America, We Have a Problem: How Fentanyl is Changing the Landscape of the Opiate Crisis (Part 1)

When music legend Prince Rogers Nelson’s death this spring was officially attributed to an overdose of fentanyl, it represented another instance in which broad public attention to a growing problem – particularly as it relates to substance abuse and addiction– was punctuated by a high-profile celebrity death (think Philip Seymour Hoffman, Heath Ledger, Amy Winehouse…the list goes on). Sadly, it seems that as a culture we still pay attention more to, or talk longer about, an issue when it affects someone in the public eye. Lives cut too short by substance abuse – famous or not – are tragic. But, the Twin Cities’ most famous son’s passing may be particularly instructive in that it went beyond highlighting the dangers of addiction generally. It helped sound a four-alarm warning about a specific substance –and in doing so, shed timely new light on how a synthetic opioid 100 times as potent as morphine has been somewhat quietly, yet completely, changing the complexion of the opiate epidemic.

Although many had not heard of the drug until it was recently linked to a more than five-fold increase in overdose deaths in many states, fentanyl has been around for decades. The man-made compound was originally formulated in 1960 by Janssen pharmaceuticals as a powerful opiate analgesic that might be used to ease severe pain associated with surgery and chronic diseases when its counterpart Demerol was not well tolerated or effective. was particularly concentrated and fast-acting. In fact, the thing that has almost consistently dominated news coverage about the substance in recent months (aside from the number of fatalities it has been driving up) is its incredible strength. Not only is fentanyl roughly 50 times as powerful as heroin (depending on the grade of the drug), its potency is measured in micrograms, not grams. To put that in perspective, a dose the size of a few granules of salt can be lethal to most adults. It also can be absorbed through the skin and inhaled in an airborne state, causing DEA and police departments to take special precautions during seizures of the drug. It seems mind-boggling to have a drug so potentially dangerous in our midst. One might even ask how a drug that has proven to be fatal even in cases of accidents and mishandling can be justified or how was approved for use in the first place. The answer lies in the often very narrow applications that the FDA deems “on the label” or medically appropriate when it approves drugs to go to market. In fentanyl’s case, the drug was really only ever intended for palliative care – doctor-approved prescriptions to be thoughtfully and cautiously meted out for pain relief and management in the final stages of serious illness. But, as with so many other substances that make their way onto the street, the black market soon saw value, and demand for, a drug that could produce euphoric highs at half the smuggling weight of heroin. Because it packed far more punch per gram, it could be much more discreetly shipped or trafficked than other opium derivatives. What’s more, unlike its more well-known counterparts heroin and opium, fentanyl could be cooked up in a lab, provided you knew what you were doing and were willing to take on the risk of production.

Enter contraband “chemists for hire” like George Marquardt. Marquardt’s is a fascinating, albeit cautionary tale of a science prodigy with a stomach for danger, an unmatched skill with complex chemical reactions, and a self-described “need of money,” who was responsible for the early clandestine fentanyl explosion of the late 80s and early 90s. Eventually busted and sentenced to 25 years in prison when his product and lab were linked to upwards of 300 fentanyl overdoses during that period, Marquardt’s persona and exploits were so legendary and intriguing that he became the inspiration for Walter White of HBO’s award-winning series “Breaking Bad.” Once Marquardt was jailed, fentanyl went underground again for a period and was not seen with much frequency until the 2000s. And, as the National Drug Intelligence Center at the Justice Department noted in 2006, it really only re-emerged on the law enforcement and public health radar due to the incredible spike in opiate overdoses that were observed beginning in 2004 and 2005. Special toxicological testing is needed to detect fentanyl in cases of overdose, but most coroners and state crime labs were not running such tests at that time unless they had a specific reason to do so. Now, clearly, they have a such reason.Stay tuned for Part 2.