Where does the deadly drug fentanyl come from?

SANDUSKY — Fentanyl — a drug synonymous with fatal overdoses — does have several approved medical uses, like pain relief and anesthesia. But that fentanyl and the fentanyl causing scores of drug deaths are not one and the same. Various versions of the drug exchanged between dealers and drug users are different than what would be used in a hospital. "Most of what you see is not prescription fentanyl, it's synthetically made in a lab," said Jon Sprague, a toxicologist at Bowling Green State University. "It's not someone taking patches or prescription drugs, it's clandestinely made fentanyl." Videos of officers passing out from casual contact with loose fentanyl powder and state health officials sending warnings about fentanyl-laced marijuana are not uncommon. Local statistics illustrate well enough the danger and lethality of fentanyl. In 2020, 144 people overdosed in Erie County, and according to an Erie County Health Department opioid assessment, fentanyl contributed to at least 20 of the fatal overdoses in the area. With the community already on high alert, a local police chief and an area toxicologist both encouraged more education on the deadly substance. What's misunderstood is exactly what kind of fentanyl is killing people at such alarming rates. Jon Sprague, a toxicologist at Bowling Green State University explained that fentanyl, and new kinds of it, are being produced at rapid rates. "There are so many different forms of it out there," Sprague said. "We don't even know how potent it is." Fentanyl hit Ohio's illicit drug market in 2017 and five years later still has a heavy presence in local communities. In February, a New London resident was arrested on a traffic stop with nearly 30 grams of the drug and earlier this month Sandusky police caught a man shoving "a large amount" of suspected fentanyl in his toilet. Sandusky police seized over 100 grams of fentanyl during a traffic stop on Wednesday. It's unlikely either of these instances involved prescription fentanyl. Sprague said the fentanyl being passed between dealers and buyers is like an altered Xerox of its medical grade "pure" form. Sprague, who is also the director of science and research for the Ohio Attorney General's Office, said most of the United States' fentanyl comes from China and Mexico. "It's not easy to make like meth," Sprague said. "You have to have a chemistry background and knowledge, they are made in labs in China mostly and then shipped to the U.S." China banned the sale of fentanyl in 2019. Sprague said that, after the ban, traffickers began producing new analogues of fentanyl to sidestep the law. By dressing fentanyl in different forms, sellers can slip the disguised drug to the United States and Mexico without being flagged. "The traffickers in China will modify fentanyl into something else so what you made is suddenly no longer illegal under the ban," Sprague said. Sprague said it is like putting a mask on the illicit chemical core, the overall chemical makeup may have changed but fentanyl core is still present. "The costume we put on fentanyl doesn't make everything better," Sprague said. "It's just a mask, they just modify certain parts of the structure." Another strategy is selling the drug precursors, or as Sprague put it, the ingredients. "It's like making cookies, you have to have flour, sugar, and eggs," Sprague said. "In this case you need to have each component, each molecule needed to create fentanyl. Those are the precursors used to make fentanyl." Because the chemical ingredients weren't banned, dealers will ship precursors in "DIY" fentanyl kits to buyers in the States. "You can modify those precursors," Sprague said. "You can ban it, but traffickers will continue to play that game just by modifying those ingredients," Sprague said. The same method was used in the production of illicit bath salts. In 2015, The Supreme Court passed a law called the Federal Analogue Act, to address the crop up of these "designer drugs". The act bans substances that have a "chemical structure" which is "substantially similar" to a controlled substance. All iterations of fentanyl are illegal in the United States, 20 variants have been identified in Ohio. Sprague said the analogues are rushing into Ohio communities quickly. Para-fluorofentanyl, a particularly strong analogue, first popped up in the state in October of 2020, since then it has shown up 70 of Ohio's 88 counties. Para-fluorofentanyl has become prevalent in Sandusky recently, according to Sandusky police chief Jared Oliver. Oliver said that as dealers and traffickers cut product with mixtures that include fentanyl analogues, "pure" drugs are becoming obsolete. "It's very rare we see pure fentanyl and pure heroin," said Oliver. "It is usually a combination." Analysis reports that come back from Bureau of Criminal Investigation show lethal mixtures even in small amounts of drugs seized by police. Sandusky police have seen and uptick in fentanyl and meth, often mixed together, said Oliver. "Normally what we see is heroin, fentanyl and meth," Oliver said. "Anyone of those combinations is lethal." Drug users are in increasing danger with these new compounds, often buyers aren't given what they've bought. Sandusky police have tested substances that return as deadly composites of meth, cocaine, fentanyl and tramadol, another opioid pain-relief drug. "You could think you're purchasing one thing, and this is what you're getting," Oliver said. "In less than three-tenths of a gram, something that small has that combination." One sample sent for analysis at BCI contained four different fentanyl analogues, all in a single two-gram gray substance. Sprague said labeling these specific synthetic variants as simply "fentanyl" is misleading and offsets the actual danger that fentanyl analogues pose. The danger of most of the newer analogues is still relatively unknown, Sprague said that the physiological effects of fentanyl variants is not well documented. "The problem is how does someone on the street know what they are getting, they haven't been tested clinically," Sprague said. "We don't know their potency. Unfortunately, oftentimes the way you find out is someone overdosing on it." Carfentnail spiked in Ohio in 2017, the drug killed 1,000 people in the state according to the Department of Health. That analogue is 100 times stronger than prescription fentanyl and has led to trials in three separate manslaughter cases in Huron County this year. "Of all the overdose deaths we're seeing, almost all of these are synthetic forms of fentanyl," Sprague said. He stressed that people take that lesson to heart to avoid more unnecessary deaths. "Knowledge is empowering," Sprague said. "If you can understand what's happening you can do something about it."