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Continuation of December Newsletter Feature Article

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Counterfeit fentanyl, not heroin or prescription opioids, identified as cause for spike in overdose deaths

A surge in counterfeit fentanyl supply from drug cartels south of the border and criminal enterprises in China, coupled with discounted street prices to addict new users, has contributed to the spike in overdose deaths.    

Addiction treatment professionals are seeing more patients presenting for OUD treatment. Most drug screens, obtained on admission to treatment, are negative for opiates (such as heroin and morphine) and prescription opioids (such as Oxycodone and Oxycotin) but positive for fentanyl.

 

More than 70 percent of patients presenting for OUD treatment started their opioid use with fentanyl, not heroin or prescription opioids. Fentanyl is 50 times more potent than heroin, according to the National Institute of Drug Abuse. This is why we have a full-blown crisis on our hands.

Comprehensive national strategy needed

 

Attempts to address this urgent and mounting drug epidemic and public health threat have failed. The most damning proof of this is the unprecedented spike in fentanyl overdose deaths. 

We need a comprehensive national strategy, informed and led by addiction treatment providers on the ground, to aggressively tackle the root causes and issues that contribute to, exacerbate, and drive the current epidemic.

Hacking at the roots of the problem

 

For example, we need to take aim at excessive and counterproductive regulation of the delivery of OUD treatment at the federal and state level. Opening a treatment program in New Jersey requires the review and approval of U.S. Substance Abuse Mental Health Services Administration, U.S. Drug Enforcement Administration, New Jersey Department of Health, New Jersey Division of Mental Health and Addiction Services, and local zoning boards. Dealing with multiple agencies is bad enough, but what’s worse is that agencies’ regulations are misaligned, creating confusion and uncertainty for applicants.

 

The regulatory compliance burden consumes countless hours and staff resources and added costs. The addiction treatment community estimates, conservatively, that 65 percent of all program costs are attributable to regulatory compliance alone. These regulations contribute little to no value to the quality of treatment. This waste of precious resources limits access to needed treatment for patients.   

Another major challenge is that government and insurance-industry funding of treatment programs is short-sighted and ill-conceived. It focuses on harm reduction, which is failing miserably. Replacement therapy – employing other medications – is also failing because of barriers to access. Poorly administered but overly regulated programs have also plagued progress.

 

A significant drawback is also the flawed perspective and approach that federal and state governments, as well as insurers have when it comes to funding treatment. They only fund short-term treatment for OUD programs. Additionally, they often refuse to support proven therapeutic strategies such as sober housing despite evidence of their efficacy. Yet effective treatment, like that for all other chronic illnesses such as diabetes or heart disease, requires not only a long-term horizon but also a full commitment of necessary resources. 

Interdiction is another serious challenge. DEA’s efforts to curb the supply of fentanyl are failing. The street price of the drug has dropped. This has caused increased access and boosted opioid use. 

Given this confluence of factors and forces, it is surprising that we have not experienced more tragic deaths and damaged lives because of the exploding fentanyl use. We cannot ignore what is happening. It’s time to develop a comprehensive national strategy that is led by those with the knowledge and experience and who work to prevent deaths and save shattered lives every day.

Jeffrey A. Berman, M.D., DFASAM is a psychiatrist specializing in addiction medicine and addiction psychiatry. The Medical Director of SOBA New Jersey and a faculty member in the Department of Psychiatry at Rutgers Robert Wood Johnson Medical School, he is a Past President of the New Jersey Society of Addiction Medicine, and an Advisory Board Member of CCSA.