Dr. Gordon Smith, WVU

MORGANTOWN, W.Va. — The implications behind the 122 percent increase in fentanyl-related deaths between 2015 and 2017 suggest the opioid problem is “only getting worse,” according to WVU School of Public Health researcher Dr. Gordon Smith.

As this increase occurred, the death toll from prescription opioids decreased by 75 percent.

“Up until about 2015, most of the drug overdose deaths were related to prescription drug overdoses or to heroin,” he said. “And then all of a sudden, the heroin supply got contaniminated or they started adding fentanyl into it.”

The synthetic opioid fentanyl is 50 times more potent than heroin, Smith said.

“And, as a result, the drug was much more lethal than the earlier heroin and has greatly increased the number of overdose deaths,” he said.

The numbers are startling: all overdose deaths were fewer than 200 before 2016. Then in 2016, there were 358 fentanyl-related deaths. In 2017, that number increased in West Virginia to 553.

“The real issue here is that instead of truck and ship in large quantities of drugs, you are now able — because it was so concentrated and so potent — to just ship (fentanyl) in through the mail,” Smith said. “It’s much easier to smuggle this in, because it’s much more concentrated.”

“There was some way that you could order this stuff, even online, and have it shipped to people,” Smith said.

And, he added, there’s no quality control in the illegal drug trade. These opioids aren’t being mixed together in laboratories — meaning lethal doses are almost a certainty and can be sold alongside non-lethal doses.

“They could sit down on the kitchen or living room table and could mix (fentanyl) with the heroin to make the drug stronger and then just distribute it,” Smith said.

Smith was more upbeat on the notion of treatment and overcoming the addiction, but said that treatment plans are meaningless if we can’t stop people from overdosing on extremely powerful opioids.

“Even within the same batch, you might have very different amount of fentanyl in the little bags that were then distributed out for sale,” he said.

He added: “We want to stop people dying. The key thing is to stop people dying and then to get them into treatment, but if they’ve already died from a drug overdose they don’t even have the opportunity to get into drug treatment.”

He also expressed concern about carfentanil, another synthetic opioid with 1,000 times the potentcy of heroin. The WVU School of Public Health has been tracking exactly which drugs are causing overdose deaths in the state.

“We’re very concerned about changing over to methamphetamine, for example,” he said. “We’ve set up an ongoing system to be able to monitor what the drugs are that are causing people to die from drug overdoses. And, once we know the kind of drugs involved, we can better inform policy.”

One suggestion Smith had: potentially adopting what police and EMS use through fentanyl “test strips.” These test strips, which can be acquired in some areas of the country but are not widely available, can test the drug before it has an opportunity to end a life.

Additional research conducted by the School of Public Health indicates that there is enough reason to fear another type of epidemic — HIV or Hepatitis. That’s a particular concern in southern West Virginia, Smith said, due to injection-drug use.

“We’re really worried about the emergence of a potential HIV outbreak among this group,” Smith said. “We’re setting up programs to get better syringe exchange or needle exchange program, and also to screen people and get people tested so they can get treated.”

The National Institutes of Health funded the research of Smith, Dr. Marie Abate, and Dr. Zheng Dai.

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