By Pat Anson, Editor

The U.S. Drug Enforcement Administration has issued a nationwide alert about the abuse and diversion of fentanyl – a potent opioid analgesic that recreational drug users are increasingly combining with heroin.

“Drug incidents and overdoses related to fentanyl are occurring at an alarming rate throughout the United States and represent a significant threat to public health and safety,” said DEA Administrator Michele M. Leonhart. “Often laced in heroin, fentanyl and fentanyl analogues produced in illicit clandestine labs are up to 100 times more powerful than morphine and 30-50 times more powerful than heroin.”

In the last two years, the DEA has seen a significant increase in fentanyl-related drug seizures, particularly in the northeast and California. While most of the seized fentanyl appears to be coming from illegal drug labs run by Mexican drug cartels, some of it is being diverted.

Over 6.5 million legal prescriptions for fentanyl were written in the U.S. in 2014, often in the form of transdermal patches used to treat chronic pain.

“Fentanyl patches are abused by removing the gel contents from the patches and then injecting or ingesting these contents. Patches have also been frozen, cut into pieces and placed under the tongue or in the cheek cavity for drug absorption through the oral mucosa. Used patches are attractive to abusers as a large percentage of fentanyl remains in these patches even after a 3-day use,” the DEA said in a statement. 

The DEA warning comes on the heels of another government report warning about a surge in heroin related deaths. This month the Centers for Disease Control and Prevention reported the death rate from heroin overdoses in the U.S. nearly tripled between 2010 and 2013. Over 8,200 Americans died of heroin overdoses in 2013.

The sharp increase in heroin deaths coincided with a crackdown on prescription drug abuse and pill mills dispensing painkillers. Some health officials have called opioids a “gateway drug” to heroin, and claimed pain patients are switching to heroin because it is now cheaper and easier to get – even though there is scant evidence to support that claim.

According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem. And in a 2014 study of urine drug screens collected from over 171,000 chronic pain patients, Ameritox says it detected heroin in just 1.3% of the samples.

“The initial entry of heroin was no doubt in response to the over-use of prescription opioids. Now it is occurring because of the influx of cheap heroin,” said Percy Menzies, president of Assisted Recovery Centers of America, which operates four addiction treatment clinics in the St. Louis, Missouri area.

“The two strongest factors contributing to addiction are price and access. Mexican farmers have lost their marijuana market in the U.S. and have switched to growing the poppies and these poppies are being converted into heroin by the drug cartels. This is immensely profitable and we are going to see a steep increase in heroin addiction as more and more heroin is smuggled into the U.S.

“The U.S. has to curb its appetite for prescription opioids and we have to find better treatments for chronic pain,” Menzies wrote in an email to Pain News Network. “To add insult to injury, the new avenue for using heroin is coming from the medications used to treatment opioid addiction - methadone and buprenorphine. The sale of buprenorphine formulations is around $2 billion and patients are using these medications to sustain their heroin addiction.

“Our addiction to opioids comes from three sources - prescription opioids, heroin and prescription opioids to treat opioid addiction. Until we drastically curtail these three sources, the addiction is going to be alive, well and thriving.”