In November of this year, there were seven reported deaths from heroin overdoses in the Upper Valley. All of them had used heroin laced with a drug called Fentanyl, an opioid sometimes mixed with heroin to make the latter more potent. Dr. Ben Nordstrom, director of addiction services at Dartmouth Hitchcock Medical Center, has had extensive experience with the drug.
Fentanyl, in the medical field, is usually used for sedation purposes and pain control. Nordstrom explains that it’s technically a schedule two drug, which means the DEA recognizes it to have some medical benefits. Although Fentanyl isn’t prescribed outside of a hospital for patients to take at home, like Vicodin or Oxycodone, it is available in some forms for take-home use.
Nordstrom says that most common take-home option for Fentanyl is a transdermal patch, allowing users to absorb the drug through the skin. The patch is designed as a pain killer, but can be misused.
“There are lots of ways people can get Fentanyl as a home prescription; it just doesn’t look the same as it does when it’s being used in an intensive care setting,” Nordstrom explains. "It’s still a restricted drug, but there is a supply out there.”
According to an article from Seven Days, Vermont saw 12 Fentanyl-related deaths in 2013 — this is roughly two times the number of cases recorded in the last five years — and 11 in the months preceding the November 2014 overdoses.
Nordstrom explains that Fentanyl, which is more potent than heroin, binds to the same receptor that heroin does, meaning it can be used to strengthen or “punch up” the effect of the heroin. It can also work to stretch out a limited heroin supply.
“The difficulty with [Fentanyl] is because the end user has no idea what’s in it … they wind up not being able to calculate the risks that they’re assuming," Nordstrom says.
Norstrom explains that a typical bag of heroin weighs between one and 25 milligrams. But Fentanyl is measured in fractions of a milligram, meaning that potentially fatal doses of Fentanyl can be much smaller than dangerous doses of drugs like morphine or heroin. And it’s impossible to tell if a batch of heroin has Fentanyl in it without extensive laboratory testing, which makes it easy to overdose, Nordstrom says. “Because Fentanyl is so potent, you can take even small amounts and have big effects."
“It’s not one of the most commonly misused drugs because the access is so restricted, relative to things like Oxycodone and Vicodin, but there are still people who seek it out and misuse it,” says Nordstrom. He does note that Fentanyl is one of the "most commonly diverted drugs" by healthcare professionals.
But hospitals do have strict accounting measures set by the DEA to keep tabs on medication supplies and transactions, Nordstrom says, including how medications are stored, used, who took the drug, how much they took and whether the drug was actually given to the patient. If the patient did not receive the full amount taken by the healthcare professional, the DEA requires a witness be present to watch the drug be disposed of, to make sure it’s not being diverted.
“Hospitals do an awful lot to make sure [Fentanyl] doesn’t get used for any purpose other than it’s intended,” Nordstrom says. But unfortunately, that's not always the case.