The drug that killed Prince — fentanyl
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According to recent reports, the fentanyl which killed Prince appears to have come from counterfeit, clandestinely manufactured pills. The imprint on the pills was WATSON 385 which means that they should have contained a combination of acetaminophen and hydrocodone.

Acetaminophen and hydrocodone is a common prescription painkiller combination sold under the brand names Vicodin, Lortab, Lorcet, etc. However, analysis of the pills showed that instead of acetaminophen and hydrocodone, these pills instead contained a mixture of fentanyl, lidocaine and U-47700. This once again brings fentanyl to the forefront of the news. But what is fentanyl, where does it come from, and why is it used if it is so deadly?

Fentanyl is a synthetic opioid which is manufactured entirely from chemical precursors. Unlike morphine or heroin, no poppies are required for its manufacture. Fentanyl was discovered in 1959. When properly dosed, fentanyl is actually almost six times safer than morphine since the therapeutic index (i.e. the safety ratio of the therapeutic dose to the lethal dose) of fentanyl is 400 and that of morphine is only 70.

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The difficulty lies in getting the dosage right, since fentanyl is 100 times stronger than morphine and 50 times stronger than heroin. This means that the correct dosage for fentanyl is measured in micrograms rather than milligrams. Getting the dosage right is not a problem for high tech modern medicine which has developed a number of technologies such as the fentanyl patch and the fentanyl lollipop to deliver safe and effective doses.

However, quality control in clandestine laboratories is notoriously poor which is why so much illicitly produced fentanyl results in overdose death. It should be noted in passing that the term, fentanyl, is frequently used to refer to a family of related compounds including fentanyl analogues. The illicit fentanyl's manufactured in clandestine labs typically have a different chemical structure than that manufactured by the pharmaceutical companies.

Where does street fentanyl come from? According to the Drug Enforcement Administration (DEA), only a minority of this fentanyl is the result of diversion from hospitals or pharmacies; the majority is manufactured in clandestine labs. This clandestinely manufactured fentanyl may then be made into pills which purport to be Oxycontin, Vicodin, or some other popular prescription painkiller with a high street value among recreational users, dependent users, and legitimate pain patients who can no longer get their medications due to the new prescribing restrictions.

The pill counterfeiters take the trouble to get the shape and color right and even reproduce the manufacturer's imprint on each pill. Clandestine fentanyl may also be cut and sold as heroin or mixed with heroin, although it seems that the DEA has released no reports on how often they have found heroin mixed with fentanyl as opposed to fentanyl masquerading as heroin.

This is not the first time we have seen large numbers of deaths as a result of clandestinely manufactured fentanyl; we are actually in the midst of the third fentanyl epidemic. The first was the China White epidemic which lasted from 1979 to 1988 and claimed at least 110 victims. The second epidemic lasted from 2005 to 2007 and resulted in 1,013 deaths; this ended with the closure of a single clandestine laboratory in Toluca, Mexico which was responsible for the manufacture of all the illicit fentanyl.

The current epidemic began in around 2013. Although the DEA reports increases in fentanyl from as early as 2009, a really large jump in seizures of illicit fentanyl and in fentanyl related deaths is seen starting in 2013. The DEA reports that fentanyl seizures increased from 942 in 2013 to 3,344 in 2014. According to the DEA there were over 700 fentanyl-related deaths reported in the United States between late 2013 and 2014. Although the CDC does not count fentanyl related deaths separately from other synthetic opioid deaths, they reported an increase of 79 percent, from 3,097 to 5,544 synthetic opioid related deaths between 2013 and 2014.

What is the answer to this problem? In my opinion the only way to solve this problem is the full legalization of all drugs. When drugs can be bought legally they can be regulated and the consumer can know what he or she is getting. It is neither drugs nor drug use which causes crime; it is drug laws and unreasonably inflated black market drug prices which cause crime. We saw similar deaths due to poison liquor during alcohol prohibition and these ended with the end of alcohol prohibition. The best way to end overdose death is to end drug prohibition now.

Kenneth Anderson, M.A., is founder and CEO of HAMS Harm Reduction Network, contributing writer for Pro Talk on Rehabs.com, an unbiased editorial platform on substance use and treatment, and author of “How to Change Your Drinking: a Harm Reduction Guide to Alcohol.”


The views expressed by contributors are their own and not the views of The Hill.