April 21, 2006, was marked by an extreme number of overdoses in Camden, New Jersey, with reports of similar overdose outbreaks coming in from other parts of the state as well as from Maryland, Chicago, Detroit, and Philadelphia. The Detroit and Chicago overdoses occurred a few months earlier than those in Camden and elsewhere and, in the beginning, were attributed to illicit use of heroin.

An in-depth investigation involving the US Centers for Disease Control and Prevention (CDC) and the US Drug Enforcement Administration (DEA) has revealed that it wasn’t heroin that caused the overdoses after all. It was homemade fentanyl, officially called nonpharmaceutical fentanyl (NPF).

Fentanyl has been synthetically produced since the 1970s. In 1990, a pharmaceutical form of the chemical, marketed as the Duragesic transdermal patch, was approved for use in patients battling severe or chronic pain, thanks to its opioid-like properties.

Bootleg fentanyl is easy to make. No extensive chemical or technological knowledge or equipment is required and recipes are available on the internet. NPF is popular on the street because it produces effects that mimic those of heroin although NPF can be 30% to 50% stronger than heroin. Just one gram of fentanyl in its pure form can be converted into 7,000 doses ready for street sale.

When various forms of fentayl are tested before ingestion, chemical analysis reveals which samples are legally manufactured and which are homemade. Once either form of the chemical is taken, the ability to distinguish the homemade from the pharmaceutical samples is lost.

NPF sold on the streets is frequently mixed with cocaine, heroin, or both and is meant to be injected. During the period from early April 2005 to the end of March 2007, as many as 1,013 people were killed after taking NPF-laced drugs. June 2006 was the peak of the epidemic, with 150 deaths attributed to fentanyl use. By February and March of 2007, the death rate had dropped to just one each month.

Gender and age remain unknown in some of the NPF-overdose cases but the demographic breakdown of many of the victims of NPF overdose are:

• Age 35 to 54 years: 577 deaths (or, 58.6%)
• Male: 788 (80.1%)
• White: 545 (55.4%)
• Black: 392 (39.8%)
• Hispanic: 41 (4.2%)

DEA restrictions on access to fentanyl took effect in April 2007, after a joint task force of public health officials combined efforts to track the source of the multi-state string of overdoses. The widespread investigation identified NPF as a compelling factor in the overdoses. So far-reaching was the investigation that an NPF-producing operation in Toluca, Mexico, was shut down in May 2006.

Source: CDC