What is Fentanyl, the Drug Linked to Thousands of Deaths in North America?

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Bags of heroin, some laced with fentanyl, are displayed before a press conference about a major drug bust at the office of the New York Attorney General, September 23, 2016, in New York City. Drew Angerer/Getty Images

Last week, a Canadian mother posted a picture of her dying son on Facebook to highlight the dangers of opioid abuse.

Sherri Kents’s 22-year-old son, Michael, had taken a fatal overdose of fentanyl, a pain medication said to be 50-100 times more powerful than morphine.

The drug has been linked to thousands of fatal overdoses in the U.S. and Canada in recent years, and burst into public awareness when it was linked to the death of pop star Prince in April, 2016.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 4,200 deaths were caused by fentanyl in 2014, and overdoses from the drug drove a 73 percent increase in synthetic opioid deaths in the United States between 2014 and 2015. More recent figures for the U.S. are not yet available: A CDC spokesman told Newsweek that fentanyl does not have its own code for officials filling out death certificates, so deaths “are often recorded generically as a multi-drug toxic overdose.” He said the 2014 statistics were established by analyzing special death certificate notes recording the presence of the drug, and similar studies are in the pipeline.

In British Columbia (BC) and Alberta, the two hardest-hit Canadian provinces, fatal overdoses linked to fentanyl soared from 42 in 2012 to 418 in 2015, the Globe and Mail reported, citing government figures. In 2016, the drug caused 922 deaths in BC alone.

Canadian Health Minister Jane Philpott has criticized provinces for not providing data to enable the federal government to get an overall picture of the scale of the crisis.

Its use may be spreading to the U.K., with police warning that a spate of drugs-related deaths in the north of England may be linked to fentanyl use.

What is fentanyl?

First developed the in the 1960s, fentanyl is an extremely powerful painkiller, used to treat severe chronic pain, or breakthrough pain which does not respond to ordinary painkillers.

As an opioid painkiller it works by mimicking the body’s natural endorphins, the hormones that block pain messages to the brain.

The drug is often prescribed to cancer patients in the form of ice pops or patches, but illicit use is spreading.

Where does fentanyl come from?

In recent years, the drug has been manufactured in illegal labs in China and Mexico, and is then trafficked to countries including the U.S. and Canada, where it is cut with heroin without the knowledge of buyers, who then overdose.

Fentanyl is also sold in the form of nasal sprays and pills, often masked to con those addicted to OxyContin, a pharmaceutical opioid weaker than fentanyl.

A previous spike in use in 2006 was traced back to a single lab in Mexico, and declined when the lab was closed down, according to a February U.S. government report. The number of illegal manufacturers has since increased.

Changes to prescription opioid OxyContin by its manufacturer that prevent it being crushed for snorting or smoking may have also inadvertently led to a rise on the use the fentanyl, Canada’s Maclean’s magazine reported.

The first indication of a spike in use came in 2015, when the Drugs Enforcement Agency announced an increase in seizures of the drug, and issued a nationwide alert about the threat it poses.

What measures have been taken?

The U.S. has introduced a range of legal and diplomatic measures to combat the spread of fentanyl.

In 2015, China responded to pressure from U.S. officials by banning the use of some of the components used to manufacture fentanyl. However, underground Chinese labs sidestepped this ban, altering the fentanyl molecule to produce new, unregulated variants of the drug, according to Science magazine.

Officials in Vermont on Thursday called for tougher sentences for those caught trafficking the drug after a spike in fatalities linked to its use, NBC reported, following states including New Hampshire, where fentanyl suppliers responsible for providing lethal doses to users have been charged with murder.

In Canada, the government introduced legislation in December 2016 tightening border search procedures, which enabled authorities to search through mail weighing 30 grams or less, with tiny amounts of fentanyl potent. But judges have been divided over whether to introduce tougher sentences for suppliers.