Men die after opioid overdoses almost three times as high as women in the United States. The number of overdose deaths is increasing faster in black and Latino Americans than in whites. The number of young adults between the ages of 25 and 34, whose death certificates contain a version of the drug fentanyl, has risen sharply.
These findings, released Thursday in a report from Centers for Disease Control and Prevention, underscore the launch of the nation's third wave of opioid epidemic. The first was prescription painkillers like OxyContin; then heroin, which replaced the pills when they became too expensive; and now fentanyl.
Fentanyl is a potent synthetic opioid that can stop breathing in less than a minute, and its popularity in the US began to increase in late 2013. Fatal overdoses were required for each of the next three years Fentanyl doubled in size "with exponential growth," says Merianne Rose Spencer, statistician at the CDC and one of the authors of the study.
Spencer's research shows an average annual increase of 113 percent (considering age). , This sum was not reported until the end of 2018, but Spencer used this report to examine the demographic characteristics of people who died of fentanyl overdose.
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Increasing drug trafficking and increasing consumption are both driving the brunt of fentanyl deaths. For drug dealers, fentanyl is easier to make than other opioids. Unlike the poppies needed for heroin, which may be affected by the weather or a poor harvest, the ingredients of fentanyl are readily available. According to the US Drug Enforcement Administration, this is a synthetic combination of chemicals that is commonly made in China and packaged in Mexico. And since fentanyl can be 50 times as potent as heroin, smaller amounts lead to higher profits.
Jon DeLena, deputy special agent of the New England Field of the DEA One kilogram of fentanyl, which is driven across the southern border of the US, can be mixed with filling or other medicines, to sell six or eight kilograms.
"I mean, imagine this business model," says DeLena. "If you went to a small business owner and said," Hey, I have a way to make your product eight times as you have it now, "there is a huge wind."
For drug users Fentanyl It is more likely to cause an overdose as heroin because it is so strong and because the high decays faster than heroin. Drug users say they inject fentanyl more frequently because the high does not last as long – and more often injects the risk of overdose.
in some supplies of cocaine and methamphetamine, meaning that some people who do not even know they need to worry about a fentanyl overdose dying.
There are several ways in which fentanyl can be absorbed in a single dose of another medicine. The mixing may be intentional as a person seeks a more intense or different high. This can happen as an accidental infection when traders package their fentanyl and other drugs in the same place.
Or traders intentionally add cocaine and meth to fentanyl to expand their clientele of fentanyl fans.
"That's something we have to take into account," says David Kelley, referring to the deliberate addition of fentanyl to cocaine, heroin, or other drugs by traders. Kelley is Deputy Director of the New England High Intensity Drug Trafficking Area. "The fact that there were cases where different drugs were present suggests that this could be possible."
The picture gets more complicated, says Kelley, as traders develop new forms of fentanyl that are much more deadly. The new CDC report shows dozens of varieties of the drug currently on the street.
The highest rates of fentanyl-related overdose deaths were found in New England, according to the study, followed by mid-Atlantic and upper-midwest states. The number of fentanyl deaths in the west – including Hawaii and Alaska – had barely risen at the end of 2016.
Researchers do not have clear explanations for these geographic differences, but some people who observe the trends have theories. First, it's easier to mix a few white fentanyl crystals into the powdered form of heroin, which is more common in the eastern states than the black tar heroin that is routinely sold in the west. Another hypothesis states that drug cartels used New England as a test market for fentanyl because the region has a strong, long-term market for opioids.
Spencer, the lead author of the study, hopes that some of the other features of Fentanyl's wave highlighted in this report will help shape the public response. For example, why did the influx of fentanyl increase overdose mortality in men to almost three times that of overdose in women? In the era of fentanyl, this increases a man's chance of overdose and death, says Ricky Bluthenthal, a professor of preventive medicine at the Keck School of Medicine at the University of Southern California.
"You have a stigma about your drug use, so you hide it," says Bluthenthal. "They use it themselves in an unsupervised environment. [If] There's Fentanyl, then you die."
Traci Green, Deputy Director of the Boston Medical Center's Injury Prevention Center, gives a few other reasons. Women buy and consume drugs more often with a partner, says Green. Women call for help more often – including 911 – and seek help, including treatment.
"Women go to the doctor more," she says. "We have health issues that make us more doctor, so we have more options to help."
Green states that any interaction with a healthcare provider is a chance to treat someone. This statement should therefore encourage more coverage and encourage healthcare providers to find more ways to connect with active drug users.
Why does Fentanyl seem to disproportionately discriminate against blacks and Latinos compared to whites, according to Green's higher incarceration rates for blacks and Latinos. Those who have previously consumed opioids are at a particularly high risk of overdose if they leave the prison or jail and inject fentanyl. They have lost their tolerance to high levels of medication.
There are also reports that African Americans and Latinos call 911 less frequently because they do not trust first responders and drug treatments may not be performed. 19659025] as available to ethnic minorities. Many Latinos say bilingual treatment programs are hard to find.
Spencer says the fatalities attributed to fentanyl in their study should be considered minimum – probably more that was not counted. Coroner testing did not occur in some states the drug or have no equipment that can detect one of the many new variations of fentanyl that would result if sophisticated testing were more widely available.
There are signs that the fentanyl wave continues. Kelley notes in the New England High Intensity Drug Trafficking Area that fentanyl seizures are on the rise. In Massachusetts, one of the hardest hit regions, state data show that fentanyl occurred in more than 89 percent of fatal overdoses in October 2018. Nevertheless, in a glimmer of hope, even though the number of overdoses in Massachusetts still continues to increase, associated deaths have fallen 4 percent over the last year. Many public health experts attribute the decline in deaths to the spread of naloxone, a drug that can overdose on opioids.
This story is part of the NPR reporting partnership with WBUR and Kaiser Health News