Epidemic of deaths from fentanyl overdose

published on September 28, 2017 by Drs. Evan Wood and Eugenia Socías in The bmj

Strategies to tackle the harms of substance misuse and addiction remain among the most controversial areas in public policy. Although new ways of thinking are slowly emerging, the overwhelming model in the past century has involved the criminalisation of production, sale, and possession of illicit drugs. This is despite a large body of research showing that this approach has not only been unsuccessful in decreasing the availability and use of drugs, but has also had numerous severe unintended negative public health consequences, including increased health harms, incarceration rates, and violence in the drug market.

History has also shown repeatedly that the emphasis on criminalisation often results in the emergence of more potent and potentially toxic drugs. Such behaviour was observed during alcohol prohibition in the US and with the criminalisation of opium, which prompted a shift from smoking to more potent forms of opioids and riskier modes of administration, including heroin injection. To make matters worse, controlling the potency and composition, or preventing contamination of substances, in such unregulated markets is impossible, greatly increasing the risk of poisoning, overdose, and other drug related harms.

The latest example of the failure of the overemphasis on law enforcement is the recent emergence of highly potent synthetic opioids (illicitly manufactured fentanyl and analogues such as carfentanyl) in the illegal market. In particular, overdose deaths involving fentanyl have risen alarmingly in many countries. For example, in the US between 2012 and 2016, the number of deaths associated with synthetic opioids rose from 2628 to 20 145, a more than sevenfold increase. Canada is facing a similarly unprecedented fentanyl related overdose epidemic, with a public health emergency being declared in British Columbia in 2016. Large increases have also occurred in several European countries, including Sweden, Germany, the UK, Finland, and especially Estonia.