WASHINGTON—Taking further steps to slow the rate of deaths from opioids, the Drug Enforcement Administration (DEA) is placing all fentanyl-related substances under emergency Schedule I controls.
Fentanyl is a synthetic opioid 50 times more powerful than heroin and 100 times more potent than morphine.
The substance is manufactured primarily in China and shipped to the United States. It is being mixed with heroin or pressed into fake painkiller pills made to look like real prescription drugs. Fentanyl was originally developed for use in hospitals as a painkiller during surgeries.
“In addition to the 16 fentanyl analogues that we have already sought to control, we’ve notified our Health and Human Service colleagues of our intent to place emergency Schedule I controls on the entire class of fentanyl-related substances,” said Robert Patterson, acting DEA administrator, on Nov. 29.
“This scheduling action is critical … because our investigations reveal efforts by some traffickers to change the molecular structure of fentanyl in an attempt to thwart law enforcement and evade prosecution in the United States.”
Schedule I drugs, substances, or chemicals are defined as drugs with “no currently accepted medical use and a high potential for abuse,” according to the DEA.
Examples include heroin, LSD, marijuana, ecstasy, and peyote. Most opioid prescription painkillers—such as Vicodin, Dilaudid, and OxyContin—are classified as Schedule II controlled substances.
The widespread introduction of fentanyl into America’s illicit drug market has pushed overdose deaths to an all-time high. More than 64,000 Americans died of a drug overdose in 2016, according to preliminary numbers. Drug overdose is now the leading cause of death for those under the age of 50.
The death toll so far in 2017 is even higher, mostly due to synthetic opioids such as fentanyl.
But the opioid crisis began with prescription painkillers such as OxyContin and Vicodin. Eighty percent of new heroin users start their habit with prescription opioids. When the prescription pills run out or become too expensive on the street, the new addict replaces them with heroin and, more recently, fentanyl.
“It is an insidious epidemic created in large part by the over-prescribing of potent opioids,” Patterson said. “This has resulted in a new generation of opioid abusers, presently estimated at 12 million Americans.”
Anyone who dispenses controlled substances, such as opioid painkillers, must register for approval through the DEA, which falls under the Justice Department.
Patterson said there are currently 1.7 million registrants handling prescription drugs in the United States.
The DEA’s diversion control program operates to stop medical practitioners from making illicit sales of prescription pills.
On Nov. 20, Dr. Robert Gene Rand in Reno, Nevada, was sentenced to 10 years in prison for involuntary manslaughter of a patient and unlawful distribution of oxycodone, according to the DEA.
Despite warnings by another doctor and the patient’s mother, Rand continued to prescribe oxycodone to the patient, leading to the patient’s overdose and death in October 2015, the DEA said.
Rand also admitted that from March 2011 to April 2016, he prescribed a total of 23,645 oxycodone 30-milligram pills without a legitimate medical purpose to a second patient.
The DEA also investigates pharmacies that fill exceptionally high numbers of oxycodone prescriptions, customers who make excessive or frequent opioid purchases, multiple customers with identical addresses, or customers traveling extreme distances to specific pharmacies despite access to more convenient options.
“More recently, we’ve seen a downturn in the overall number of opioid prescriptions, but there remains more work,” Patterson said.
President Donald Trump declared the opioid crisis a nationwide public health emergency on Oct. 26. The declaration included ways to increase access to treatment and imposed stricter requirements on opioid prescriptions.
Previously, only long-acting opioids—about 10 percent of opioid prescriptions—were subject to strict regulation. Recently, that was expanded to include immediate-release opioids. The new requirements will make all opioids that are manufactured subject to the same strict regulations.
New Justice Department Initiatives
On Nov. 29, Patterson and Attorney General Jeff Sessions announced three initiatives to help tighten the net around the illicit distribution of opioids and other drugs.
In the first new plan, the Justice Department is sending more than $12 million in grants to state and local law enforcement agencies “to take heroin, methamphetamines, cocaine, and other illicit drugs off our streets,” Sessions said. He didn’t elaborate on how local law enforcement agencies would spend the money.
Second, a new field division within the DEA will open in Louisville, serving Kentucky, West Virginia, and Tennessee. The move is aimed to align DEA efforts in the Appalachian mountain region, and the new division is the first in almost 20 years.
“These three states combined are problematic in the Appalachian region and very specific to the opioid crisis,” said Patterson.
Third, all U.S. Attorney offices in the country must appoint an opioid coordinator, who will “convene a task force of state, federal, and local law enforcement and help determine which cases to take federal,” Sessions said.
“We will not slow down for one day or even one instant. With one American dying of a drug overdose every nine minutes, enforcing our drug laws is more important than ever.”