A-Z of Drugs

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F for Fentanyl

Fentanyl and the death penalty.

In August 2019 Carey Dean Moore, a 60-year-old inmate on death row in Nebraska was executed. After having spent over half his life knowing that he could end his days on the seat of a barbaric contraption that is the electric chair, he went to meet his maker saying that he would not try to stop it, nor did he want anyone else to intervene.

After killing two cabdrivers back in 1979 his story would probably not have received much attention in the normal course of events. This however was the first execution in the state of Nebraska for 21 years and just three years after the state had abolished capital punishment, only for the decision to be overturned. Lawmakers in Nebraska decided to restore the death penalty following a state wide ballot in 2016 where 60% of voters voted for a more ‘humane’ method of execution. What was also a first was the method of execution involving the administration of the powerful opioid fentanyl. Four drugs were to be used in total. Potassium chloride to stop the heart, another, cisatracurium besylate to paralise the muscles, and valium and fentanyl to render the subject unconscious and unresponsive.

Nebraska officials obtained the said drugs legally and legitimately, but some argued their choice of drugs used was governed not by the principle of ‘humaneness’ but rather by the fact that their purchasing options were very limited. Drug companies began to object to their products being used in this way and used ‘legal means’ to stop the practice reaccuring. To counter this development the state of Ohio is currently considering legislation that would allow prison officials to obtain fentanyl from drug seizures. The Ohio state patrol recovered over 108 pounds of fentanyl in 2018, according to state records. The state has over 20 scheduled execution lined up running through to 2022. Local representative Rep. Scott Wiggam said “This is certainly a workaround,” and added “This is something that we know can bring deaths quickly to individuals”. Some commentators see this particular approach as not only being crass, but also disrespectful to those who have passed away in overdose incidents.

Fentanyl may have been responsible for just one death in this instance but is implicated in 3,431 overdose deaths in the state seen during 2017. Nationally it has been estimated to have been implicated in the deaths of around 30,000 people a year across the United States as a whole. Fentanyl can be 100 times more potent than the painkiller morphine, while carfentanil, a type of fentanyl used to tranquillise elephants, can be 10,000 times more powerful. In fact, synthetic opioids like fentanyl are now involved in twice as many deaths as heroin. Notable deaths have included the musician Prince who died from an accidental overdose in April 2016 and the rappers Lil Peep and Mac Millar a year later.

The drug was first synthesized in Belgium way back in 1959 with the first branded product ‘Sublimaze’ entering medical use as a general anaesthetic. Later the ‘Duragesic’ patch was developed by utilising an inert alcohol gel infused with a dose of fentanyl. It provided for constant administration of the opioid over a 48-72 hour period. Subsequent developments saw the appearance of flavoured lollipops (under the brand name Actiq) and even soluble film used for certain forms of cancer pain management.

Its use throughout the medical world continued apace, with clinicians seeing it as an effective product for many aspects of pain management. Although some overdose deaths do occur (4%) when a prescription is misused, the vast majority of incidents involve illegally manufactured fentanyl or one of its analogues, which are often given the street name of ‘China White’. As with heroin, the risk is highest when taken by people with no tolerance to opioids or those in poor health, especially long-term, heavy smokers and those with chronic obstructive pulmonary disease (COPD), such as bronchitis and emphysema, or other lung disease. Additionally, it is believed that fentanyl is commonly been mixed with heroin and sold to the unsuspecting buyer as heroin only. Subsequently this may be the reason it is implicit in an alarming number of overdoses internationally in recent years.

A simple economic model of the heroin market suggests that profit-maximizing dealers would substitute cheap fentanyl for expensive heroin roughly up to the point at which the user doesn’t notices a decline in the quality of the experience. Fentanyl ($5,000 per kilo) is a cheaper opioid than heroin ($25,000 for 50% pure heroin) and this may be the reason for its popularity as a mixing agent with heroin. Unfortunately and tragically economics are priorities over the wellbeing of the user in the case of fentanyl in the illicit drug markets.  Consequently, this method of manufactured fentanyl mixed with heroin, with or without the user’s knowledge, is the driving force in many fentanyl overdoses for unsuspecting users.

On 14th August 2019 at 10:47am Carey Dean Moore became another registered overdose death caused by fentanyl use. However unlike all the other registered deaths involving fentanyl in 2019, this one was intentional and pre planned.

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