[A Sip of Books] Why the Drug 'Pentanil' Is Especially Dangerous

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Drugs have emerged as a serious social problem. As drug transactions increase on the dark web and SNS, more people are getting involved with drugs, and the age of access is getting lower. More people than before are encountering drugs at a young age. According to the 2023 'White Paper on Drug Crimes' by the Supreme Prosecutors' Office, the number of drug offenders in Korea in 2022 reached a record high of 18,395. The situation overseas is even more severe. According to data from the U.S. National Institutes of Health, in 2021 alone, 70,601 people in the U.S. died from synthetic drug abuse such as fentanyl. The author, a professor at a national pharmacy university, thoroughly examines the context in which the fentanyl crisis occurred in the U.S., including the greed of giant pharmaceutical companies and institutional loopholes. From the story of Paul Janssen, who invented fentanyl, to the history of opioid-like substances such as morphine that made the creation of this drug possible, the book sheds light on humanity's long battle against drugs.

The country facing the most severe crisis due to fentanyl is the world's strongest nation, the United States. In the U.S., more than 100 people die from drugs every day, and most of these deaths are attributed to fentanyl. The reason for the vague term 'most' is that multiple types of drugs are often mixed and used. Therefore, authorities find it difficult to grasp the exact situation. However, there is no doubt that fentanyl is always involved.

What does 100 deaths per day mean in numbers? That is 3,000 people per month. For reference, 2,977 people died in the 9/11 terrorist attacks in 2001. In other words, the U.S. is experiencing a 9/11-scale event every month. Of course, the 9/11 attacks were visually shocking due to the horrific scenes of planes crashing into buildings, which is hard to compare with drug addicts quietly dying from respiratory failure across the country. But still, the number is too high. And it is increasing. The figure of 100 deaths per day is just an average over the past six years. According to recent data from the U.S. Centers for Disease Control and Prevention (CDC), 220 people die from drugs daily. The 9/11-scale event that happened once a month has now doubled to twice a month. - p.8-9, from "Introduction"

At the center of this crisis is ultimately the pharmaceutical companies. To make money, they exploited the system and targeted loopholes, putting the entire North American continent, including people like Monique, at risk. In Europe, which did not allow such changes, social problems caused by OxyContin have not emerged. Europeans are still satisfied with heroin. Of course, heroin is also a hopeless drug and should not be taken lightly. But it is hard to deny that the problems the U.S. is facing now are the result of their own actions. - p.51, from Chapter 1 "We Offer You Drugs 'We Offer You Drugs. 1995'"

How much fentanyl did the deceased forcibly take? The fentanyl patch prescribed to him at the time contained 8.4 milligrams of fentanyl as the active ingredient. This painkiller was designed to be absorbed slowly through the skin and act at a low concentration for three days, but he forcibly took it all at once, which caused his death. Is 8.4 milligrams a large amount? According to the U.S. Drug Enforcement Administration, just 2 milligrams of fentanyl can be lethal. So how much is 2 milligrams? It's about the size of an eyelash of a child. It's also the amount that fits on the tip of a pencil lead. The lethal dose of cyanide, a notorious poison, varies depending on the body weight of the person but is roughly around 200 milligrams. Simply by mass, fentanyl is about 100 times more dangerous. - p.74, from Chapter 2 "Fentanyl and the 21st Century Opioid War 'People Chewing Patches'"

Fentanyl is not entirely a bad substance. What medicine is simply good or bad? There are medicines that are used effectively and those that are not. If used properly, fentanyl is one of the best painkillers available. It has about 100 times the analgesic effect of morphine, is convenient to use in patch form, and is chemically easy to produce. When maintained at a low concentration, it dramatically improves the quality of life for patients suffering from surgical pain or those nearing death, which is almost magical. It is still used today for painless childbirth and cesarean sections. Banning this drug would inevitably cause significant problems. It is a double-edged sword. Fentanyl is an extremely dangerous but miraculous painkiller that must be used with proper knowledge. - p.75, from Chapter 2 "Fentanyl and the 21st Century Opioid War 'People Chewing Patches'"

Fentanyl also has its downsides. Like other opioid-derived painkillers such as morphine, it causes respiratory muscle paralysis. Fentanyl's effect is particularly severe, also causing rigidity of skeletal muscles. The risk of addiction remains. Because its analgesic effect is strong, its sedative and euphoric effects are also significant, increasing the potential for addiction. However, the drug was mostly known and used by medical professionals, so abuse was not widespread. It was difficult to obtain pills because there were few suppliers. At most, there were patches to apply to the skin. It was easier to get heroin. Therefore, problems caused by fentanyl did not become severe until people started chewing fentanyl patches. - p.84, from Chapter 2 "Fentanyl and the 21st Century Opioid War 'The Ultimate Painkiller'"

Looking at the bigger picture, supply follows demand, and a market forms. Until then, those seeking fentanyl were people legally prescribed patches. But as more people sought fentanyl, suppliers began providing it illegally in pill form. From the perspective of fentanyl addicts, pills were more convenient to consume than patches. Addicts also care about their health to some extent. They know not to eat patches.

Morphine or heroin can be extracted from opium or made with just one additional chemical process. Opium can be harvested from poppies growing in the chaos of war-torn Afghanistan. On the other hand, fentanyl must be chemically synthesized through multiple steps, which is more labor-intensive. Suppliers need chemical expertise to produce it, making it difficult. But if there is demand, the story changes. Although it involves several steps, once set up, it can be more efficient than cultivating poppies and producing opium in wide fields. Sometimes a factory is better than a farm. - p.92, from Chapter 2 "Fentanyl and the 21st Century Opioid War 'Drug Dealers'"

One reason drug addicts avoid hospitals is that to receive treatment, they must admit to drug use, which is illegal in Korea. Therefore, they fear being stigmatized as criminals rather than going to the hospital. However, this worry is unfounded. Laws have been revised to guarantee confidentiality so that treatment can be received safely. - p.244, from Chapter 5 "The Road Back to a Drug-Free Nation 'Addiction is a Disease'"

Prevention education is crucial. Looking at the U.S. case, fentanyl became a problem child because the market expanded due to the abuse of opioid painkillers represented by OxyContin in the 2000s. As the market grew, demand arose, and fentanyl began to rise in that gap. In other words, if the drug market is small from the start, fentanyl has no foothold. No demand means no supply. It would be better to suppress the supply, which was the initial cause of the fentanyl crisis, but that is beyond our control. We should do what we can ourselves. To do that, we need to reduce drug addicts, making prevention education important. - p.255, from Chapter 5 "The Road Back to a Drug-Free Nation 'Substance Use Disorder'"

The Great Drug Era | Written by Baek Seungman | Hippocrates | 296 pages | 18,000 KRW

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