Worldwide, about 500 000 people die annually due to drug use. More than 70% of those deaths are related to opioids, 30% of which are caused by overdose.1 The addiction crisis has worsened due to the proliferation of the synthetic opioid fentanyl, which is attracting more people 40 and under.2 Complicating matters, new, even more deadly synthetic opioids, such as xylazine are entering the global illicit drug market.3
Ending the flow of illicit drugs has proven to be difficult. Between July 2022 and January 2023, for example, U.S. authorities seized about 2,200 pounds of fentanyl -- more than they grabbed in all of 2018.4 Even so, they believe they are netting just 5% to 10% of the fentanyl coming in from Mexico. Maybe less.
A Different Approach
Public health and medical professionals, some lawmakers, and even law-enforcement officials believe it’s time to focus on prevention and treatment of those with opioid use disorder rather than prison time. Careful usage of medications can be a start. Some progress can already be seen. For example, in the United States, the percentage of emergency department (ED) visits in which an opioid was prescribed at discharge fell from 12.2% in 2017-2018 to 8.1% in 2019-2020.5
Some medications, such as buprenorphine, have been shown to reduce opioid misuse and decrease the risk for injection-related infectious diseases and overdoses. But they present hurdles for medical and public health professionals due to policy and safety considerations.6 Fentanyl’s potency has meant that patients transitioning to buprenorphine experience excruciating symptoms known as “precipitated withdrawal.”7 Often, the discomfort is so severe that patients give up on buprenorphine altogether. That said, researchers report that giving patients who are beginning buprenorphine treatment tiny doses of ketamine -- an anesthetic used both medicinally and recreationally and that has hallucinogenic effects at high doses -- has all but eliminated their withdrawal symptoms.
Public health and medical professionals, some lawmakers, and even law-enforcement officials believe it’s time to focus on prevention and treatment of those with opioid use disorder rather than prison time.
How About a Cease-Fire?
Rather than criminalize illicit drug usage, some countries have opened overdose prevention centers, or OPCs, which are designed to provide safe places for those living with substance abuse.8 In these centers, people can consume drugs with sterile equipment under the supervision of trained staff. More than 200 OPCs operate in 14 countries.
Distributing fentanyl test strips to opioid users is another way to reduce the risk of overdose.9 These low-cost strips of paper can detect the presence of fentanyl in different drugs (cocaine, methamphetamine, heroin, etc.) and drug forms (pills, powder, and injectables).
Applying a clinical universal-precautions approach could help drive culture change among healthcare providers.10 Standard interventions which every clinician could offer in every interaction with a person at risk of overdose include:
• Offering medications to individuals interested in reducing their use or managing overdose risk. (There’s work to be done here, as only 22% of people in the U.S. with opioid use disorder receive medications.11)
• Providing naloxone to people who use drugs and ensure training in its proper use.
• Offering take-home fentanyl test strips.
• Counseling people who use drugs on how to reduce their risk of fatal overdose (e.g., never use when alone, start with a small amount of a drug to assess its potency, and avoid mixing opioids and other sedatives.)
All patients receiving opioids should be routinely monitored for signs of misuse, abuse and diversion. The ARK™ Fentanyl Assay from Sekisui Diagnostics is intended for the qualitative detection of fentanyl in human urine at a cutoff concentration of 1 ng/mL.
The ARK Tramadol Assay from Sekisui Diagnostics is a homogeneous enzyme immunoassay intended for the qualitative and/or semiquantitative determination of tramadol in human urine at a cutoff concentration of 100 ng/mL. Tramadol is a centrally acting opioid analgesic that is prescribed for the management of moderate to moderately severe pain in adults.
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