FocusOn: Fentanyl: A problem on the rise

“Fentanyl is becoming an increasingly serious problem in the UK … According to Public Health England, between 2015 and 2019, deaths from fentanyl-related drugs quadrupled”.

Overview – What is Fentanyl?

Fentanyl is a powerful, synthetic opioid that is prescribed to treat severe pain, for example following major surgery or for cancer patients. Fentanyl is much stronger than most other opioids and can be up to 100 times more potent than morphine.

When prescribed, Fentanyl comes in a variety of forms such as:

• Transdermal patches
• Sublingual tablets / sprays
• Transmucosal lozenges
• Nasal spray
• Injectable formulations (usually only administered in hospitals)

In the UK, the most common form of prescribed Fentanyl is ‘Fentanyl patches’, which delivers a slow-release of the drug and is prescribed to people with long-term severe pain. The use of Fentanyl as a cutting agent in heroin and other types of illicit drugs is due in part to its availability as a ‘take home’ patch. More information regarding the history and background of Fentanyl can be found in our original article from 2017.

Street Fentanyl

Illicit Fentanyl comes from two sources:

Diverted route – Fentanyl which has been stolen from – or sold by – people in receipt of a prescription

Illegal drug labs – As a synthetic opioid, Fentanyl is easily modifiable and cheap to produce. The Drug Enforcement Agency (DEA) reports that the Sinaloa and CJNG (Cártel de Jalisco Nueva Generación) cartels in Mexico are likely the primary trafficking groups responsible for smuggling Fentanyl into the United States from Mexico. In 2019, the DEA reported that each Fentanyl pill costs only $1 to produce, but can be sold in the US for at least 10 times as much

Typically, lab-made Fentanyl is sold as a powder or a pill, and the potency can vary widely. When  used as a cutting agent in other drugs – specifically heroin but sometimes also cocaine and methamphetamine – then the risk of overdose significantly increases. For example, heroin which has been cut with Fentanyl – or other Fentanyl analogues such as isotonitazene or carfentanyl – was linked to at least 60 deaths in the UK in 2017.

On 3rd February this year (2023), the Home Office announced that 11 synthetic opioids will be banned in the UK to help stop the rise in drug-related deaths.  

The UK picture In the UK, deaths from Fentanyl and other synthetic opioids has remained relatively stable over the past few years, however, with just under half (45.7%) of all drug-related deaths in England and Wales in 2021 involving an opiate, the risk of overdose from heroin cut with Fentanyl /  synthetic opioids remains an ongoing concern.

In recent years, contaminated batches of heroin cut with Fentanyl and Fentanyl analogues have appeared across the UK, leading to serious harm. The spike in Fentanyl-related deaths in 2017 led the UK government to release specific guidance for local authorities around how to plan for and manage future threats, with a view to preventing the opioid crisis currently sweeping across North America being replicated in the UK.

Harm Reduction

Although not widely trialled in the US or Canada, there have been recent moves by some UK-based service providers to include drug test strips in Needle Exchange packs that test for traces of Fentanyl. However, due to limited distribution and variances in sensitivity between the different test kits available, the efficacy of these test strips as a harm reduction tool has yet to be established. 

How to help someone who has overdosed

Fentanyl is around 50 times stronger than heroin, and some Fentanyl analogues, such as carfentanil, are estimated to be 10,000 times stronger. At these levels of potency the risk of overdose is extremely high and can occur rapidly, sometimes taking hold before the user has finished injecting their dose. This is especially the case where users are not aware that the drugs they’re using have been cut with Fentanyl / Fentanyl analogues. 

Fentanyl overdoses can be reversed by administering Naloxone. It is crucial to remember that the Naloxone may take up to 3 minutes to start working because of the high quantities of opioids present. Even if the person appears conscious following the initial dose of Naloxone, the Fentanyl will still be in the body and the user might potentially overdose once the Naloxone has broken down. Repeat Naloxone dosages can be given every 2 to 3 minutes; in any situation, paramedics should be notified and CPR administered until they arrive.

How ILLY can help

ILLY’s leading Case Management system LINKS CarePath has functionality to record Naloxone kits, when they were dispensed and whether they’ve been administered (and by whom). Workers can also record the batch numbers and expiry dates of individual kits, and dashboard reminders are available to alert workers to any client that may be in possession of expired Naloxone.

LINKS CarePath has a fully maintainable Harm Reduction section where specialist Needle Exchange packs can be configured -this could include Fentanyl testing strips for those services looking to pilot this initiative. In addition to this our comprehensive reporting tools give service managers and commissioners the visibility that they need at their fingertips to identify areas of concern and target effective support in a timely manner.

If you have any questions or would like to find out more, please get in touch with our Client Services Team and we’ll be happy to help.

+44 (0)20 4566 5727

clientservices@illycorp.com