The vast majority of the opioid overdose deaths in Massachusetts this year have been associated with fentanyl, according to the state’s Department of Public Health.
Bryce Pardo of the RAND Corporation has worked with national, state and local governments on crime and drug policy. Pardo spoke with WGBH Radio’s Jeb Sharp about fentanyl and how it’s finding its way to drug users here in Massachusetts.
Jeb Sharp: Bryce, most of us had never heard of fentanyl until pretty recently. What is fentanyl and what’s it used for?
Bryce Pardo: Fentanyl has been around for about 60 years. It’s a very potent, fast-acting synthetic opioid. It is something that’s been used for quite some time in surgeries, as well as a very strong painkiller. In the last five or six years, it has started to make its way into the illicit drug market, heroin markets in particular. This is the fifth outbreak of fentanyl in illicit drug markets. The first was as early as 1979, but those earlier outbreaks were pretty much limited by the fact that chemists who could actually synthesize or manufacture fentanyl often didn’t have the means with which to distribute it in illicit markets. And that’s all changed in the last six years with the arrival of cheaply produced products coming from China.
Sharp: What are the implications of that for trying to fight it at the local level?
Pardo: So that means we need to start thinking more innovatively about how to reduce the risk of overdose, like expanding access to naloxone is very important. Extracting individuals from these markets very quickly is also important. RAND last year put out a pretty substantial report looking at the evidence base regarding prescription heroin. This is a very controversial policy intervention, but there’s some good research, randomized controlled trials, looking at individuals who have been assigned heroin versus individuals randomly assigned methadone. And when you look at the outcomes, indeed you see that individuals that are receiving prescription heroin — are given heroin, have to come in two or three times a day and receive the medication and use under supervision, they’re on-site — you see that their health outcomes are improved, their psycho-social outcomes are better than those receiving methadone. And then furthermore, they stop sourcing heroin from the illicit street market. And that really is key here, since that’s where the exposure to fentanyl is coming in.