JONESBORO, AR (KAIT) - Fentanyl is a drug that is showing up more and more in conversations about the opioid epidemic in the United States.
The powerful Schedule II narcotic has been found in states across the country, including Southeast Missouri, where police seized $3 million worth of pure Fentanyl.
Both doctors and law enforcement in Region 8 are now issuing warnings about the drug because it can be very deadly, even to touch.
"The big deal is that Fentanyl is anywhere from 50 to 100 times more potent than morphine or even heroin," said Dr. Shane Speights, dean of the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University.
The New Hampshire State Crime Lab released a graphic showing the difference in potency.
It takes 30 milligrams of heroin to kill an average-sized man, but it only takes 3 milligrams of Fentanyl.
In fact, Fentanyl is still measured in micrograms in the medical setting.
"It's used largely in the operating room and it's used post-operatively," Dr. Speights said. "So, it may be a medication that's given in an IV form to an individual who is undergoing a major surgery."
The Federal Drug Administration has also said that Fentanyl can also be prescribed for chronic cancer pain that isn't being relieved with traditional opioids.
"But that's truly a very small percentage of the population," Dr. Speights said. "Maybe 2% to 3%."
Man of the problems associated with this drug come from illegally manufactured versions of it.
"What we're hearing is that these are made in the clandestine labs and they're not actually the pharmaceutical," an undercover Drug Task Force agent told Region 8 News. "Now, that it is obviously here because we do have patients in this area that are on Fentanyl patches and have a legitimate need for Fentanyl, so there is some misuse that's going on with that. But as far as a larger scale, it's going to be the illicit, clandestine lab-made Fentanyl."
The agent said local officers have not found Fentanyl during traffic stops or home searches yet, but that doesn't mean the drug hasn't made it's way to Arkansas yet.
"It's here and it's only a matter of time before we do come across it," the agent said.
The DTF and other law enforcement agencies across the state are preparing for the reality of finding pure Fentanyl, which is dangerous because many versions of the drug are transdermal, meaning it is absorbed into the bloodstream through the skin.
"We're going to have to better inform our officers because, I mean, merely touching this stuff can kill you, accidentally inhaling it, any of these things," the undercover agent said. "So, it's going to be something that we have to prepare for in-depth and train our officers as well as the public."
Its deadly touch isn't the only reason that Fentanyl is more dangerous than other drugs that officers see every day, though.
Law enforcement's biggest defense against overdose deaths is naloxone, better known by the brand name Narcan.
It can stop an overdose from most opioids and even heroin when administered in time, but Fentanyl is different.
"Fentanyl binds and attaches itself very tightly to those receptors in the brain and it doesn't want to get knocked off, so it takes large doses of the naloxone to actually counteract the Fentanyl," Dr. Speights said. "So that's an issue where even sometimes you can still have death when the patients get the medication in a timely fashion because it takes so much of that antagonist or that medication. It doesn't really do the job."
What doctors and police both realize is that Fentanyl is just part of a more significant problem: an opioid epidemic that is gripping the entire country.
Just last month, President Donald Trump declared it a public health emergency.
"About 25% of the patients who are on a narcotic or are prescribed an opioid will misuse that medication to some degree," Dr. Speights said.
That misuse can be a variety of things, including using more of the medication than they should, giving the medicine to others who it is not prescribed for, or selling the pills on the street.
While a nationwide problem, the Centers for Disease Control and Prevention shows Arkansas has an even higher rate of addiction than the national average, the second highest in the country.
In 2016, the state had a rate of 114.6 prescriptions per 100 people.
The United States average is 66.5 prescriptions per 100 people.
Northeast Arkansas has an even worse outlook with nearly all of the counties showing more than 112 prescriptions per capita.
Greene County has the highest prescribing rate in the state with 177.8 pills dispensed per capita.
"I'll be the first to tell you that physicians bear some of the blame in terms of prescribing," Dr. Speights said.
But doctors are trying to combat this rising problem.
"One of the best things that we have at our disposal these days, and it's kinda new, it just came down the pipeline a few years ago, is the prescription drug monitoring program," said Dr. Nicholas Guinn with St. Bernards Healthcare. "That allows us to look online in real time and see what kind of prescriptions patients have gotten as far as opioids and other scheduled drugs."
Dr. Guinn said it's a tool that doctors utilize every day. They typically check the database each time they prescribe a narcotic like opioids or a benzodiazepine, which includes Xanax.
"It allows us to gauge how many pills a patient may be taking, it allows us to gauge if they are seeing multiple providers and trying to get more prescriptions than they really should, and it can give us a sense as to whether or not the patient is taking the medication appropriately or inappropriately," Dr. Guinn said.
He also said doctors should be prescribing opioids at the lowest effective dose they can and having those patients back into the office before ordering refills on the prescription.
"Something we typically do is have patients, especially those with chronic pain who are taking opioids, we have them come back monthly or at least every 3 months to assess how they're doing with their pain levels and their ability to function appropriately," Dr. Guinn said. "Because that's the ultimate goal with some of these pain medications is being able to reduce their pain and improve their function so that they have a decent quality of life."
Dr. Speights does have a theory about why Northeast Arkansas is facing this opioid crisis at such a high rate: a shortage of doctors.
Arkansas has one of the lowest numbers of physicians per capita in the country.
Dr. Speights believes that if there were more doctors, patients would be monitored better.
"The more providers we have in these areas, these rural areas like Arkansas is, the better we can get that education out there to prevent that," Dr. Speights said.
But the danger that Fentanyl poses likely won't be fixed by the methods these doctors discussed.
"A lot of these things start out with someone needing a legitimate prescription and then, you know, opioids have a strong dependency, not only a mental but physical dependency," the Drug Task Force agent said. "The brain has receptors that grab that opioid and when you don't have it anymore, you need it. The natural progression is going to be to something stronger, something stronger, something stronger."
So people who can no longer get the opioid prescription, and who continue to seek that stronger fix, could unknowingly get a deadly one instead.
"And now these heroin dealers, they're putting Fentanyl in their heroin to make it stronger and that's not good for someone who is used to ingesting a certain amount of heroin, now they're ingesting that heroin laced with Fentanyl," the agent said.
"So individuals that are getting illegal heroin may not know from their drug dealer whether it's laced with Fentanyl or not," Dr. Speights said. "If they get heroin laced with Fentanyl that's where you get the lethal dose of the medication that causes the deaths."
The DTF agent is confident that Region 8 officers are being trained to handle Fentanyl, but he said they also need the community's help.
"A lot of the times that is our part, we have to make people criminally responsible for their actions," he said. "But in my opinion, I would rather see someone get help than I had see them go to prison or affect their children any worse."
He said community members need to recognize the symptoms of people with secret opioid addictions and get them help.
Those symptoms of addiction include uncontrollable cravings, inability to control opioid use despite negative effects on relationships or finances, small pupils, shallow breathing, slurred speech, and sensitivity to pain.
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