Thread by @DrDavid_IDEM

Here are data for Rx opioid dispensing and drug overdose deaths in #America. The notable feature is the 📉 of Rx opioid disp rate having no impact in reducing overdose deaths, then the rise of illicit fentanyl contributing to a sharp 📈 in the mid-2010s.

*thread* 🧵

https://twitter.com/jeppdx/status/1447723288147283969

The U.S. drug overdose/poisoning death rate has increased almost every year since 1999 (2018 had a 📈), but in the mid-2010s, there was a larger than normal increase in that rate. The rise of illicit fentanyl in the black market has been a big contributor to this mid-2010s spike.

The health danger with illicit drug supplies is that the user has no clue exactly what is in the drug. Poor quality control by clandestine lab chemists in manufacturing these illicit drugs is nowhere near the level of QC performed by a legitimate pharmaceutical manufacturer.

When illicit suppliers/dealers are adulterating/cutting their heroin, cocaine, etc. supplies with fentanyl, they are not adding a precise dosage in each batch of the drug. One sample of heroin could have 1 milligram of fentanyl and another one could have 20 milligram of fentanyl.

From a synthesis standpoint, clandestine labs don't usually have the necessary experts or infrastructure for manufacturing and performing QC on their drug supplies. Chemical synthesis is a lot like baking - deviations from recipes will lead to poor products.

Lab synthesis of most drugs require multiple important QC steps in the process. Like baking, chemical synthesis requires the correct amount of ingredients, temperature, time at temperature, mixing, etc. Not following directions can lead to dangerous chemicals in the final product

Certain QC steps are meant to remove those dangerous chemicals that may be in the final product. A legitimate pharmaceutical manufacturer follows QC standards to remove them and that's why your pharm Rx pills can be trusted over the drugs bought from the neighborhood drug dealer.

This is what makes illicit fentanyl so dangerous. Many people are not educated about WHY it is so dangerous and that is a huge problem. When fentanyl hit the black markets in the 2010's, users that were used to the heroin of the 90s/2000s were now getting a more potent/toxic drug

Now think of the vulnerable populations that are potential illicit drug users: ppl with substance addiction, ppl buying counterfeit pain pills or benzos for recreation, and chronic pain patients whose med doctors are federal-restricted from prescribing Rx opioids.

I may be missing some vulnerable populations, but just these 3 provide a LARGE pool of our US population that may potentially purchase illicit drugs and unknowingly consume a poorly-QC'd batch of illicit drugs. Rx opioids are not the biggest cause of overdoses in the 2020s.

A record 93,000+ ppl in the US died of a drug overdose in 2020. Data in recent years indicate there are much bigger problems than Rx opioids such as meth, coke, illicit fentanyl. And a large amount of Rx opioid-involved overdose deaths involved alcohol and/or other drugs.

It's very important to educate our public officials because I've seen firsthand that many of them don't know sh*t about this. Many of them are still speaking the 2000s narrative about "Rx opioids causing addiction", not realizing that illicit fentanyl is the 2010-2020s problem.

We need new/innovative govt policies that will shift our focus to mitigating the risks of ALL illicit drugs and additionally eliminate the stigma against addiction and against the pain patients that (responsibly) take Rx opioid to treat their every day pain to live a normal life.

Call/email/talk to your local state representatives and senators, local US congresspeople and senators, and state governors. Those are the people with the influence and power to shift policies that affect these issues. If you need data to show them, I can provide some assistance.