
Individuals in the Eastern Cape and KwaZulu-Natal have been found to test positive for fentanyl, a synthetic painkiller that has played a crucial role in the opioid crisis in the United States (US). This powerful drug has resulted in numerous fatalities each year in the US, particularly affecting individuals in their 20s and 30s. Although it can be prescribed legally, the increase in opioid-related deaths in the US is largely linked to fentanyl that is illegally manufactured and trafficked by drug syndicates.
Until recently, South Africa appeared to be insulated from the illicit fentanyl crisis. However, emerging research suggests that fentanyl has begun to permeate the streets. While the study is ongoing, lead researcher Dr. Alanna Bergman has shared some initial findings with GroundUp.
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Bergman, an American nursing scientist, received assistance from Johns Hopkins University to introduce highly precise urine drug tests. In February, she commenced testing at clinics in East London, Port Elizabeth, and Durban.
The individuals tested were patients with drug-resistant TB who were being monitored for a different research project. Nurses suspected that a significant portion of this group might be using drugs.
Several factors may contribute to this scenario. One is the high prevalence of HIV infections among South Africans who inject drugs, primarily due to needle sharing. This compromises the immune system, thereby increasing the likelihood of active TB.
In light of this situation, Bergman was invited to conduct voluntary drug testing at these clinics. Aligning with the nurses’ expectations, her tests indicated that 60 out of 100 patients tested positive for illicit substances, with 32 specifically testing positive for fentanyl.
Medical records confirmed that none of these patients had been prescribed legitimate fentanyl. Surprised by these results, Bergman acquired additional tests, which she has been administering since October.
“I believe we now have 320 individuals that we’ve tested,” Bergman explains, “The rate of fentanyl positivity remains elevated. Daily, a few more individuals join the sample. My observations show that anywhere between 25 and 33% test positive for fentanyl at any given time.”
Bergman’s research represents one of the first direct assessments revealing fentanyl use in South Africa. Nevertheless, there have already been signs of a potential issue. For example, a largely overlooked 2021 study explored wastewater at several Gauteng treatment plants and found biological markers for fentanyl in the sewage at each facility.
Another indicator is a recent series of police reports concerning fentanyl, as summarized by Daily Maverick here.
What is fentanyl?
Fentanyl is classified as an opioid medication (analogous to codeine and heroin). It was developed as a potent pain reliever and can be delivered in various forms, such as pills, patches, lozenges, or injections.
In South Africa, it is occasionally used for medical procedures, such as an epidural during childbirth. It may also be prescribed for chronic pain that cannot be managed by less potent medications, similar to its use in other countries.
Some individuals misuse the drug to achieve a high, as it can induce euphoria and relaxation. Like other opioids, prolonged use may lead to physical dependence. With a potency rated at 30 to 50 times greater than that of heroin, it poses significant dangers. There exists a narrow margin between a dose capable of producing a high and one that might be fatal.
In the US, the epidemic is primarily tied to illicitly manufactured fentanyl, which is reportedly produced in China, according to the US Drug Enforcement Agency. This includes pills (often referred to as Blues) and powders that can be snorted or injected. Canada has also been facing an illicit fentanyl crisis.
Are people using fentanyl by accident?
In North America, some individuals using drugs may inadvertently consume fentanyl without their knowledge. A study in Canada found that approximately three-quarters of those who tested positive for fentanyl were unaware that they had ingested the substance. This often happens because fentanyl is frequently mixed with other drugs, such as heroin. One study suggested this is done to “minimize the amount of heroin needed per dose” due to fentanyl’s higher potency.
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Researchers suspect a similar scenario may be occurring in South Africa, although the extent remains unclear.
Shaun Shelly, a drug policy researcher from South Africa, commented to GroundUp: “I don’t believe anyone in South Africa is intentionally seeking out fentanyl; who here is aware of what that is?” He suggests that individuals testing positive for fentanyl likely thought they were purchasing heroin.
Bergman noted that some individuals who tested positive for fentanyl also exhibited morphine presence in their systems (as heroin metabolizes into morphine). However, she adds that “the majority are solely positive for fentanyl.” This implies that in some cases, fentanyl may have substituted the heroin supply instead of simply being a cutting agent. Further research will be necessary for confirmation.
If the adulteration or substitution of fentanyl is indeed happening, reversing this trend could pose significant challenges. “Fentanyl offers a distinctly different experience compared to heroin,” Shelly observes. “Users become accustomed to fentanyl, and eventually, that is the only substance that can achieve their desired state.”
He elaborates that when fentanyl is mixed with heroin, it often “clumps,” resulting in uneven distribution. Therefore, “a person could consume a dose from one batch and be fine, while the next dose might be life-threatening, depending on the concentration of fentanyl in that second serving.”
Urgent action required from government
To prevent widespread overdoses, researchers emphasize the need for immediate government action. Bergman suggests a fundamental step would be to expand the distribution of naloxone, a medication designed to counteract opioid overdose without any risk of addiction.
The World Health Organization promotes naloxone distribution to anyone likely to witness an opioid overdose, including emergency personnel and the friends or family of drug users.
“Public health and safety education will also be essential,” Bergman stresses. For example: “Avoid using [drugs] alone. It’s crucial to have someone present who can administer overdose reversal.”
“These are the most basic, readily achievable steps,” she concludes.
© 2024 GroundUp. This article was first published here.
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