The Unyielding Grip of Fentanyl on America's Streets: A Pharmacist's Perspective
Independent pharmacists, health care providers, community leaders, and law enforcement must all work together to address the fentanyl epidemic.
In recent years, the US has witnessed a devastating surge in drug-related deaths, with 107,941 lives claimed in 2022 alone.1 According to the CDC, fentanyl and other synthetic opioids are responsible for approximately 70% of these fatalities, making fentanyl the nation's most urgent drug threat.2 The crisis is particularly acute in the Kensington neighborhood of Philadelphia, where the streets have become a stark battleground in the war against drug abuse.
As an independent pharmacist, I have seen firsthand the havoc that fentanyl wreaks on individuals and communities. Fentanyl, a powerful synthetic opioid, is up to 50 times more potent than heroin and 100 times more potent than morphine. Even a minuscule dose of 2 mg can be fatal. The Drug Enforcement Administration (DEA) has reported that the average fentanyl pill seized contains 2.4 mg of the drug, with some containing as much as 9 mg.3 This potency, combined with its increasing presence in other illicit drugs, has led to a dramatic rise in overdose deaths.
Independent pharmacists have a role to play in addressing the current fentanyl crisis. | Image credit: Darwin Brandis - stock.adobe.com
The problem is exacerbated by the fact that fentanyl is often mixed with other synthetic opioids or sedatives such as xylazine, a veterinary drug, making it even more dangerous. In 2023, 30% of the fentanyl powder seized by the DEA contained xylazine, up from 25% in 2022.4 These mixtures increase the risk of overdose and complicate the efforts of first responders to save lives, as traditional opioid overdose treatments such as naloxone may not be as effective against these drug combinations.
In Philadelphia's Kensington neighborhood, the fentanyl crisis is particularly severe. Once known for its vibrant community, Kensington is now infamous for its open-air drug markets and rampant addiction. The neighborhood has become a microcosm of the larger opioid epidemic, with fentanyl at the center of the chaos. Streets are littered with the remnants of addiction: discarded needles, crumpled packets, and the hollowed eyes of those who have fallen prey to the drug's deadly allure.
READ MORE: Pharmacists Should Adapt Harm Reduction Efforts to Address Unregulated Substances
For pharmacists working in or near these hard-hit areas, the challenge is immense. We are on the front lines, dispensing medications that can save lives, but also witnessing the heartbreaking consequences of addiction. Every day, we see patients struggling with substance use disorders, some of whom are seeking help, while others are spiraling deeper into their addiction. The presence of fentanyl in so many illicit drugs has made the situation even more precarious, as users often don't know what they are taking. This uncertainty increases the risk of overdose, particularly for those who are not regular opioid users.
The DEA's efforts to combat the fentanyl crisis are substantial. In 2023, the agency seized 13,176 kilograms (29,048 pounds) of fentanyl powder, nearly double the amount seized in the previous 2 years.3 Additionally, more than 79 million fentanyl pills were confiscated, almost triple the number seized in 2021.3 Despite these efforts, the flow of fentanyl into the United States continues, fueled by international drug cartels with deep ties to precursor chemical companies in China and money laundering organizations.
The digital age has also transformed the drug trade. Social media platforms and encrypted messaging apps have become new avenues for drug dealers, allowing them to reach customers without ever meeting face-to-face. This shift has pushed drug dealing off the streets and into the digital realm, making it harder for law enforcement to track and intercept these transactions. As a result, fentanyl is now more accessible than ever, reaching communities across the country, including those where drug abuse was once a rarity.
The situation in Kensington is a stark reminder of the broader challenges we face in addressing the fentanyl crisis. As pharmacists, we must advocate for stronger measures to control the distribution of prescription opioids and increase access to life-saving interventions like naloxone. Education is also critical: We need to ensure that both healthcare providers and the public are aware of the dangers of fentanyl and the importance of proper medication management.
However, the solution to this crisis extends beyond the pharmacy counter. It requires a comprehensive approach that includes law enforcement, public health initiatives, and community support. We need more resources for addiction treatment, mental health services, and programs that address the social determinants of health, such as poverty and homelessness, which are prevalent in areas like Kensington.
The fentanyl crisis is a complex and multifaceted problem that demands our immediate attention. As an independent pharmacist, I see the toll it takes on individuals and communities every day. We must work together—pharmacists, health care providers, law enforcement, and community leaders—to combat this epidemic and save lives. The streets of Kensington and countless other neighborhoods across the country depend on our collective action.
Brian Walker, RPh, is a registered pharmacist with over 33 years of clinical experience. He has worked across nearly every aspect of pharmacy, and for the last 18 years has been the owner of Delmar Pharmacy in Folcroft, Pennsylvania
READ MORE: Substance Use Disorder Resource Center
References
Provisional data shows US drug overdose deaths top 100,000 in 2022. CDC. National Center for Health Statistics. May 18, 2023. Accessed August 29, 2024. https://blogs.cdc.gov/nchs/2023/05/18/7365/
Fentanyl. CDC. Reviewed May 7, 2024. Accessed August 29, 2024. https://www.cdc.gov/overdose-prevention/about/fentanyl.html
DEA releases 2024 National Drug Threat Assessment. News release. Drug Enforcement Administration. May 9, 2024. Accessed August 29, 2024. https://www.dea.gov/press-releases/2024/05/09/dea-releases-2024-national-drug-threat-assessment
Statement from DEA Administrator Anne Milgram on the increase in DEA fentanyl seizures containing xylazine. Drug Enforcement Administration. April 26, 2024. Accessed August 29, 2024. https://www.dea.gov/documents/2024/2024-04/2024-04-26/statement-dea-administrator-anne-milgram-increase-dea-fentanyl
