Fentanyl Deaths Rise as Narcotics Shortage Continues

By Joan Spitrey via Multibriefs

As healthcare facilities continue to experience shortages with injectable narcotics, researchers report that synthetic opioid deaths have now outpaced prescription drug overdoses. It seems counter-intuitive — how can facilities be short, but deaths in the community continue to rise?

As with much of the opioid crisis, the problem is complicated.

Fentanyl, a potent opioid, is typically used in healthcare facilities to control severe pain, especially during procedures and surgeries. A common medication with the potency 50 times that of morphine is the staple for many anesthesia providers due to its effectiveness and concentrated effects.

Currently the largest manufacturer of injectable fentanyl, Pfizer, continues to have to cut back on production due to factory upgrades. Maintaining 60 percent of the injectable market, this cutback as been far-reaching.

The few other manufactures are overwhelmed with back-orders, but do not have the capacity to expand production. Even if they were able to expand productions, due to restrictions from the Drug Enforcement Agency (DEA), they would be unlikely to get the materials needed for production.

The DEA has placed caps on raw materials that can be used and has refused to shift those caps to other manufacturers to meet the current supply need. Again, this is crippling new manufacturing of the injectables.

The DEA regulations were put in place in an attempt to prevent diversion while still meeting annual needs. For 2018, the DEA mandated a 20 percent reduction in the amount of opiate and opioid medication — including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, meperidine, and fentanyl — that would be produced annually.

The decisions were consistent with the views of several U.S. senators who called for DEA to limit opioid production and sales as another mechanism to combat the opioid epidemic. However, the mandate has left those responsible for prescribing and administering the medications looking for other modalities and facility pharmacists scrambling to meet the needs of their patients.

While healthcare facilities continue to meet the pain control needs of their patients, fentanyl has topped the ranks of the most common drug involved in fatal overdoses. Results recently published in a Journal of the American Medical Association research letter noted that synthetic opioid involved deaths increased from 14.3 percent in 2010 to 45.9 percent in 2016. This demonstrated a significant increase in synthetic opioid involvement.

Often the synthetic opioid was not the primary killer, however, they were surmised to be involved in almost 80 percent of all overdose deaths in 2016 that involved another drug or alcohol.

"Synthetic opioids are increasingly found in illicit drug supplies of heroin, cocaine, methamphetamine and counterfeit pills," the researchers noted.

By having other illicit drugs laced with a potent medication such as fentanyl, the potency of the original drug becomes compounded and the onset of side effects become immediate. Simply put, the risk of death is immediate, versus over a period of time.

Melissa Moore of the Drug Policy Alliance noted, "Now, as fentanyl is being cut into the heroin supply, it makes that much more dangerous. People don’t know what they’re getting. An overdose from straight heroin might take a couple hours. An overdose from fentanyl can happen in 60 seconds."

Most of the illegal fentanyl has been reported to be manufactured in China and comes to the U.S. via mail order or smuggled across the border from Mexico. The appeal for drug smugglers is the small quantity needed to get the effect desired. In all practicality, it makes shipment and smuggling easier and more profitable.

As the opioid crisis continues, it is clear new measures will need to be undertaken to insure those in need get what they need, while still protecting those with addiction issues.

Joan Spitrey has been a registered nurse for more than 16 years, specializing in critical care and acute care services. She currently is a clinical nursing instructor, sharing her passion with the next generation of nurses. She can be found blogging at TheNurseTeacher.com.