South Africans Testing Positive for Fentanyl: The Arrival of a Powerful Opioid
Individuals in the Eastern Cape and KwaZulu-Natal have been identified as testing positive for fentanyl, a synthetic painkiller that has been pivotal in the opioid epidemic in the United States (US). This potent drug has led to numerous fatalities annually in the US, particularly impacting those in their 20s and 30s. While it can be legally prescribed, the surge in opioid-related deaths in the US is mainly attributed to fentanyl produced illegally and trafficked by drug syndicates.
Until recently, South Africa seemed to be shielded from the illicit fentanyl problem. However, emerging research indicates that fentanyl has started to infiltrate the streets. Although the study is ongoing, lead researcher Dr. Alanna Bergman has shared some preliminary findings with GroundUp.
Bergman, an American nursing scientist, received support from Johns Hopkins University to bring in highly accurate urine drug tests. In February, she initiated testing at clinics located in East London, Port Elizabeth, and Durban.
The individuals tested were patients with drug-resistant TB who were under observation for a different research project. Nurses suspected that a significant portion of this group might be using drugs.
Several factors may contribute to this situation. One is the high rate of HIV infections among South Africans who inject drugs, primarily due to needle sharing. This leads to a compromised immune system, increasing the likelihood of active TB.
In response to the situation, Bergman was invited to perform voluntary drug testing at these clinics. Aligning with the nurses’ expectations, her tests revealed that 60 out of 100 patients tested positive for illicit substances, with 32 specifically testing positive for fentanyl.
Medical records indicated that none of these patients had been prescribed legal fentanyl. Astonished by these findings, Bergman procured more 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 is among the first direct assessments revealing fentanyl use in South Africa. Nonetheless, there have already been indicators of a potential issue. For instance, a largely underappreciated 2021 study investigated wastewater at several Gauteng treatment plants and discovered 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 (similar to codeine and heroin). It was developed as a powerful pain reliever and can be administered in forms such as pills, patches, lozenges, or injections.
In South Africa, it is occasionally utilized for medical procedures, such as an epidural during childbirth. It may also be prescribed for chronic pain unmanageable by less potent medications. This mirrors its application in other countries.
Some individuals misuse the drug to achieve a high, as it can induce a state of euphoria and relaxation. Like other opioids, prolonged use can lead to physical dependence. With a potency rated at 30 to 50 times greater than that of heroin, it poses significant risks. There is a narrow margin between a dose sufficient for a high and one that could be fatal.
In the US, the epidemic is primarily associated with illicitly manufactured fentanyl, which the US Drug Enforcement Agency asserts is produced in China. This includes pills (commonly referred to as Blues) as well as powders that can be snorted or injected. Canada has also experienced an illicit fentanyl crisis.
Are people using fentanyl by accident?
In North America, some individuals who use drugs inadvertently consume fentanyl without realizing it. A study conducted in Canada indicated that approximately three-quarters of those who tested positive for fentanyl were not aware that they had ever ingested the substance. This often occurs because fentanyl is frequently mixed with other drugs, such as heroin. According to one study, this is likely done to “minimize the amount of heroin needed per dose” given fentanyl’s higher potency.
Researchers believe a similar scenario may be unfolding in South Africa, though the scale remains uncertain.
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 posits that individuals testing positive for fentanyl likely believed they were purchasing heroin.
Bergman pointed out that some individuals who tested positive for fentanyl also had morphine present in their systems (as heroin metabolizes into morphine). However, she adds that “the majority are solely positive for fentanyl.” This suggests that in some incidents, fentanyl may have supplanted the heroin supply, rather than just being a cutting agent. More research will be required for substantiation.
If the adulteration or substitution of fentanyl is indeed occurring, reversing this trend could be challenging. “Fentanyl offers a distinctly different experience compared to heroin,” Shelly notes. “Users become accustomed to fentanyl, and eventually, that is the only substance that can achieve their desired state.”
He further explains that when fentanyl is mixed with heroin, it often “clumps,” leading to uneven distribution. Therefore, “a person could consume a dose from one batch and be fine, while the next dose could be life-threatening, depending on the concentration of fentanyl in that second serving.”
Urgent action required from government
To avert widespread overdoses, researchers stress the need for swift government action. Bergman suggests a fundamental measure would be to broaden the distribution of naloxone, a drug intended to counteract opioid overdose without any risk of addiction.
The World Health Organization advocates for 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 emphasizes. For instance: “Avoid using [drugs] alone. It’s critical 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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