Synthetic Opioids Have Public Health And Medical Investigators Playing Catch-Up

Unfamiliar Formulations And Vital Statistics Conventions Are Obstacles Amid Crisis
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Illustration by Scott Gordon; molecular structural formulas via Wikmedia Commons (public domain)

In late March 2017, Wisconsin saw its first death attributed to an overdose of carfentanil, a powerful drug that is legally used to anesthetize large animals like elephants and horses. It is one of a diverse array of potent synthetic drugs becoming more prominent in the opioid crisis, creating difficulties for medical investigators and public health officials seeking to better understand and in turn quell their abuse.

Some of these drugs are difficult to pinpoint simply because of their sheer novelty. While some opioids have legal applications and have properties known to medical science, others are synthesized and manufactured expressly for illicit use. Many of these new substances do not have scientific benchmarks for human medical use. Additionally, they're typically mixed with or confused for heroin or other substances, clouding the question of how they may affect a given drug user. These factors complicate the work of toxicologists and coroners who diagnose overdose deaths, who oftentimes lack access to technology that is sensitive enough to identify specific and potentially unfamiliar chemicals.

Understanding the impact of synthetic opioids likewise creates an obstacle in broader public health efforts to document overdose deaths by location and over time. Conventional systems for tracking overdose deaths can make it hard to document the roles of specific substances. Reliable death reporting also depends to some degree on local-level recordkeeping practices that are not necessarily consistent.

Meanwhile, synthetic opioids continue to spread in Wisconsin. Carfentanil contributed to more overdose deaths in Milwaukee in March and April, and the drug is suspected in another fatality in the Fox Cities.

On the May 3, 2017 edition of Wisconsin Public Radio's Central Time, host Rob Ferrett spoke with WisContext associate editor Scott Gordon about the increasing use of synthetic opioids and how their emergence challenges public health efforts to determine their impact.

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