You may not have heard of fentanyl five years ago, but chances are you're more than familiar with the musicians whose deaths it has contributed to. Jessica Dale investigates the issue and how deadly the drug can be.
In the past ten years, some of the highest profile deaths in the music industry have all had one thing in common. No, it's not just superstardom, best-selling records or critical acclaim that ties the likes of Prince, Tom Petty and Michael Jackson together; it's the fact that they all had the opioid fentanyl in their systems at the time of death. So, what is fentanyl and why is its use on the rise?
"Fentanyl is like the nuclear option of opioid. It's one of the strongest drugs you can be prescribed," says Laura Bajurny, spokesperson for the Alcohol & Drug Foundation (ADF). "Fentanyl is a wholly synthetic opioid, so you don't need to have access to an opium poppy plantation in order to manufacture it.
"Because of the fact it's synthetic, it's also considerably stronger than its natural analogues. It's about 80-to-100 times more powerful than the morphine you'd be given in a hospital. It's scary-strong."
Amanda Roxburgh is a senior research officer and coordinator at the National Illicit Drug Indicators Project through UNSW's National Drug & Alcohol Research Centre (NDARC) and spends her time analysing drug use and trends in Australia.
"In probably about 2006 in Australia, it was actually expanded out to the use for the treatment of chronic, non-cancer pain, so then that's why we started seeing an increase in prescribing of fentanyl in this country," she explains.
According to the ADF, medicinal fentanyl is available in three main categories, although their forms and strengths vary — transdermal patches (Durogesic and generic versions), lozenges/lollipops (Actiq) and intravenous injection (Sublimaze).
Additionally, to these prescribed, pharmaceutical options, fentanyl can also be obtained illegally through illicitly manufactured versions (referred to as fentanyl analogues), as well as extracted from the transdermal patches to then be injected.
So far in Roxburgh's studies, illicit fentanyl use is still low in Australia. According to the 2017 Illicit Drug Reporting System survey study, which found of drug injecting users surveyed, just 9% nationally had injected pharmaceutical fentanyl in the past six months.
The risks between using legally and illegally produced fentanyl is easy to understand, but what should be made clear is that, according to Bajurny, "a lethal dose of fentanyl is about two milligrams," which carries a risk for both variants of the drug.
In the case of Tom Petty, who passed away in October 2017, the Los Angeles County Medical Examiner ruled that he died from "multisystem organ failure due to resuscitated cardiopulmonary arrest due to mixed drug toxicity".
As well as noting that Petty also had coronary artery atherosclerosis and emphysema, they found fentanyl, oxycodone, temazepam, alprazolam, citalopram, acetyl fentanyl and despropionyl fentanyl in the musician's body at his time of death.
"Our family sat together this morning with the Medical Examiner - Coroner's Office and we were informed of their final analysis that Tom Petty passed away due to an accidental drug overdose as a result of taking a variety of medications," shared Petty's wife Dana and daughter Adria in an official statement. "Unfortunately, Tom's body suffered from many serious ailments including emphysema, knee problems and most significantly a fractured hip…"
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"On the day he died, he was informed his hip had graduated to a full-on break and it is our feeling that the pain was simply unbearable and was the cause for his over-use of medication. We knew before the report was shared with us that he was prescribed various pain medications for a multitude of issues including fentanyl patches and we feel confident that this was, as the coroner found, an unfortunate accident."
"If people have underlying issues in terms of cardiac problems or liver function problems then that's also going to complicate their ability to process the drug through their liver," explains Roxburgh. "And so, it will actually mean that it's definitely a risk marker for overdose."
According to a 2016 report from the Australian Bureau of Statistics, drug-induced deaths caused by "other synthetic narcotics" - which categorises opioids fentanyl, tramadol and pethidine - was at 68 people in 1999, dropped to 19 people in 2007 and then rose up to 234 in 2016, making it the sixth most common cause of death that year - with benzodiazepines the leader, followed by opioids including oxycodone/codeine, psychostimulants with abuse potential (amphetamine, ecstasy, MDA, MDMA, speed, methamphetamine, ice, caffeine), heroin and other and unspecified antidepressants.
While death caused by fentanyl is still relatively low in Australia, compared to the 663 deaths caused by benzodiazepines in 2016, it's the potential influence of illicitly produced fentanyl analogues that holds great risk for the future.
"It's just really important to be clear, because they're really different drugs with obviously a really different harm profile," explains Roxburgh when comparing the differences between pharmaceutically and illicitly produced fentanyl. "And we're obviously wanting to be very vigilant for the fentanyl analogues hitting this country."
"British Columbia [Canada] has such a fentanyl crisis they've declared it a public health emergency. It's terrifying. Nine months in 2017, they had over 1,000 fatal overdoses in that one province alone," shares Bajurny.
"The police seizure data has found traces of fentanyl in every single type of drug except for cannabis, so that's MDMA, that includes cocaine. People who are not expecting to get an opioid drug are winding up accidentally overdosing."
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