Fentanyl Part 2: Opioids vs. Opiates
“This is a disease of capitalism run amok.” – Andrew Yang
In 2021, 311 people died from accidental drug overdoses in East Baton Rouge Parish, and 88 percent of those deaths were fentanyl related.
This year – as of Sept. 20, 2022 – 208 people have died from drug overdoses in EBR.
I wanted to understand why so many people were dying from fentanyl, so I reached out to East Baton Rouge Parish Coroner Dr. William “Beau” Clark.
The EBR Coroner’s Office is a one-story building tucked between the Baton Rouge Metropolitan Airport and the Emergency Operations Center, off T.B. Herndon Avenue. This was not the first time I had visited the coroner’s office. I interviewed Clark in 2015 for a profile piece I wrote about him for 225 Magazine.
I had a lot of questions for Clark, all jotted down on a piece of notebook paper. I wanted to know why so many people were dying locally and nationally. In 2021, more than 70,000 people died from fentanyl-related overdoses in the United States, according to data from the Centers for Disease Control and Prevention.
While the statistics are alarming, the news stories are even more frightening. In August 2022, the DEA warned people about brightly colored fentanyl tablets being marketed towards children. These “Rainbow Pills” and powder, made to look like candy, were seized in 18 states.
When I typed, “Baton Rouge Fentanyl” into google, I got 161,000 results, including local news stories about overdose deaths and drug seizures. According to The Advocate, on June 26. 2022, a 2-year-old boy died from fentanyl, when he ingested some pills that contained the drugs that his mom allegedly left within reach. On Sept. 22, 2022, the East Baton Rouge Parish Sheriff’s Office reported that it seized drugs, guns and money, including 1.25 pounds of heroin/fentanyl. On May 12, 2022, EBRSO’s Narcotics Division arrested three people and confiscated illegal firearms, drug paraphernalia, illicit drugs, including two pounds of fentanyl – which can kill thousands of people, according to the story reported by WBRZ.Com.
“Fentanyl as a whole is more powerful than other opioids, and it’s in nearly every illicit street drug,” Clark explained. “We used to see heroin overdoses all the time, now it’s rare to see heroin. We are exclusively seeing fentanyl. Rich people. Poor people. Young. Old. And they have no idea what they are getting themselves into. The first time you take fentanyl could kill you.”
Fentanyl is a synthetic opioid that is 50 times more potent than heroin and 100 times stronger than morphine, according to the U.S. Drug Enforcement Agency and the CDC.
While opioids and opiates are both narcotics that produce a feeling of euphoria, they differ in the way they are produced. Opioids are either fully or partially synthetic and opiates are naturally occurring and are derived from opium poppies. Heroin, morphine, and codeine are all opiates. Fentanyl, Oxycontin, Percocet, Methadone and Tramadol are all examples of opioids.
Unlike heroin, which is produced from the opium poppy plant, fentanyl can be made anywhere. If the demand for fentanyl increases, supply can adjust accordingly and quickly.
“With heroin, you need sun, soil, mother nature,” Clark said. “With fentanyl, all you need is a lab.”
Doctors began using medicinal fentanyl in the mid-1960s for anesthesia and to treat pain. When I told my friend, Ryan Senn, I was working on this project, he said he was given fentanyl during his 66-day hospitalization in 2020, when he nearly died from COVID.
I asked Clark how they differ. Medicinal fentanyl is produced in regulated laboratories and has to meet certain safety standards set by the Food and Drug Administration, he said. But the ingredients for illicit, street fentanyl comes from laboratories, often from China and sometimes Russia. Those ingredients are sent to Mexico – and most recently, some ingredients are even produced in Mexico – combined to create fentanyl and then shipped to the United States. Once in the U.S., fentanyl is mixed in with other illicit drugs.
He told me to think of it like the television series, “Breaking Bad,” where chemistry teacher Walter White makes methamphetamine with a former student in a rolling meth lab. But instead of meth, they are mixing fentanyl.
I was confused. If just 2 mg of fentanyl, which is the equivalent of 10-15 grains of table salt can kill someone, why would drug dealers mix it in with other drugs? Why take the chance of killing their customers?
“Here’s why,” Clark explained. “If you like to use marijuana on the weekend, and I put fentanyl into marijuana and sell it to you, you are going to think that’s the best marijuana you have ever had, not because of the marijuana but because of the fentanyl, but you don’t know that. So now I have converted you from a weekend user to a daily user. Now I have a hold on you.”
So how did this all start? How did we get here? Is it true that 80 percent of addicted fentanyl users started out as prescription pill users, I asked him.
“Pill mills,” Clark answered. “Money. Supply. Demand. This is all a business.”
And his final answer: “Yes.”
Clark recommended that I watch “The Pharmacist” on Netflix, a documentary series about Dan Schneider, a Chalmette pharmacist who exposes the Oxycontin crisis in New Orleans in the late 1990s and early 2000’s after his son was murdered in New Orleans during a drug deal. I watched it, and I learned about Purdue Pharma, the Stamford, Conn.-based pharmaceutical company that produced the opioid, Oxycontin, in 1995 to treat pain and marketed it as non-addictive. I read every newspaper article I could find on Purdue Pharma and the Sackler family, who owned the company.
Those articles led me to the series “Dopesick” on Hulu. I then watched ABC’s “Poisoned: America’s Fentanyl Crisis,” which led me to a National Geographic Series, “How Fentanyl is Made: Trafficked with Mariana Van Zeller.” And then I watched “Heroine,” and “Recovery Boys.”
Each documentary led me down the same path – corporate greed, addiction and the vulnerability of the working class, and I learned about the complexity and destructiveness of the opioid crisis across our country.
The demand for fentanyl is the third wave of opioid addiction in the United States.
The first wave began in the late 1990s when doctors prescribed what they thought was a “non-addictive” pain medication, Oxycontin. Oxycontin did the exact opposite and led to a tidal wave of people with addiction issues. This eventually led to pill mills, businesses that prescribe narcotics for non-medical reasons. When law enforcement and legislation began to crack down on pill mills, people who were addicted needed a new drug to feed their addictions.
The second wave began in 2010 when those suffering with addiction began buying heroin at a cheaper and more accessible rate. The third wave started in 2013 as our country began to see an increase in more potent, illicitly manufactured, synthetic opioids – mainly fentanyl.
Clark has been talking about the dangers of fentanyl in Baton Rouge since 2015, and when I asked him how we combat this drug, he offered a two-prong approach.
“Limit the addicted person’s access to the drugs,” he said. “And treat the addiction both cognitively and physiologically.”
He is referring to the physical act of detoxing from the drug and ridding it from the body as well as treating the brain. (I talk about this issue in detail in the fourth part of this series.)And that treatment must be done simultaneously to work.
“We can’t just fill you full of vivitrol and not look at what’s going on with you cognitively,” he explained.
Similar to methadone and suboxone, which are pills to treat opioid dependence and addiction, vivitrol is an injectable medicine used to treat opioid and alcohol dependence. And Clark’s point makes complete sense. For opioid addicts to remain in recovery, they have to understand the pain that caused them to take the drugs in the first place.
The second part, he said: “Eliminate drug dealers. Make it hard on them.”
The third part of this series, “The Addict” will be published Monday, October 3 , 2022.
September 26, 2022