This editorial by Dr. Marv Shepherd was published in The Washington Examiner on October 10, 2017. Dr. Shepherd served as Director of the Center for Pharmacoeconomic Studies and Chairman of the Pharmacy Administration Division at the University of Texas at Austin's College of Pharmacy. He is the president of the Partnership for Safe Medicines.
Facing Down America's Fentanyl Epidemic
Counterfeit drugs shipped from China and routed through Canada and Mexico are increasingly being intercepted by the U.S. Drug Enforcement Administration (DEA), Customs and Border Protection (CBP), and the Food and Drug Administration (FDA). Among them is fentanyl, a synthetic opioid and one of the most dangerous and deadliest drugs on the streets.
Fentanyl pops up as standalone or mixed, illegally sold as the source of an illicit high or even blended into pills without the user's knowledge.
According to a new analysis by the Partnership for Safe Medicines, illegal fentanyl and its analogs have surfaced through incidents involving counterfeit drugs in 40 states and counting. Most recently, authorities in New York seized nearly 200 pounds of the illicit substance, enough to make 32 million lethal doses.
This new report details the challenges faced by federal law enforcement and regulatory agencies in having the resources to identify and intercept the increasing shipment volume. The reality is that Chinese manufacturers ship illegal fentanyl outside the legitimate supply chain, flooding the streets with counterfeit fentanyl both in bulk form for pill-making and in finished pills.
In hospital settings, fentanyl is known as a fast-acting medication used as a first-line treatment for surgical patients in the operating room and also for those experiencing pain in the recovery room. Patients receiving fentanyl intravenously must be on a heart monitor with their vital signs closely monitored. This drug is so potent and so fast-acting that it can cause a patient to stop breathing if administered in too high a dose.
For those taking the drug illegally, there's no one to watch for respiratory arrest as a result of taking a drug at too high of a dose with such a short fuse. Worse yet, some ingesting the drug do not even know that they are taking fentanyl.
Because fentanyl is a synthetic opioid and cheaper than other high-profile street drugs like heroin and cocaine, it can be mixed by twistedly enterprising individuals looking to make their high-inducing drugs both cheaper and more potent. Not only that, fentanyl can be manufactured in bulk and shipped in smaller volumes from China with the same effective dose.
We simply cannot ensure the protection of American consumers if we don't reinforce our first lines of defense to our relatively closed drug distribution system. CBP and DEA agents must have the resources needed to intercept counterfeit drugs. As an example, access to equipment, such as pill presses, used by individuals to create illegal drug mixtures should be restricted.
A recent release from the DEA noted the extreme danger and that law enforcement should "take extreme precautions when handling fentanyl, because exposure to an amount equivalent to a few grains of sand can result in death."
Worse yet, the law of unintended consequences is increasingly a factor in the current healthcare debate. As the issue of drug pricing continues to dominate the national conversation, some policymakers have suggested that we should legalize importation. While studies show that these proposals would have little impact on costs, there are greater concerns than monetary factors, including the cost in lives and the risks of counterfeit drugs making their way to not just those seeking illegal, but also legal prescription drugs.
Currently, the DEA, local law enforcement, and other federal officials have their hands sufficiently full finding illegal drug shipments writ large. Finding fentanyl among other illegal contraband being shipped to the U.S. and brought across borders is tough enough, but the human consequences are significant. In one documented case, an individual seeking to take a Xanax to help him sleep had actually taken a fentanyl-laced mixture in the form of a counterfeit drug that killed him.
The reality is that criminals throughout the illegal supply chain from China to the streets of U.S. cities are making money at the cost of American lives. We need to be taking steps to eliminate illegal fentanyl from our communities, not providing new avenues for those who want to see just the opposite happen.