Individuals in the Eastern Cape and KwaZulu-Natal have been identified as testing positive for fentanyl, a synthetic painkiller that has played a significant role in the opioid epidemic in the United States (US). This powerful drug is responsible for numerous fatalities each year in the US, particularly affecting individuals in their 20s and 30s. While legally prescribed, the increase in opioid-related deaths in the US mainly stems from fentanyl manufactured illegally and distributed by drug syndicates.

Until recently, South Africa appeared to be insulated from the problem of illicit fentanyl. However, recent research suggests that fentanyl has begun to penetrate the streets. Though the study is ongoing, lead researcher Dr. Alanna Bergman has shared some initial findings with GroundUp.

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Bergman, an American nursing scientist, received backing from Johns Hopkins University to introduce highly accurate urine drug tests. In February, she commenced testing at clinics in East London, Port Elizabeth, and Durban.

The individuals tested were patients with drug-resistant TB who were part of a different research project. Nurses suspected that a significant number of this group might be using drugs.

Several factors may contribute to this issue. One is the high rate of HIV infections among South Africans who inject drugs, primarily due to needle sharing. This results in a weakened immune system, heightening the risk of active TB.

In response to this situation, Bergman was invited to conduct voluntary drug testing at these clinics. In line with the nurses’ expectations, her tests uncovered that 60 out of 100 patients had tested positive for illicit drugs, with 32 specifically showing positive results for fentanyl.

Medical records indicated that none of these patients had been prescribed legal fentanyl. Surprised by these findings, Bergman obtained more tests, which she has been administering since October.

“I believe we now have 320 individuals that we’ve tested,” Bergman explains, “The rate of fentanyl positivity remains elevated. Daily, a few more individuals join the sample. My observations show that anywhere between 25 and 33% test positive for fentanyl at any given time.”

Bergman’s research represents one of the first direct assessments revealing fentanyl use in South Africa. Nonetheless, indicators of a potential issue have already surfaced. For instance, a largely overlooked 2021 study analyzed wastewater at several Gauteng treatment plants and identified biological markers for fentanyl in the sewage at each facility.

Another sign is a recent series of police reports concerning fentanyl, as highlighted by Daily Maverick here.

What is fentanyl?

Fentanyl is classified as an opioid medication (similar to codeine and heroin). It was developed as a potent pain reliever and can be administered in forms such as pills, patches, lozenges, or injections.

In South Africa, it is sometimes used for medical procedures, such as an epidural during childbirth. It may also be prescribed for chronic pain that cannot be managed by less potent medications, mirroring its use in other countries.

Some individuals misuse the drug to attain a high, as it can produce feelings of euphoria and relaxation. Like other opioids, prolonged use can result in physical dependence. With a potency rated at 30 to 50 times greater than that of heroin, it carries significant risks. There is a slender margin between a dose sufficient for a high and one that could be fatal.

In the US, the epidemic is mainly connected to illicitly manufactured fentanyl, which, according to the US Drug Enforcement Agency, is produced in China. This includes pills (commonly referred to as Blues) as well as powders that can be snorted or injected. Canada has also faced an illicit fentanyl crisis.

Are people using fentanyl by accident?

In North America, some individuals who use drugs unintentionally consume fentanyl without realizing it. A study conducted in Canada indicated that approximately three-quarters of those who tested positive for fentanyl were unaware that they had ever ingested the substance. This often occurs because fentanyl is commonly mixed with other drugs, such as heroin. According to one study, this is likely done to “minimize the amount of heroin needed per dose” given fentanyl’s higher potency.

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Researchers believe a similar scenario may be unfolding in South Africa, though the scale remains unknown.

Shaun Shelly, a drug policy researcher from South Africa, remarked to GroundUp: “I don’t believe anyone in South Africa is intentionally seeking out fentanyl; who here is aware of what that is?” He suggests that individuals testing positive for fentanyl likely thought they were purchasing heroin.

Bergman noted that some individuals who tested positive for fentanyl also had morphine in their systems (as heroin metabolizes into morphine). However, she added that “the majority are solely positive for fentanyl.” This implies that in some cases, fentanyl may have replaced the heroin supply, rather than merely being used as a cutting agent. Additional research will be needed for confirmation.

If the adulteration or replacement of fentanyl is indeed occurring, reversing this trend could be difficult. “Fentanyl offers a distinctly different experience when compared to heroin,” Shelly explains. “Users become accustomed to fentanyl, and eventually, that is the only substance that can achieve their desired state.”

He further elaborates that when fentanyl is mixed with heroin, it often “clumps,” leading to uneven distribution. Consequently, “a person could consume a dose from one batch and be fine, while the next dose could be life-threatening, depending on the concentration of fentanyl in that second serving.”

Urgent action required from government

To prevent widespread overdoses, researchers emphasize the urgent need for government intervention. Bergman recommends a fundamental measure: expanding the distribution of naloxone, a drug designed to counteract opioid overdose without any risk of addiction.

The World Health Organization advocates for naloxone distribution to anyone likely to witness an opioid overdose, including emergency personnel and the friends or family of drug users.

“Public health and safety education will also be vital,” Bergman stresses. For instance: “Avoid using [drugs] alone. It’s crucial to have someone present who can administer overdose reversal.”

“These are the most basic, readily achievable steps,” she concludes.

© 2024 GroundUp. This article was first published here.

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