Illegal street drugs, not prescriptions, now powering opioid abuse, study finds

The widespread abuse of the potent opioid fentanyl appears to be largely the result of illicit manufacturing of the synthetic drug as opposed to the misuse of legally prescribed versions of the painkiller, according to two US government studies released Thursday.

That represents a dramatic change in the way opioids have traditionally been abused, and means public health officials will likely have to adjust their response to the two-decade-long crisis.

Until recent years, much of the illegal trafficking in opioid painkillers started in a doctor’s office with a prescription for drugs like OxyContin and Percocet. Some patients became addicted after getting a prescription for a legitimate injury. Others stole drugs prescribed to family members or friends.

And unethical doctors working out of “pill mills” wrote huge numbers of prescriptions to addicts or to middlemen who sold them to drug dealers.

But it appears that much of the fentanyl now on the street is coming from clandestine labs. Many of these are in China, and the fentanyl — which can be 50 to 100 times more potent than heroin — is often routed through Mexican drug cartels and then distributed in the US.

The number of drugs containing fentanyl seized by law enforcement jumped 426 percent from 2013 to 2014, and then almost tripled from 2014 to 2015, the Centers for Disease Control and Prevention reported. The number of synthetic opioid deaths nationally went up 79 percent from 2013 to 2014.

But the number of prescriptions for fentanyl from 2010 through 2014 has remained flat.

In Ohio, which has been particularly hard hit by fentanyl overdoses, prescriptions for fentanyl actually declined by 7 percent from 2013 to 2014.

Identifying the source of the illegal drugs is important because it helps public health officials determine the best way to respond. Much of the response to the opioid crisis so far has focused on curtailing prescriptions and educating doctors and patients about the potential for abuse.

The CDC researchers who worked on the study are now calling for expanded access to naloxone, an antidote that can reverse overdoses, and for more addiction treatment programs. They also said government officials need to improve the timeliness of opioid abuse tracking nationally.

“The markets are changing much faster than we have seen previously,” said Matthew Gladden, a behavioral scientist at the CDC who coauthored the reports released Thursday. “We need to know the basics of where are these products, and where do we mount real public health responses, to get ahead of it in states being impacted.”

The CDC recently received funding from Congress to work with up to a dozen of the hardest-hit states to track overdose data in real time, he said. The agency is also working on getting information from local coroners and medical examiners faster. Currently, annual national opioid overdose death data is reported about a year after the events occur.

Preliminary data from a handful of states for both 2015 and the first half of 2016 indicate the fentanyl problem has grown significantly worse since 2014.

Ohio this week reported fentanyl-related overdose deaths more than doubled in 2015, to 1,155 from 503 in the prior year. In Massachusetts, which is one of the few states to report overdose estimates in close to real time, the state reported opioid deaths in the first half of this year were tracking 26 percent higher than in the first six months of 2015. Fentanyl was detected in two-thirds of the cases where toxicology screens were done so far in 2016, the state reported.