If heroin is coffee, fentanyl is espresso. Just as a minuscule cup of espresso can hype you up more than a whole mug of coffee, a single exposure to fentanyl can get a user vastly higher than injecting the same volume of heroin. In fact, the Centers for Disease Control and Prevention says fentanyl is 50 times stronger than heroin.

More widespread naloxone distribution, including to injection drug users and their families, is one way to combat the state- and nationwide increase in fentanyl-related deaths, suggests Gordon Smith, an epidemiologist with the WVU School of Public Health.

In a recent study funded by the National Institutes of Health, West Virginia University researchers Gordon Smith, Marie Abate and Zheng Dai found that fentanyl-related deaths are on the rise in West Virginia, even as deaths related to prescription opioids decline.

By analyzing all drug-related deaths in the state from 2005 to 2017, the research team—which included medical examiners from the West Virginia Department of Health and Human Resources—discovered that between 2015 and 2017, deaths from fentanyl were 122 percent of what they were between 2005 and 2014.

In contrast, prescription opioids played a role in 75 percent fewer deaths between 2015 and 2017 than over the previous 10 years.

Why did fentanyl-related deaths skyrocket in 2015? One factor was a surge in illegal fentanyl imports from China. “Up until then, people who were shifting from legal prescription drugs to illegal drugs were shifting to heroin and opioids coming in from Mexico and other places. But then people started manufacturing fentanyl in China, setting up clandestine labs, staying one step ahead of drug-enforcement agencies,” said Smith, an epidemiologist in the School of Public Health.

“The big thing about fentanyl—and now carfentanil, a fentanyl analog that’s a thousand times stronger than morphine and heroin—is that it’s very easy to export. Instead of having to smuggle truckloads of heroin in, someone can send small packages through the mail,” he said.

Another contributor is fentanyl’s potency itself. Smith explained, “You might need to take—let’s say—200 Tylenol before you get into some serious trouble, but with some other pain reliever, you might only need four of them because it’s so much stronger.”

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