Fentanyl’s Unwavering Grip on America’s Streets: A Pharmacist’s Perspective

In recent years, the number of drug-related deaths in the US has increased dramatically, with 107,941 people dying in 2022 alone.¹ According to the CDC, fentanyl and other synthetic opioids are responsible for about 70 percent of these deaths, making fentanyl the most urgent drug threat facing the country.² The crisis is particularly acute in Philadelphia’s Kensington neighborhood, where the streets have become a battleground in the fight against drug abuse.

As an independent pharmacist, I have seen firsthand the devastation 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 deadly. The Drug Enforcement Administration (DEA) reports 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 increase in overdose deaths.

Independent pharmacists play a role in tackling the current fentanyl crisis. | Image: Darwin Brandis – stock.adobe.com

The problem is compounded by the fact that fentanyl is often mixed with other synthetic opioids or tranquilizers such as xylazine, a veterinary drug, making it even more dangerous. In 2023, 30% of fentanyl powder seized by the DEA contained xylazine, up from 25% in 2022.⁴ These mixtures increase the risk of overdose and make it harder for emergency 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 acute. Once known for its vibrant community, Kensington is now notorious 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 packages, and the hollow eyes of those who have succumbed to the drug’s deadly allure.

READ MORE: Pharmacists must adapt harm reduction efforts to tackle unregulated substances

For pharmacists working in or near these hard-hit areas, the challenge is immense. We are on the front lines, providing life-saving medications, but we also witness the heartbreaking effects of addiction. Every day, we see patients struggling with substance use disorders, some seeking help, while others spiral deeper into addiction. The presence of fentanyl in so many illicit drugs has made the situation even more dire, as users often don’t know what they are taking. This uncertainty increases the risk of overdose, especially 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 two years.³ In addition, more than 79 million fentanyl pills were seized, almost three times as many as in 2021.³ Despite these efforts, the flow of fentanyl into the United States continues, fueled by international drug cartels with close ties to Chinese chemical companies 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 them in person. This shift has pushed drug trafficking 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 wider challenges we face in tackling 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 such as naloxone. Education is also key: we must ensure that both healthcare providers and the public are aware of the dangers of fentanyl and the importance of good medication management.

But the solution to this crisis goes 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, like 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 neighborhoods across the country depend on our collective action.

Brian Walker, RPhis a registered pharmacist with over 33 years of clinical experience. He has worked in almost every aspect of pharmacy and has been the owner of Delmar Pharmacy in Folcroft, Pennsylvania for the past 18 years

READ MORE: Substance Use Disorders Resource Center

References

1. Preliminary data shows U.S. drug overdose deaths to 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/

2. Fentanyl. CDC. Reviewed May 7, 2024. Accessed August 29, 2024. https://www.cdc.gov/overdose-prevention/about/fentanyl.html

3. DEA Releases 2024 National Drug Threat Assessment. Press 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

4. Statement by DEA Administrator Anne Milgram on Increase in DEA Fentanyl Seizures with 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