Health

Fear that Fentanyl is behind the laws that can lead to overdose


SWith the start of the United States’ declared drug war in 1971, various drugs have been identified as public enemy number one — from crack cocaine, in the 1980s, to prescription opioids in the early 1990s. 2000. Today, the main culprit is fentanyl, a synthetic opiate about 50 times stronger than heroin. In 2021, more than 71,000 won people in the United States have died from overdoses involving synthetic opioids — mainly fentanyl, according to interim data published by National Center for Health Statistics May 11.

Such a deadly drug requires a solid public health response, and fortunately, decades of evidence have shown that there are tools that can prevent overdoses, including the drug naloxone ( sold under the brand name Narcan). However, the fear of fentanyl and the desire to appear proactive are leading many state legislators to adopt approaches that have previously done more harm than good — namely, punitive policies aimed at incarceration. hold drug dealers and users for a long time, and contribute to mass incarceration. There is ample evidence that such policies are ineffective: for example, a 2018 analysis from Pew found that harsher penalties for drug possession did not reduce use or overdose, and Report of the National Research Council 2014 found that the increase in successfully prosecuted drug offenses did not clearly reduce drug use, and had mixed effects on Black and Hispanic communities.

As deaths related to opioids and especially fentanyl have increasedsome states have implemented harm reduction policies such as expanding access to opioid use disorder drugs, or legalization of fentanyl test strips and in some cases, making them available for free to make it easier for drug users to find out before it’s too late whether their medication has been adulterated with fentanyl. But at the same time, several states have passed or are currently considering new laws to strengthen penalties for drug crimes, many explicitly mentioning fentanyl. Mississippi, for example, recently passed a law As of July 1, additional penalties will be added if giving someone fentanyl results in death. Kentucky recently passed a law increased jail time required for those convicted of bringing fentanyl into the state with intent to sell or distribute. This March, Wisconsin legislation makes the “production, distribution or transportation” of any amount of fentanyl a felony.

Colorado is a particularly helpful case study. In 2020, 1,477 Coloradoans Died of a drug overdose, an increase of 38% year over year, an increase that the Colorado Institutes of Health attributes largely to fentanyl. In response, on May 11, the state legislature passed Fentanyl . Prevention and Liability Act, will expand access to drugs for opioid use disorder and allocate funds for fentanyl education. However, the proposed law would also make possession of more than one gram of the drug a felony if it contains any amount of fentanyl, which advocates say could make the overdose crisis a smoldering crisis. worse by sending users into hiding or putting them in jail.

Like crack cocaine before it — which is wrongly blamed for making users more violent — the focus on fentanyl is linked to fear and misinformation. In April, Colorado Public Radio Governor Jared Polis asked the Governor if he thought fentanyl possession becoming a felony in the state would lead to the same catastrophic results as the War on Drugs started by President Richard Nixon in the 1970s. in the US or not. “You have to treat fentanyl as a poison rather than a drug,” replied Polis, comparing it to anthrax. Indeed, local news across the states has been flooded with similar misinformation about fentanyl, including first responders stories people who claim to have overdosed on fentanyl through skin contact with patients who are taking it — although experts say that overdose is almost impossible.

Stories like this that allow politicians to paint fentanyl — and the road users in it — are particularly nefarious. But really, it’s a public health crisis – not a crime crisis. “What we need is to strengthen the things that we know to prevent people from dying of drug overdoses, and not continue to focus on the enforcement side, where we have little evidence to improve public health outcomes. professor of public health at West Virginia University.

Seen from the ground

One of the biggest fears among proponents of the law is that it will expand the detention of drug users, and contribute to the socioeconomic instability that often fuels addiction. and abuse in the first place. Colorado’s bill would only apply to people knowingly carrying more than one gram of any drug-containing substance, which assumes that carrying this amount means that the person is a dealer. “I would say the goal of this bill, if done properly, is not to put drug users in jail. The goal of this bill is to put drug dealers in jail,” said Colorado Attorney General Philip Weiser.

However, experts say there are many reasons why someone might carry more than a gram for personal use. First, the amount of fentanyl in street drugs can vary widely, meaning that it can be difficult for users to really know how much they are carrying. Also, compared to other opioids, fentanyl provides a shorter but stronger high, which means someone uses it several times a day to avoid painful withdrawals. That means they can buy as much as they can whenever they can — especially if they have limited mobility or live in a rural area.

Dr Sarah Axelrath, who treats Denver patients with substance use disorders, said Colorado’s attempt to separate “users” from “dealers” was based on “false discrimination”. Most of the drug traffickers she meets are users and are engaged in “subsistence drug distribution:” dealing in drugs to sustain their addiction and to satisfy their needs. basic demand. In such communities, the drug dealer is less likely to become a shadowy stranger than a trusted friend — and a buyer one day may be selling the next. That’s why about 225 drug users who use services at the Harm Reduction Action Center in Denver signed the “Do not prosecute” form, created by activist group Urban Survivors Union , to call on law enforcement, in this case. overdose, they do not pursue the person who provided the drug. The point they want to tell lawmakers is that when police arrest drug traffickers, “they’re not going to catch big drug dealers or the commonly envisioned gang,” said Center Director Lisa Raville. variable. It is family and loved ones” who are both buying and selling at the low end.

Harm reduction, not harm reduction

Experts fear that such laws being considered in Colorado would backfire, exacerbating the opioid epidemic. First, a person convicted of a felony and sentenced to prison for drug possession can become destabilized and lose their support system, making it difficult to overcome a substance use disorder. more and more difficult. Dr Joshua Barocas, an infectious disease physician and associate professor at the University of Colorado School of Medicine, said: “There is unintended and collateral damage that occurs with incarceration. That includes increased instability in housing, food, and access to work, all of which can lead opioid users to relapse.

Right off the bat, criminalizing fentanyl could prevent people from saving lives. When someone overdoses on an opioid, their best hope of survival is an injection of naloxone. But if the only person around doing treatment (or calling for help) is also an opioid user or seller (or both), they can waste precious minutes wavering before making a decision. Should I call for help or not, because I’m worried. arrest. “Overall, these kinds of laws promote drug use further underground,” said Robin Pollini, an associate professor of public health at West Virginia University. “The higher the penalties for drug use or the level of security around drug use, the less likely people are to be in public to get the services they need.”

Then there’s the potential for destruction of fentanyl which could lead to the emergence of even more dangerous drugs. One of the reasons fentanyl has become so dominant is that drug traffickers move through the punishment system more easily than other opiates — it can be made from common, alternative ingredients. because it was grown in a poppy factory, and it’s more compact, making it easier to transport and store. Currently, drug manufacturers are developing new and more dangerous chemical analogues of fentanyl that cannot be detected by drug tests.

Among Colorado health care providers who work with drug users and have known many who have died from overdoses, there is a sense that the proposed measure is a wasted opportunity. to invest state resources in tools that are actually proven to prevent overdoses. “The evidence is overwhelming that criminalization, felony crimes and incarceration will not reduce rates of substance use disorders or even recreational drug use, and it certainly will not,” Axelrath said. reduce mortality from drug overdose. “But we have things that work. And so it’s frustrating to see our resources put into interventions that we know from 50 years of research and practice are not working. “

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