By HOWARD TAYLOR, PhD
Readers will be familiar with news on the opioid epidemic. Overdose deaths are common and strike victims of all socioeconomic backgrounds in every U.S. state. This epidemic is killing Americans more quickly than HIV during its peak in the 1980s.
But the specific drugs being used are shifting, thanks to the work of illicit chemists working clandestinely to develop new analogs of the synthetic opioid fentanyl. These drugs are far stronger than heroin, with typically 50 to 100 times the analgesic power of morphine.
Carfentanil, an analog developed as an elephant tranquilizer under the brand name “Wildnil” is 10,000 times stronger than morphine. It is difficult to find a living survivor of Carfentanil, which can absorb through the skin while a user simply handles the substance.
Data show that fentanyl deaths skyrocketed 540 percent in the past three years. It caused more overdose deaths than heroin in 2016. If current trends continue, it will be responsible for more deaths in 2017 than heroin, cocaine, and methamphetamine combined. Often users don’t know they are using fentanyl, as the synthetic is mixed with their usual drug to which they may have an acclimated tolerance. Recently in Tennessee, fentanyl was found in marijuana – making deadly a drug that is usually perceived as harmless by its users.
Fentanyl was developed in 1959 by Janssen Pharmaceuticals. It is a potent analgesic and anesthetic with an important role in legitimate healthcare services. Well known analogs include Duragesic, a slow-releasing pain patch that is used for breakthrough pain among the chronically ill. Other forms of the medication are developed for use by spray, IV, and even lollipop.
The strength of the medication and its highly addictive properties perhaps guaranteed its recreational abuse. And a tragic truism is that those struggling with addiction tend to “chase the dragon,” seeking drugs that are known to be deadly on the assumption that the euphoric high must be worth the danger.
Fighting on the front lines of the epidemic, addiction treatment centers are working to save thousands of lives across the country. Whether the setting is a detox unit, residential center or outpatient program, treatment typically begins by sending a urine specimen for diagnostic testing to determine what an addicted patient has been using. Treatment programs rely on lab testing for the initial assessment of a patient, for guidance in their therapy, and for ongoing long-term monitoring as patients renew lives of sobriety. Unfortunately, the nature of fentanyl has been particularly challenging for laboratories as new substances are continually invented.
Brentwood, Tenn. is home to a unique laboratory – Addiction Labs, which is dedicated to addiction treatment. Recognizing the impact of new synthetic drugs, Addiction Labs is breaking new ground in the testing for fentanyl analogs. The lab team is faced with the challenge of identifying new drugs that impact communities. Recent deaths have been caused by drugs such as acetyl fentanyl, ocfentanil, furanyl fentanyl, and butryl fentanyl, all of which are now common. What else is out there?
To answer that question, the Addiction Labs team monitors DEA drug seizures lists. They then work to identify which smuggled substances are likely to become problems in the community. Adding to the challenge, the prevalence of many synthetics varies regionally. The lab’s response has been to develop testing for more drugs, knowing that not all of them will become problems on the street.
Addiction Labs is among the very first American laboratories to test for carfentanil. While most labs are unable to identify fentanyl analogs, and even the largest labs test for just four or five, the Brentwood laboratory is in the process of validating testing for its 53rd fentanyl analog.
The goal is to enable treatment centers to properly diagnose and treat their patients. Many treatment centers utilize medically assisted therapy, prescribing drugs that could prove deadly if patients have untested substances in their body. Effective testing, as part of evidence-based addiction treatment, will permit physicians to educate those patients as to what is actually in their system.
If the United States is to stem the tide of newly designed synthetics, it is critical that treatment and diagnostic science meet the shifting challenge. Tennessee’s Addiction Labs is breaking new ground to battle America’s deadliest epidemic.
Dr. Howard Taylor is the laboratory director for Brentwood-based Addiction Labs. A nationally known toxicologist with more than 30 years of experience, he holds his doctorate in biochemistry from the Medical College of Georgia and completed a post-doctoral fellowship at the Medical University of South Carolina. Taylor is double board certified by both the American Board of Forensic Toxicology (ABFT) and the American Board of Clinical Chemistry with a specialty in Toxicology (ABCC-Toxicology). A popular speaker and writer, he has authored two books, more than a dozen book chapters, and more than 30 publications in peer-reviewed journals.