A couple years ago, when local news agencies reported a spike in overdose deaths related to fentanyl in St. Paul, Minnesota, clinicians at an outpatient treatment clinic in that city saw an immediate effect.
"A dozen of our patients disappeared," says Dr. Marvin Seppala, chief medical officer of the Minnesota-based Hazelden Betty Ford Foundation. "They'd been in treatment from six weeks to two years and were sober." The patients dropped out of the program to try fentanyl, a synthetic opiate painkiller that was new to the area. "Nobody in their right mind would want to get near fentanyl, which is 50 to 100 times more powerful than morphine and up to 50 times stronger than heroin," he says. "Our patients heard about fentanyl and thought, 'I want to try that.' They wanted to recapture the euphoric high they hadn't felt since they'd started using."
Luckily, Seppala says, none of these patients died during their relapses. Still, the anecdote helps explain why the deadly opioid epidemic is getting worse; the grim fact is that some people with opioid use disorder are drawn to substances they know might kill them – and not because they're suicidal. The pull helps explain the growing death toll the opioid crisis is exacting. Every day, more than 115 people in the United States die of an opioid overdose, according to the National Institute on Drug Abuse. More than 64,000 people died of drug overdose in the U.S. in 2016, and the lion's share of those fatalities – more than 42,000 – involved opioids, a record number, according to the Centers for Disease Control and Prevention. Opioid overdoses in recent years have claimed the lives of acclaimed actor Philip Seymour Hoffman and the musicians Prince and Tom Petty. Opioids include heroin and prescription medications such as hyrdrocodone, oxycodone, oxymorphone, morphine, codeine and fentanyl. Lately, authorities have seen carfentanil – which is typically used to tranquilize elephants and other large animals – show up on the street. Carfentanil is about 100 times more potent than fentanyl and 10,000 times stronger than morphine, according to the Drug Enforcement Administration.
The grim fact is that for many people with opioid use disorder, the lethality of a particular batch of drugs isn't a deterrent – it's an attraction, says Howard Samuels, chief executive officer of The Hills Treatment Center in Los Angeles. Samuels, 60, speaks from experience: He's been in recovery from heroin addiction for more than 30 years...