By: Megan Hesse
By now, there are few people within the United States who are unaware of the opioid epidemic that, despite national measures being taken to stem the rate of overdose deaths, continues to ravage the country.
According to the U.S. Centers for Disease Control and Prevention (CDC), in 2016 opioids were responsible for more than 42,000 deaths. In the context of this statistic, the CDC specifies that this is a combination of prescription opioids, heroin, and the synthetic opioid analog fentanyl.
The CDC cites about 40 percent of these opioid-related deaths involved prescription opioids, 37 percent involves heroin, and a study published in May of this year by The Journal of the American Medical Association reports that roughly 46 percent involved fentanyl.
According to the 2017 National Drug Threat Assessment (NDTA), opioids were reported as some of the greatest drug threats, with heroin in the number one spot. This is substantially due to the fact that heroin, fentanyl, and controlled prescription medications, which include opioids, were all also in the top spots for how easy a substance is to obtain.
So the question is, even after restrictions have been placed on prescription opioids and the U.S. Drug Enforcement Administration (DEA) has made major crackdowns on drug manufacturers as well as increasing border security, why are opioids still so easily obtained? Exactly where do opioids come from? The answer is a multi-faceted and complex one.
Heroin and the Mexican Drug Cartels: A Deadly Monopoly
Heroin is the number one drug threat in America, as determined by the DEA. It also ranks second only to marijuana as the easiest drug to obtain, which is extremely significant when considering that marijuana is available for legal purchase in many parts of the country. Heroin availability has seen a massive increase in the past decade, so where is it coming from, and how has it become so widespread?
The short answer is the Mexican drug cartels. The DEA believes that heroin manufactured from poppy farms grown in Mexico is the primary source of the substance in the U.S. drug market and that production has been rapidly increasing since 2015 to provide a steady output of low-cost, high-purity heroin.
Based on the reports from the 2017 NDTA, there are eight primary Mexican cartels controlling production and distribution through hubs in major U.S. cities. While these illicit opioids are still frequently smuggled across the southwest border of the U.S. in regular cars as well as tractor trailers, it is becoming more common for heroin to be trafficked into the country by air and sea, specifically in the northeast New England area. This is a significant factor in why heroin overdose deaths are clustered in that region since states like New Jersey, Maryland, and New Hampshire are all along major trafficking routes.
Fentanyl: From China to Your Front Door
Fentanyl, a synthetic opioid that can be anywhere from 25 to 50 times more potent than heroin, depending on the purity, has grown to be a truly frightening threat in what seems like an incredibly short amount of time. According to the 2017 NDTA, the number of fentanyl seizures by law enforcement in 2016 was six times higher than what it had been just two years earlier.
While fentanyl can be obtained from health care facilities on an extremely restricted basis and is sometimes diverted for misuse, the CDC reports that this represents only a small fraction of available fentanyl. Instead, the overwhelming majority of fentanyl that is abused in the U.S. comes from China and Mexico and is often either mixed in with heroin or pressed into counterfeit pills meant to resemble prescription opioids.
While is often smuggled into the U.S. across the northern and southwestern borders by way of parcels mailed from China to either Canada or Mexico, through the use of dark web Internet drug markets, fentanyl from China can often be mailed directly to the purchaser’s home.
Large-scale shipments of fentanyl are frequently seized at the border to Mexico, but these are generally very low quality and have an average potency of only seven percent, as compared to the much smaller volumes mailed directly to the U.S. from China, which average a staggering 90 percent purity level.
Fentanyl from China can be extremely difficult for law enforcement officials to properly trace back to the source due to the use of long chains of custody where the package is passed between multiple freight forwarders and often incorrectly labeled and manifested to avoid detection. China and other foreign countries will also supply the pill presses needed to create counterfeit fentanyl pills in the U.S., mislabeling the equipment or sending it in disassembled shipments to avoid having to notify the DEA, as is the law with all purchases of a pill press.
In order to stem the mass quantities of fentanyl being shipped into the U.S., in 2017, Beijing reclassified fentanyl, carfentanil, and several other fentanyl analogs as controlled substances, making it much more difficult to send out of China. This proved to be an effective measure in 2015 when China similarly scheduled more than 100 other synthetic substances, and it resulted in a decrease in availability in the U.S. Hopefully, this will prove to be the case with fentanyl as well.
Getting High with Help from Your Friends
When trying to pinpoint the source of the opioid epidemic, the first thing that many people will reference is the overprescribing of prescription painkillers, and there is certainly objective truth to that statement.
According to the CDC, as of 2016, the rate of opioid prescriptions in the U.S. had reached an average 66.5 per 100 people, or an average of 3.5 prescriptions per patient. In some states, the rates were even higher, such as in Alabama and Arkansas, which both had more than 110 prescriptions per 100 people.
However, although over-prescribing opioids is a very real issue that plays a role in the overall crisis, it is only a piece of the prescription opioid picture, especially when it comes to substance use disorders. An unseen factor in the prevalence of prescription opioids available for misuse is friends and family.
The issue, as researchers are beginning to gain a clearer understanding of, is that doctors will often prescribe far more opioids for short-term pain from injuries or surgery than necessary. Patients frequently get a month’s supply of medication when only a week’s worth is needed. As a result, patients usually end up not needing most of their prescribed dose and are then left with a surplus of pills.
Rather than drug dealers, forged, or even legitimate prescriptions, it is actually friends and family that are the primary source of prescription opioids diverted for misuse. The 2017 NDTA reported that more than 55 percent of those who were either recent or occasional recreational users obtained prescription opioids from their family and friends.
While frequent users reported higher instances of obtaining prescription opioids by means of doctor-shopping or forged prescriptions, 39 percent still reported friends and family as their main source for prescription opioids.
So, in the case of prescription painkillers, the ones getting misused and abused are far more likely to come from someone’s co-worker, friend, neighbor or uncle than a cartel or drug dealer.
Are You Struggling with an Addiction to Opioids?
If you or someone you care about is currently struggling with a dependence on opioids, the addiction professionals at Delphi Behavioral Health Group can provide the resources and support you need to help you or your loved one take the first steps towards recovery and a sober future.
We have recovery treatment facilities located across the country and admissions specialists ready to take your call seven days a week, 24 hours a day to help get the admissions process started and answer any questions or concerns you might have.