Individuals in the Eastern Cape and KwaZulu-Natal have been reported as testing positive for fentanyl, a synthetic painkiller that has played a crucial role in the opioid epidemic in the United States (US). This powerful drug has resulted in numerous fatalities each year in the US, particularly affecting those in their 20s and 30s. While it can be legally prescribed, the rise in opioid-related deaths in the US is largely attributed to fentanyl produced illegally and trafficked by drug syndicates.
Until recently, South Africa appeared to be insulated from the illicit fentanyl issue. However, emerging research suggests that fentanyl has begun to penetrate the streets. Although the study is still in progress, lead researcher Dr. Alanna Bergman has shared some preliminary insights with GroundUp.
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Bergman, an American nursing scientist, received support from Johns Hopkins University to introduce highly accurate urine drug tests. In February, she launched testing at clinics in East London, Port Elizabeth, and Durban. The individuals tested were patients with drug-resistant TB who were being observed for another research project. Nurses suspected that a notable percentage of this group might be using drugs.
Several factors could contribute to this situation. One is the high rate of HIV infections among South Africans who inject drugs, primarily due to needle sharing. This results in a compromised immune system, elevating the risk of active TB.
In response to the situation, Bergman was invited to conduct voluntary drug testing at these clinics. Aligning with the nurses’ expectations, her tests showed that 60 out of 100 patients tested positive for illicit substances, with 32 specifically testing positive for fentanyl.
Medical records revealed that none of these patients had been prescribed legal fentanyl. Shocked 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, more individuals are joining 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 signs of a potential issue. For example, a largely overlooked 2021 study investigated wastewater at several Gauteng treatment plants and found biological markers for fentanyl in the sewage at each site.
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 created as a powerful pain reliever and can be administered in various forms like 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. This mirrors its use in other countries.
Some individuals misuse the drug to achieve a high, as it can induce feelings of euphoria and relaxation. Like other opioids, long-term use can lead to physical dependence. With a potency rated at 30 to 50 times greater than that of heroin, it poses substantial risks. The margin between a dose sufficient for a high and one that could be lethal is very narrow.
In the US, the epidemic is mainly connected to illegally manufactured fentanyl, which the US Drug Enforcement Agency claims is produced in China. This includes pills (commonly referred to as Blues) and powders that can be snorted or injected. Canada has also faced 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 suggested that approximately three-quarters of those who tested positive for fentanyl were unaware that they had ever ingested the substance. This often occurs because fentanyl is commonly mixed with other drugs, such as heroin. According to one study, this likely happens 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 unfolding in South Africa, although the scale remains uncertain.
Shaun Shelly, a drug policy researcher from South Africa, told GroundUp: “I don’t believe anyone in South Africa is intentionally seeking out fentanyl; who here is aware of what that is?” He argues that individuals testing positive for fentanyl likely thought they were purchasing heroin.
Bergman noted 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 implies that in some cases, fentanyl may have replaced the heroin supply, rather than merely being a cutting agent. More research will be necessary to confirm this.
If the adulteration or substitution of fentanyl is indeed occurring, reversing this trend could be difficult. “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 provide their desired state.”
He further explains that when fentanyl is mixed with heroin, it often “clumps,” resulting in uneven distribution. Consequently, “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 prevent widespread overdoses, researchers emphasize the urgency of government action. Bergman proposes that a fundamental step would be to expand the distribution of naloxone, a drug designed to counteract opioid overdose without any risk of addiction.
The World Health Organization advocates for naloxone distribution to anyone likely to encounter an opioid overdose, including emergency responders and the friends or family of drug users.
“Public health and safety education will also be crucial,” Bergman stresses. For example: “Avoid using [drugs] alone. It’s essential 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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