One Pill Can Kill – Fentanyl Awareness Day May 10

News Release – Uppsala, Sweden, May 10, 2022

May 10 is the first ever National Fentanyl Awareness Day, set up to draw attention to the fentanyl crisis that has been in the shadows of the opioid epidemic for too long. It is time for it to be front and center as the destruction left behind by illicitly manufactured fentanyl (IMF) is a public health emergency. To understand the recent developments, we asked Geri-Lynn Utter, Medical Liaison at Orexo, about the prevalence of fentanyl, who is at risk and what needs to be done to save lives.

The number of fatal overdoses has reached a record high. More than 105,000 Americans died from an overdose over the last year; 75 percent of these deaths are related to the misuse of opioids, including synthetic opioids such as fentanyl[i]. Fentanyl supply is accelerating in the US, largely due to a significant increase of illegal manufacturing in Mexico.

Geri-Lynn Utter works at Orexo´s Medical Affairs department as a Medical Science Liaison. Orexo manu-factures ZUBSOLV® for the treatment of opioid use disorder (OUD) and Geri-Lynn is responsible for providing education about the disease of addiction as well as in-depth clinical knowledge about ZUBSOLV® to healthcare providers throughout the US. Ahead of the National Fentanyl Awareness Day, we asked Geri-Lynn a few questions to get a deeper understanding of why IMF is causing so many people to overdose in the US.

What is happening with illicit fentanyl in the US?

Across the US, people are illicitly manufacturing fake pills and passing them off as prescription pills such as oxycodone (brand name – OxyContin) and even benzodiazepines such as alprazolam (brand name – Xanax). These counterfeit pills are scored and dyed to look seamlessly identical to legally manufactured pills. Testing by the US Drug Enforcement Administration (DEA) found that 4 in every 10 pills containing fentanyl have a concentration strong enough to be potentially lethal[ii]. More than 9.5 million counterfeit pills have been seized so far this year[iii]. It is important that people do not trust anything they find on the street or online, such as through social media platforms or websites, and only take medications prescribed to them by a medical professional and that are dispensed by a licensed pharmacist.

Fentanyl that is approved by the Food and Drug Administration (FDA) is an extremely potent opioid drug that is indicated for use as an analgesic, for treating severe pain, and as an anesthetic. When it is prescribed in this way, for short-term use, it is a highly effective way of treating acute pain. It is roughly 50 - 100 times more potent than morphine[iv]. It is crucial to understand the difference between FDA approved fentanyl and IMF. There are multiple analogues of IMF in which the half-life, purity and potency vary, making it difficult to predict how much fentanyl can lead to a fatal overdose. It is also imperative to learn the difference between a fentanyl overdose and a fentanyl exposure or poisoning.  

A fentanyl overdose occurs when an individual with a tolerance for opioids such as oxycodone or heroin, consumes fentanyl, but believes their tolerance to other opioids can compete to them ingesting similar amounts of IMF. The consequence of assuming that IMF is comparable to the tolerance one develops from ingesting other opioids often ends with the individual suffering from a fentanyl overdose. A fentanyl exposure occurs when an opioid naïve individual is unknowingly exposed to fentanyl, because the drug they believed they purchased, such as oxycodone, is really a counterfeit pressed fentanyl pill, disguised to look like a legally manufactured pill. A fentanyl exposure can also occur due to inadvertent cross-contamination, for instance, marijuana is contaminated with fentanyl because the two drugs are being transported or packaged in close proximity to one another. Depending on the analogue of fentanyl, as little as a few small granules can be fatal for both opioid dependent and opioid naïve individuals.

Who is most at risk?

Broadly, there are two groups of people at risk of unintentional death due to IMF. The first are people who already have opioid dependency and have built a tolerance to opioids. Even though these people consume opioids daily, they do not know what type of fentanyl they are being exposed to when purchasing illegal opioids. There are various analogues that represent an array of purity and potency, some of which are fatal. Therefore, opioid dependent individuals are not “safe” or “inoculated” from a fatal fentanyl overdose because they are opioid tolerant. For example, an individual who has an established tolerance to consume 50mgs of oxycodone, may consume what they believe to be 50mgs of oxycodone, but in reality, they are counterfeit pressed IMF pills that may lead to fatal overdose. The same applies for individuals abusing heroin. They might have an established tolerance of consuming 6-bags of heroin but experience a fatal overdose due to IMF because the heroin has either been “laced” (adulterated) or replaced with IMF.

The second group of people are recreational drug users, and sometimes first-time drug users, who may buy what they believe to be an opioid like oxycodone, or a benzodiazepine like alprazolam (brand name – Xanax), when in fact, they are getting a counterfeit pill pressed with IMF. These counterfeit pills are scored and dyed to look like the “real thing.” Deaths involving fentanyl are fastest growing in 14–23-year-olds, which is typically the ages at which young people are trying things out and going to college[v]. People in this second group do not have a previous substance use disorder and are considered opioid naïve, meaning they have no tolerance to opioids. This speaks to one of the key takeaways for National Fentanyl Awareness Day, which is making the public aware and helping them understand that - One Pill Can Kill.

It is also important to call attention to drug-dealers who may be exposing other drugs, including marijuana and stimulants such as cocaine, with fentanyl due to cross-contamination. Cross-contamination occurs when one drug, such as cocaine is contaminated with fentanyl. This can be intentional or unintentional. For example, a dealer may be packaging up fentanyl on a designated area and neglect to clean it before emptying and packaging another drug, such as marijuana on the same surface area. The consequence that follows is exposing an individual who intended to buy only marijuana with fentanyl, which could unfortunately result in a fatal fentanyl exposure or poisoning.

What needs to be done?

In addition to equipping many more people with life-saving rescue medications designed for overdoses caused by synthetic opioids such as fentanyl, it is imperative that people are educated about the dangers of fentanyl. They should learn about counterfeit, fentanyl-pressed pills,

adulterating or “lacing” other drugs such as heroin with fentanyl, and the risks with cross-contamination when a drug such as marijuana or cocaine inadvertently makes contact with IMF. This is vital to providing people with the knowledge they need to make informed choices that reduce their risks of unintentional death due to IMF.

Today, Orexo is joining the growing coalition of people and companies sharing information about this critical issue.

Written by Georgina Hoy