Fentanyl concerns on the rise, local pharmacist warns of abuse

In light of recent fentanyl seizures, local authorities are calling for a public education campaign on the dangers of using, or even coming into contact with, the illegal drug.

A recent report from the US Centers for Disease Control and Prevention stated that overdose deaths from fentanyl hit record levels in 2021 in the US and the death toll from abuse of the drug is continuing to mount.

Health Services Authority Chief Pharmacist Colin Medford says Cayman is not immune to the threat of fentanyl and the need for public education is pressing as Customs and Border Control agents have already thwarted attempts to smuggle the drug through local ports.

“To have a drug like this, or any drug at all, made accessible to lay persons or to young people or any person who is a user is a very dangerous thing. Once it gets out, once the horse gets out of the gate and starts to run wild, it’s very difficult to contain it again. It’s very difficult to curb it,” Medford said.

Ignorance can lead to death

Fentanyl, he said, is a major contributor to drug overdose deaths in the US and has surpassed quite a few of the other drugs, according to statistics from the California Department of Public Health.

“Based on preliminary 2021 data, there were 6,843 opioid-related overdose deaths in California; 5,722 of these deaths were related to fentanyl. So you can see the percentage there. It is huge,” he said.

However, the more startling impact, he said, was that in 2021 there were 224 fentanyl-related overdose deaths among teens aged 15 to 19.

I think education is key. It is key for adults and it is also key for our children. There are situations where education has made a difference. People become wiser to something and they avoid it, and it is not going to be a 100%, but I’m sure we’ll reach a lot of people who didn’t know. – HSA Chief Pharmacist Colin Medford

“That has been attributed to ignorance of what the drug is, what it can do, and also because of the way in which it was marketed to them. They just took it for granted and used it and killed themselves and that is the kind of fear that I have as far as this drug is concerned… someone may take one dose and that’s the end of it for them and the possibility of that is highly likely,” Medford said.

The CDC reported that 70,000 people in the US died of drug overdoses that involved fentanyl in 2021, a 24.1% increase over 2020.

Medford said he would not be able to say if Cayman has logged any fentanyl-related deaths, but education starts in the schools as it is one of the easiest places for trends to begin.

“I think education is key. It is key for adults and it is also key for our children. There are situations where education has made a difference. People become wiser to something and they avoid it, and it is not going to be 100%, but I’m sure we’ll reach a lot of people who didn’t know,” he said.

Likewise, he said, it will also reach people who might be using the drug and know the risks, but talking about it reinforces the fact that “you’re killing yourself and you need to do something about that”.

A problem we cannot ignore

Fentanyl, he said, is the most potent synthetic opioid on the market; it is about 50 to 100 times more potent than morphine and about 30 to 50 times more potent than heroin or dihydromorphine, which is described as a semi-synthetic opioid related to morphine.

With such a high potency, he said, there is a lot of concern as the adverse effects can occur quite rapidly, and with the illegal manufacture of the drug there is no way to tell what is being mixed with it or in what quantities.

It can also be absorbed through the skin which makes it a safety concern for those working on the front lines.

“The idea right now is to curb accessibility to this product as much as possible. Try as much as possible to catch it coming across our borders. That is going to be very difficult considering people are very creative when it comes to getting these things into countries,” he said, adding that traffickers will try a myriad of ways to evade Customs.

“I think our Customs staff here need to be commended because they’ve done a really good job at capturing quite a bit of drugs coming across our borders,” Medford said.

Incidents of fentanyl being seized by CBC officials have been on the rise, with the most recent on 24 Feb. 2023 when, during the inspection of a parcel at the Airport Post Office, officers discovered 200 Fentanyl tablets concealed in an incoming package.

Three people were arrested in connection with that seizure.

CBC Director Charles Clifford issued a statement after the most recent discovery, expressing concern about the incidents of fentanyl being seized.

“It is very worrying that we continue to see the deadly drug Fentanyl being imported into our country. It is well known that drug dealers will mix this drug with other street drugs prior to sale and therefore the consumer is sometimes unaware that they are consuming a cocktail of drugs that could instantly kill them. Consuming Fentanyl, even in a very minute quantity, can be fatal,” he warned.

Early last year, CBC seized a total of 288 Fentanyl tablets.

That seizure prompted a statement from Bruce Smith, CBC senior deputy director, who said, “Illicit Fentanyl is produced in clandestine labs and is often mixed with other drugs such as cocaine and heroin, which multiplies the danger and risk of sudden death from consuming it.”

Antidote issued, training under way

Medford, who has been holding training sessions for the CBC team to guard against accidental exposure, stressed that once they start it is very difficult to reverse the adverse effects in all of the people who have taken the drug.

“We can have as much of the Naloxone [which reverses an opioid overdose] as is available in the whole world. You’re not going to be able to reverse every person that has an adverse reaction. People will suffer, people will die. People will have long-lasting effects from the abuse of the drug,” he said.

Users and handlers of fentanyl have been known to experience symptoms such as haemorrhaging, severe physical pain and organ failure which often lead to death, according to a CBC statement issued last year.

Medford said even touching a fentanyl pill can trigger a reaction, which is why it is critical for local law enforcement officers not only to be trained, but also to be protected.

He said supplies of Naloxone (also sold as Narcan) have been procured for front-line staff to ensure their safety should there be any accidental contact during searches.

Medford added that abuse of prescription drugs is another area of concern globally and while Cayman has ethical prescribing and dispensing, there is a need to ensure legally that that remains the case, though fortunately such a problem does not exist here at the moment.

“[We need to] put things in place, meaning laws and regulations, to ensure that we keep Cayman safe as far as the regular dispensing is concerned because in many countries, dispensing and prescribing has gone wrong and we are no different. The possibility exists anywhere,” he said.