing its responsiveness and making it difficult to experience pleasure outside of the opioid.

Some of the side effects of fentanyl use are extreme happiness. It can cause mental confusion, memory issues, drowsiness, nausea, confusion and unconsciousness.

Fentanyl also affects the respiratory system leading to breathing difficulties and chest wall tightening. It is also known to cause an irregular heartbeat and lead to constipation and decreased bowel mobility.

The long-term effects put users at risk of heart attack or heart failure, immune system suppression, anxiety, depression, and other mood disorders.

Why are fentanyl-related deaths increasing?

It can be attributed to the 4 Ps of fentanyl.

The first P is for potency. As stated by the DEA and other drug control organisations, fentanyl is roughly 50 times more potent than heroin, making it highly addictive.

The second P is production. Due to fentanyl’s cheap production costs, it’s an alluring commodity for would-be illegal drug manufacturers. Moreover, the raw ingredients to produce fentanyl are available on the open market. Unlike cocaine and heroin, the manufacturing process for fentanyl requires very little cultivation, making it easy to produce in small remote locations.

The third P stands for profit. According to law enforcement officials in Canada, 1kg (2.2 pounds) of 8 percent pure fentanyl yields a profit of $640,000 to $1.6m.

The last P depicts packaging. Because fentanyl is so concentrated, large amounts can be manufactured and smuggled in small packages. The low volume and hence the low cost of smuggling make it easy to distribute the drug in small trucks and vehicles.

These factors make fentanyl a preferred choice for illegal drug dealers and make it difficult for law enforcement agencies to limit the exposure and lethality of the illegally manufactured fentanyl economy.

Source: Al Jazeera

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