This article is dedicated to Group Supervisor Special Agent Michael G. Garbo of the Drug Enforcement Administration (DEA). SA Garbo was tragically killed on October 4, 2021 while conducting a routine drug search on the Amtrak train in Tucson, AZ. He spent his career devoted to keeping drug traffickers at bay from the midwest, the corridors of Nogales, and Afghanistan. His legacy lives on through his wife, daughter, and niece (Dr. M. Kennedy Valinevicius- author) with their committed efforts to ending the opioid crisis and war on drugs just as he did for so many years.
Background:
It is no secret that the United States has encountered quite the eventful past couple of years with COVID numbers rising, mass unemployment, mental health crisis and the most deadly of all: the opioid crisis. From May 2020-April 2021 alone, over 100,000 individuals in the United States have died due to opioid related causes. Notably, a drug known as “fentanyl” has shown its ugly head in the US in recent years. Substance use and abuse is not a new concept to America, however, the individuals promoting this behavior continue to make their own advancements in distributing illicit substances to vulnerable citizens, including teenagers and young adults. Such distributors have no moral bounds, making this crisis a nationwide risk.
Why Fentanyl?
Any US pharmacist can tell you they have heard of fentanyl at some point in their career. This synthetic opioid prescription medication, while highly dangerous if used incorrectly, does have its uses. However, the typical usage shall be reserved for those with severe chronic pain, terminal illness such as cancer, or postoperative management of invasive surgeries. Fentanyl comes in a wide-range of formulations: patch, oral pill, injection, sublingual, lozenge and nasal spray.
Fentanyl potency is what makes this substance highly dangerous (80 times more potent than morphine). To put things into perspective, the tip of a pencil or a few grains of salt could equate to a deadly dose of fentanyl. An even more scary reality is that leftover patches, broken vials, lozenges’ that have the appearance of candy could fall into the hands of children if not disposed of or stored properly.
Effects of fentanyl may range from feelings of euphoria, pain, relief, drowsiness, respiratory alteration. It is no wonder why those who struggle with addiction may seek fentanyl or be deceived by the similar effects that other opioids emit such as morphine, being from the same class of medication.
So why do drug cartels insist on using fentanyl if it has been shown to be much more potent and fatal than other options? The answer is simple: low cost and greater effect or “a bigger bang for your buck.” Remember the comparison to the tip of a pencil or grains of salt? The amount of fentanyl that can be purchased can go a long way for those looking to distribute illegally.
Government Response:
The Drug Enforcement Administration (DEA) of the United States has issued many warnings on the dangers of fentanyl and what to look for. Specifically, “M-30’s” has come to be a well-known term as officials have discovered that drug cartels and distributors are masking what are typically marked as oxycodone tablets with traces of fentanyl in order to cost-save while still providing the effects from opioids. So where are they getting it? It has been found that the Mexico drug cartels are receiving fentanyl supplies from China and now India and then bringing them directly into the US across our borders.
Next Steps:
While the DEA has confiscated more than 12,000 pounds of fentanyl in the past year alone, what can you do as a pharmacist and reader? Addiction and abuse must start somewhere. Educating providers, prescribers and patients receiving such treatments on proper pain management techniques and the effects and dangers of agents can serve as the earliest intervention and roadblock for addiction. Substance abuse medicine has become more and more popular since the spike of mental health crisis and the slowly fading stigma surrounding it. Pharmacists may serve as educational resources on treatments for recovery and may also recognize signs and symptoms of possible addiction early on in patients who may not know they are becoming addicted.
The war on drugs is far from over. These illicit substances are killing our citizens and in turn, creating havoc for law enforcement officials. This has become something bigger than us and involves each and every person in this country. We must persist in the fight to end this crisis.
Dr. M. Kennedy Valinevicius, PharmD (IN/AZ)
Clinical Pharmacist | Mental Health Advocate
Indianapolis, IN and Greater Tucson, AZ
References:
- O’Neill, J, 2022. Drug Enforcement Agency provided image of illicit pills. [Accessed 13 February 2022]. <https://nypost.com/2022/01/25/teen-drug-dealer-charged-with-murder-after-12-year-old-dies-of-fentanyl-overdose/>
- Media Relations (DEA), 2022. Administrator Anne Milgram Remarks on the Overdose Epidemic. [online] DEA. Available at: <https://www.dea.gov/press-releases/2021/11/17/administrator-anne-milgram-remarks-overdose-epidemic> [Accessed 13 February 2022].
- Cdc.gov. 2022. Drug Overdose Deaths in the U.S. Top 100,000 Annually. [online] Available at: <https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm> [Accessed 13 February 2022].
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