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1 1 (December 2018)

handle is hein.amenin/aeiaaio0001 and id is 1 raw text is: Fentanyl and Fatal Overdoses: From Chemical Production in China to Users in Pennsylvania By Roger Bate December 2018 Policies to restrict the use of prescription opioids, such as oxycodone, accelerated an already lively illicit opioid market. Fentanyl, a powerful opioid, treats real patients, but it and its new ana- logues have found their way into illicit markets. The tiny amounts required to provide a high to users and the resulting value are ideal for illicit traders, as hiding products, especially in transit, is useful to avoid discovery. As a result, there has been an explosion in the use of fentanyls in the past few years. Original research of online sellers in China and surveying drugs users and dealers in the Philadelphia area leads to the inevitable conclusion that fentanyl use has exploded over the past two years, and with it has come a significant increase in fatal overdoses. Due to the devastating effects of opioid addiction in the US, resulting in more than 42,ooo deaths in 2016 (CDC 2018), one of the Trump administration's policy aims is to halt or heavily restrict imports of illicit opioid compounds such as fentanyl from China (White House 2018). Fentanyl is legitimately used as an analgesic in the form of lozenges, patches, and parenterally to manage acute or chronic pain, usually in cancer patients. According to the Drug Enforce- ment Administration (DEA), Licit fentanyl is diverted via theft, fraudulent prescriptions, and illicit distri- bution by patients, physicians, and pharmacists. Illicitly manufactured fentanyl is chiefly responsible for the current domestic crisis, having played a role in nearly half of opioid-related deaths (DEA 2008). The major concern over fentanyl misuse is that it is up to 100 times more potent than morphine, and as little as 2 milligrams can be fatal in patients not previously exposed to it. Precise dosing is vital yet challenging given the drug's narrow therapeutic window. An excessive dose can easily result in respiratory depression and death. The substance is lethal to not only users but also anyone intercepting products, such as customs and mail agents and even first responders. It can pose a threat to sniffer dogs as well, as US Customs and Border Protection (CBP) has indicated. Although exposure to the heavily diluted preparations sold on the street appears far less risky (Szalavitz 2018), the seized samples sent through the mail are extremely pure and potent (Owen 2018). In addition to fentanyl, several fentanyl analogues exist. These are compounds that are chemically sim- ilar to fentanyl, such as carfentanil, a tranquilizer used to sedate large animals that is nearly ioo times the potency of fentanyl. Many other fentanyl ana- logues exist as designer drugs intended to under- mine efforts to prohibit legal procession. Beyond concerns surrounding the drug's extreme potency, fentanyl presents additional challenges for

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