KMFK Safety Services array of harm reduction materials includes Narcan nasal spray, as photographed at a rave on Saturday, March 4, 2023, in the Pittsburgh area. (Photo by Stephanie Strasburg/PublicSource)
The increased detection of fentanyl analogs exacerbates an enduring challenge: People don’t know the potency of the substances they’re using.
by Amelia Winger, PublicSource
In the fall of 1987, seven strangers at the Allegheny Country Rifle Club struck an agreement: They’d work together to start up a new drug network.
In the year that followed, they peddled “China White,” a white powder marketed as heroin. But produced in a laboratory using stolen chemicals and swindled prescription drugs, the substance was hundreds of times more potent, leading to the deaths of 18 people and as many as 60 nonfatal overdoses before the ringleaders were arrested in December 1988.
That white powder was the first analog of fentanyl recorded in Allegheny County, setting the stage for a variety of others to sweep into the region in the decades since — especially over the past two years.
Fentanyl is a synthetic opioid that is pharmaceutically used to treat severe pain, but it has become the most common drug involved in fatal overdoses nationwide. Its analogs are substances with similar uses and effects but different chemical compositions, leading some to be significantly weaker than fentanyl and others to be dozens of times stronger.
Fatal overdoses in Allegheny County have risen since 2018, with 2021 reporting the highest since record-setting 2017. Fentanyl analogs and other non-prescription synthetic opioids are becoming increasingly common across the county, with data showing that they were tentatively detected in 49% of fatal overdoses in 2022 — up from 21% in 2020. The county’s Office of the Medical Examiner has not yet completed toxicology tests on some of last year’s suspected overdoses, and expects to have that finalized by June.
Researchers fear that the proliferation of fentanyl and its analogs reflects a troubling nationwide trend: People no longer know the strength and composition of the substances they’re using.
“You don’t know the potency of it,” said Dr. Jeanine Buchanich, associate dean for research at the University of Pittsburgh’s School of Public Health and a professor within the school’s Department of Biostatistics. “You do become at-risk for having a potency higher than you wanted or intended, and then in that case, you’re very much at greater risk of overdose or death.”
Dr. Karl Williams, Allegheny County’s chief medical examiner, said that fentanyl and its analogs are among a range of substances contributing to overdoses across the county. “It’s rare to find a single drug,” he said. “They’re all mixtures — two, three, sometimes as many as nine different drugs through those stamp bags.”
‘The difference between life or death’
Nationwide, drugs are becoming increasingly adulterated, and this weighs heavily on people using substances, Buchanich said.
“They don’t always know what they’re on,” she added. “They know that it’s giving them this effect, but they don’t know exactly what it is.”
When fentanyl and its analogs are sold illegally in Western Pennsylvania, Williams said they’re often distributed in stamp bags. The stamp bags contain a powder form of the substances, which presents physical complications for the people packaging them.
“It’s not easy to get that perfect mixture when what you’re mixing is a solid,” said Jonathan Caulkins, a professor of operations research and public policy at Carnegie Mellon University. “You can have deaths caused by, in effect, an accident. They don’t realize there’s more in the bag than they thought.”