Medical and law enforcement experts gathered before the United States Sentencing Commission (USSC) on Tuesday to give testify about the nation’s growing fentanyl epidemic, in the third hearing on synthetic drugs held by the Commission this year.
Over the course of the morning, a group of nine doctors, chemists, emergency medical staff and law enforcement agents discussed the chemical structure, trafficking patterns, and impact of fentanyl and fentanyl analogs, widely believed to be responsible for the sudden acceleration of fatal drug overdoses in recent years.
The latest round of expert testimony still shows this class of drug to be a mercurial and proliferating enemy, due to fentanyl’s extreme potency and the ease with which it can be chemically modified and moved across global markets.
According to CDC data, 33,000 U.S. citizens died of opioid-related deaths in 2015, a number which has quadrupled since 1999; when the The New York Times crunched state-level data, it estimated that fentanyl and its analogs caused 20,000 deaths that same year.
But according to statements by Washington D.C.’s chief medical examiner Roger Mitchell Thursday, national data doesn’t provide the full picture.
“Many medical examiners and coroners are not listing each drug on their death certificate,” Mitchell told the Commission during the hearing, which was broadcast live over the internet.
He said they fill out their reports “using terms like ‘mixed drug toxicity’ accident,” so there is no way to know which combination of drugs caused the death. For better detail, Mitchell added, you have to turn to local jurisdictions.
According to Mitchell, Washington, D.C. saw a 178 percent increase in fatal opioid overdoses between 2014 and 2016, with 62 percent of cases involving fentanyl or fentanyl analogs in 2016. Some 84 percent of all overdoses were among adults between 40-69 years of age, while fatalities hit those between ages 50-59.
And contrary to the epidemic’s characterization as a disease killing white Americans, 81 percent of opioid deaths in the District of Columbia between January 2014 and August 2017 were among African Americans.
Major Juan Colon, commanding officer of the New Jersey State Police Drug Monitoring Initiative, reported an illicit drug market that has come full circle since a flood of prescription opioids first created a reservoir of addicted and dependent customers in the 1990s.
Many of these people later moved on to use street drugs, as greater restrictions were placed on narcotic pain medications. Now, fentanyl and fentanyl analogs are being used to make counterfeit prescription drugs.
New Jersey has seen an increase of naloxone use by EMS and law enforcement, from around 5,000 administrations a year in 2010, to over 12,200 so far in 2017, reported Colon. While naloxone use alone isn’t a sufficient measure of fentanyl overdose rates, Dr. Brian Brown, chair of the University of Maryland Medical School, says first responders are among the first to notice a change.
“Without clinically knowing that [the patient took] fentanyl, we find that suddenly now the paramedics are realizing that they give some and it’s not working, because of the intensity and the strength of the fentanyl and the analogs,” he told the Commission.
“They have to give more of it, and it isn’t lasting as long.”
So although emergency responders are not testing for it, he added, “the clinical circumstances are indicating—this is not the usual opioid overdose.”
According to the United States Customs and Border Protection (CBP), the agency charged with identifying and responding to global narcotics trafficking trends, the majority of illicit fentanyl sold in the U.S. is manufactured overseas in China and Mexico, and smuggled into the country over the southern border.
CBP’s Acting Executive Assistant Commissioner Robert Perez testified that his agency has overseen a “dramatic increase in seizures” of fentanyl and its analogs, from one kilogram in fiscal year 2013, to 208 kilograms in 2016, to 550 kilograms in 2017–a 160 percent increase over the previous year. CBP expects this number to keep climbing in 2018.
Perez said that the relatively low purity of fentanyl trafficked through southern points of entry makes it more difficult to detect in the field, a fact that has led the agency to introduce a number of pilot programs that make use of handheld tools, reagent test kits, and the development of more “signature odor profiles” for training canine units.
But in terms of potential harm, an even greater threat is posed by the increased availability of high-potency fentanyl sold on the internet and shipped into the country by mail or carrier service. Small amounts of pure fentanyl are more maneuverable and don’t require the coordinated efforts of cartels and gangs, opening the market to individual entrepreneurs and small-scale retailers.
Joe Schleigh, the Acting Chief of Synthetic Drugs and Chemicals for the Diversion Control Division of the Drug Enforcement Administration (DEA), added that manufacturing tools such as pill presses are also easy to order online from China, Mexico and Germany.
Witnesses reported different prices for one kilo of Chinese fentanyl (ranging from $200 to $5,200), but agreed that a single kilo can yield over $6 million in profits if cut into pills in doses of 1.5mg or less.
Schleigh said the DEA “has become increasingly alarmed” by the proliferation of fentanyl and its synthetic analogs. Street chemists and retailers are constantly altering their products to stay ahead of law enforcement, often introducing new unregulated compounds as soon as the DEA takes action to classify a particular substance as controlled.
Perez also noted that the types of fentanyl and fentanyl-class compounds seen by U.S. Border Patrol laboratories grew from three in 2008 to 120 in 2016; and so far this year, CPB labs have analyzed 333 different kinds of fentanyl (broken down into five different class compounds and two starting materials).
It is enormously difficult for the DEA to trace the movement of Chinese drug compounds, said Schleigh, since traffickers use multiple freight forwarding services, making sure packages go through numerous chains of custody between the original supplier and border customs.
While CPB inspects mail arriving from over 140 different countries, Perez said agents are stymied by a lack of standardized cargo information, as well as the “sheer volume” of mail that needs to be manually inspected.
The Sentencing Commission also heard testimony from Dr. Howard Taft of the Maryland Department of Health and Mental Hygiene; Barry K. Logan, chief of Forensic Toxicology at NMS Labs; and Dr. Srihari Tella, Drug and Chemical Control Unit chief at the U.S. Drug Enforcement Agency.
Following the fentanyl panels, the Commission heard further testimony on the topic of synthetic cannabiniods.
Victoria Mckenzie is Deputy Editor of The Crime Report. She welcomes comments from readers.