Synthetic opioids like fentanyl “kill on a scale that is unprecedented among illegal drugs,” according to a new report conducted by the RAND Corporation.
Existing strategies are not enough, therefore researchers at RAND advocated for a broad range of innovative approaches to address the synthetic opioid crisis, such as supervised consumption sites, creative supply disruption and new evidence-informed treatment modalities.
“Given the rapid increase in overdoses from fentanyl and other synthetic opioids, we wanted to systematically try to better understand the present and possible futures of fentanyl and other synthetic opioids found in illicit drug markets in the U.S.,” Bradley D. Stein, MD, PhD, director of Opioid Policies, Tools, and Information Center of Research Excellence at RAND Corporation, told Healio Psychiatry.
Based on findings from the report, Stein offered some take-home messages for clinicians on fentanyl that should be considered when treating individuals with opioid use disorder.
The synthetic opioid crisis is different from previous illicit drug-related epidemics because the spread of synthetic opioids is primarily driven by suppliers' decisions, rather than by growing user demand, according to Stein.
“In fact, in many cases individuals using fentanyl often don’t know they are getting fentanyl. This matters, since we know that relapse is common among patients with opioid use disorder, and relapsing individuals who go back to using the same amounts they used before starting treatment are at greater risk of overdose,” he said. “But they are at much, much greater risk if they unknowingly take fentanyl because of its potency.”
In markets with access to fentanyl, Stein advised that clinicians be proactive when discussing the risks for relapse and overdose with patients.
Also, Stein emphasized that fentanyl’s reach is very regional. The large-scale analysis revealed that overdose deaths involving fentanyl and other synthetic opioids rose from about 3,000 in 2013 to more than 30,000 in 2018, but remained concentrated in Appalachia, the mid-Atlantic and New England in the U.S.
Sometimes, if a community moves quickly, they may be able to prevent fentanyl from getting established in drug markets when it first appears; however, it’s hard to expel once it is established, according to Stein.
“There are parts of the country in which it is common and almost seems to be displacing heroin. But then in other parts of the county, including most of the country west of the Mississippi, it seems to have hardly penetrated,” he told Healio Psychiatry. “However, it can do so very quickly, so clinicians in those communities must remain vigilant.” – by Savannah Demko
RAND Corporation. The future of fentanyl and other synthetic opioids. https://www.rand.org/pubs/research_reports/RR3117.html. Accessed on Aug. 29, 2019.
Disclosure: Stein is an employee of RAND Corporation.