Drug users aren't choosing dangerous fentanyl — they don't know what's in their drugs

Fentanyl poisonings from accidental overdoses are not a result of drug users seeking out a more powerful opioid, and in fact users choice seems to have little to do with the presence of fentanyl on the market. A new study suggests that instead, the prevalence of the powerful synthetic opioid and its analogues has to do with decisions made by drug suppliers and wholesalers.

This in turn suggests that strategies aimed at convincing drug consumers to avoid fentanyl, and enforcement at the bottom end of the drug trade will have little effect on the catastrophic toll the drug is taking.

Last year, fentanyl was implicated in three quarters of the four thousand opioid overdose fatalities recorded in Canada. The numbers in the US were proportional, with about 29,000 deaths attributed to fentanyl and similar potent synthetic opioids.

Understanding the fentanyl 'market'

Dr. Sarah Mars, the qualitative project director on the Heroin in Transition Study at the University of California San Francisco, was part of a team that interviewed drug users about their experiences and understanding of fentanyl.  

• Paper in Addiction

The particular lethality of fentanyl seems to be a result of the fact that it is generally sold on the street as generic "heroin" or as counterfeit opioid pills, and so drug users have no reliable way of estimating its potency and adjusting their dose accordingly.

The interviews Mars and her colleagues collected suggested that because street level drug sellers and users had no good idea what was in their drugs, they could neither seek out fentanyl if they preferred it, nor could they avoid it if they disliked it or feared overdosing on it. 

Supply, not demand is driving the drug

This led them to conclude that street-level demand for fentanyl had little to do with it's presence on the illegal drug market. 

Instead, it seemed that fentanyl was being introduced into street drugs by dealers and wholesalers up the chain, despite the lack of demand and the lethal toll it was taking on their customers.

They speculate this was because partly because lab-manufactured fentanyl provided a more reliable supply of product than traditional heroin harvested from opium poppy, which was subject to the fluctuations of any agricultural product. Fentanyl was also more compact and thus traffickers could ship it at lower risk of detection, seizure and arrest.