As authorities cracked down on prescription opioids and then on heroin, the black market offered up fentanyl as a substitute. Fentanyl – a synthetic opioid up to 50 times as strong as heroin and 100 times as strong as morphine – was developed for use as an anesthetic in the sixties. It is currently classified as a Schedule II narcotic, and it is used medicinally in end-of-life care.

Fentanyl, although similar to heroin, is far deadlier. As little as six grains of salt worth of fentanyl can be lethal if ingested. Fentanyl is often mixed with heroin and other narcotics sold on the street because it is cheap yet potent – leading many unsuspecting users to overdose. The National Institute on Drug Abuse reported that in 2017, 59.8 percent of opioid-related deaths nationally involved fentanyl, up from 14.3 percent in 2010.

US officials believe most of the illicit fentanyl in the US is produced in illegal labs in China. Customs and Border Patrol experts believe fentanyl from these labs flows into the US though three major pipelines – from China to Canada to the US, from China to Mexico to the US, and from China directly to the US. Fentanyl is primarily transported through the mail after being bought and sold over the dark web, but shipments are sometimes routed through less-suspicious countries like Canada.

Fentanyl seizures by Customs and Border Patrol have grown steadily from 2015. After the first six months of fiscal year 2019, CBP is on pace to match fiscal year 2018’s fentanyl seizures.

Fentanyl is highly concentrated, so even small shipments are highly profitable and deadly. A lethal dose of fentanyl is about three milligrams – so one smuggled kilogram contains over 333,000 lethal doses. Because fentanyl can be produced in large quantities at a high potency, it is among the cheapest and most prevalent illicit opioids in the US – and in Kentucky.

By the numbers, methamphetamine seizures in Kentucky grew more than cocaine, heroin, and fentanyl between 2013 and 2017. Fentanyl seizures during this same period grew by nearly 145 times – from 17 seizures in 2013 to nearly 2,500 seizures in 2017. Both trends are concerning, but fentanyl poses different problems for law enforcement and users than methamphetamine.

Not only is fentanyl use growing more rapidly than methamphetamine use, fentanyl is also more lethal than methamphetamine. Fentanyl, or a fentanyl derivative, was involved in nearly three times as many overdoses in Kentucky as methamphetamine in both 2016 and 2017 even though methamphetamine seizures were over five times greater during these years.

Methamphetamine use is spread relatively evenly across the state, and in 2014 and 2015, fentanyl overdoses appeared to be distributed similarly. In 2016, fentanyl overdoses began to cluster in the main city centers – Lexington, Louisville, and Northern Kentucky. This trend continued into 2017.

While legislation and law enforcement have slowly addressed prescription opioids and heroin, the opioid problem in Kentucky is far from over - in fact, the new culprit is cheaper and dangerously more potent. Government action to address this new crisis must be mindful of what narcotics could take fentanyl's place.

This is the second part in our series on the drug crises that emerged while the nation focused on the prescription opioid and heroin crises.

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