Giving Compass' Take:

• Bryce Pardo, Jonathan P. Caulkins, and Beau Kilmer explain why treating the fentanyl crisis like a drug epidemic will prove ineffective: users are not intentionally taking fentanyl. 

• How can the fentanyl crisis be adequately addressed as a poisoning phenomenon within the drug epidemic? What role can donrs play in addressing this crisis? 

• Learn how the fentanyl supply flows into the U.S.

America's fentanyl problem is far deadlier than past crises with other illegal drugs. It also has a fundamentally different character. For most victims, fentanyl was not their drug of choice. Rather, they were poisoned by dealers who mixed it into baggies of heroin or pressed into fake-opioid tablets.

What is happening with fentanyl is unlike the trajectory of previous drug epidemics. Those typically involved “contagious” spread of initial use—primarily among those who may have been ignorant of the drug's risks. This was the case with prescription opioids, which were prescribed aggressively for chronic pain. Some individuals who sought pain treatment now have an opioid use disorder. So do others who got the pills from neighbors or friends for recreational use.

In the case of fentanyl, it is largely the suppliers—not users—who have embraced the drug because it is an ideal cost-cutting substitute. Synthetic opioids are produced in labs, so they are much cheaper than heroin—perhaps as much as 99% cheaper per dose after adjusting for potency. It's also easy to acquire. Anyone with an internet connection can purchase synthetic opioids that are most frequently made in China and delivered through the mail or by parcel service. Some Mexican crime syndicates trafficking heroin are also adding fentanyl to their portfolios.

Dealers add fentanyl, which is up to 100 times more potent than morphine, to heroin and counterfeit tablets made to look like genuine prescription medications. Adding a few milligrams gives a powerful kick; a few more turn deadly.

Most of the people exposed to—and dying from—fentanyl didn't think they were buying it and didn't want to use it.

In short, most of the people exposed to—and dying from—fentanyl didn't think they were buying it and didn't want to use it. Rather than increasing the number of users, fentanyl is driving up the death rate.

This distinction is important: It means our traditional methods for responding to drug epidemics won't reverse the death toll. Usually government agencies focus on preventing experimentation, reducing accessibility of drugs, and treating individuals to suppress demand. These efforts remain valuable, but they won't immediately curb overdose deaths in places that are drowning in fentanyl.

It is better to conceptualize the fentanyl problem like a poisoning outbreak. The poison is out there—but how can exposure to it be minimized? How can its spread to other regions be contained?

Read the full article about tackling fentanyl by Bryce Pardo, Jonathan P. Caulkins, and Beau Kilmer at RAND Corporation.