Anatomy of a Chemical Weapon Drug & Its Debut in India

Fentanyl is a drug 50 times stronger than heroine and 100 times stronger than morphine.

Fentanyl is an analgesic painkiller falling in the same class as morphine.

(GIF: Aroop Mishra/The Quint)

A drug 50 times stronger than heroine and 100 times stronger than morphine, fentanyl is a synthetic analgesic painkiller falling in the same class as morphine. This powerful analgesic is used to treat acute or chronic pain and is used commonly in combination with epidurals given to women during childbirth to manage the pain of the procedure.

Recently, it has also made its debut in India. So here’s everything you need to know about the lethal drug.

Anatomy of Fentanyl

Available as a pill, crushed powder, blotter paper, tablet, spray or under-the-tongue film, fentanyl is considered akin to morphine, only far more potent.

While fentanyl is a generic name for this analgesic, the brand names it goes by are Actiq, Abstral and Fentora. Fentanyl is available in patches as Denpax.

Fentanyl has the same effect as any other dopamine-releasing opioid drug, resulting in an effect which calms the body down and is known to leave the one who consumes in a state of total relaxation. The chemical formulation of this drug is such that it significantly reduces how one’s body feels pain, and responds to it. In addition to this, fentanyl improves functional activity in neuropathic pain states.

For its effect on dopamine levels, which increase the feeling of relaxation, euphoria, reward and pleasure, it is termed a boon in the world of medicines.

Because of its soothing impact for those in chronic, crippling pain or discomfort, prolonged use of fentanyl can result in habit or addiction.

Fentanyl – India’s China White

In what could be disastrous news for India, fentanyl has made inroads in the country and, according to officials, is known by the name of ‘China White’.

The Asian Age reported in 2017 that while India has not recorded any incidents of either consumption or death by fentanyl, the drug has somehow seeped into the Indian drug market.

India’s Narcotics Control Bureau has confirmed that the drug has entered India’s north eastern states from Myanmar and in a lower quantity. It is from there that it has traveled to Delhi and other parts of India.

According to a report by The Times of India, an investigation in late September 2018 into illegal possession of fentanyl from Indore revealed that a global drug syndicate, managed by local businessman Manu Gupta, was active for almost a decade and sending consignments to Mexico.

The report mentions that the drug, which until recently was smuggled from China to Mexico and to Canada from there to the United States, which is facing a massive opioid crisis.

Moreover, Gupta was manufacturing fentanyl for his contact in Mexico who provided the formulae and other specifications. The manufacturing of fentanyl was delegated to Sadiq, a local resident and a PhD in Chemistry by educational qualification, who set up the “lab”. The same resident also told the investigators about his hatred for the United States, The Times of India reported.

The ‘makeshift’ lab was set up by Gupta and a local resident in Indore.

Chinese Fentanyl Fueling America's Opioid Epidemic

This painkiller has worsened an ongoing opioid epidemic in the United States. America’s opioid epidemic has caused a dent in an otherwise flourishing economy by reducing the country’s life expectancy by two years, reported TIME.

Out of over 72,000 deaths caused due to drug overdose in 2017 in America, nearly 49,000 were opioid related, with fentanyl causing more than 29,000 deaths, reported The Guardian.

The US Drug Enforcement Administration told Bloomberg that it is the illegally manufactured fentanyl in overseas laboratories, and not the domestically produced stock for pharmaceutical purposes, that is adding to America’s plight. Additionally, America claims that China is responsible for more than 90 percent of world’s supply of fentanyl.

The established networks of heroine and cocaine in the country are put to use by Mexican cartels to move fentanyl. Officials in the US have stated that most of the fentanyl originates in China, one of the world’s top manufacturers and exporters of raw pharmaceutical ingredients.

Fentanyl as (Pain) Killer Drug

Incidentally, there is no specific quantity of fentanyl that can result in fatality, Oxford Treatment Centre observed.

“The drug is potent almost beyond comprehension — and that’s what changes the game. It’s prescribed by the millionth of a gram. Two milligrams, the equivalent of seven poppy seeds, can kill. It’s often crudely diluted, which makes it difficult for illicit users to determine how much they’re consuming.”

<a href="https://www.bloomberg.com/news/features/2018-05-22/deadly-chinese-fentanyl-is-creating-a-new-era-of-drug-kingpins">Bloomberg</a>

The consumption and tolerance ranges from person to person. While consuming 3 micrograms can relieve one person of stinging pain, the consumption of the same amount can cause death in another.

Interestingly, for use as pain relief in childbirth, fentanyl is present in the epidural given to women in labor, but only in combination with other painkillers like bupivacaine or ropivacaine, both of which are derived from cocaine, reported The Conversation.

It is classified under Schedule-8, also known as controlled drugs, which are mainly used for therapeutic purposes and also have high potential for abuse and addiction – that’s what makes it complicated.

“Public hospital patients given fentanyl as an epidural during childbirth will not be charged for the cost of the drug. Private patients will have the cost of the drug included as part of their treatment bill which is usually covered by their health insurance.”

Nial Wheate, The Conversation&nbsp;

The Drug That Claimed Prince’s Life

While fentanyl has medically safe and desirable uses like pain relief during childbirth, consuming fentanyl without prescription can have fatal consequences. Since this synthetic opioid can be repackaged with illegally sold heroin on streets, the risk of overdose and death is high.

This was well-demonstrated in the death of legendary musician Prince whose autopsy and medical examination reports specified “fentanyl toxicity” as the only cause of death.

Now, according to a Rolling Stones report, Prince resorted to fentanyl to alleviate the discomfort and pain he was reeling from due to his hip injury, which probably arose from “decades of punishing live performances.”

Another report published by The Guardian highlighted that the 57-year-old musician had exceedingly high quantities of fentanyl in his blood, stomach and liver. While his blood had 67.8 micrograms of fentanyl, other recorded fatalities were caused by consuming amounts as minuscule as 3 micrograms.

The level of fentanyl in Prince’s liver was found to be 450 micrograms per kilogram. His confidential toxicology report noted that this amount was 6 times higher than the dose capable of causing liver toxicity – concentrations greater than 69 micrograms per kilogram represent overdose, The Guardian reported.

Also a Chemical Weapon

The most lethal use, attesting to the drug’s potency, dates back to October 2002. A group of Chechen rebels stormed into a theatre in Moscow and held nearly 800 people hostage.

While this continued for nearly four days without any respite, The Conversation reported that Russian special forces pumped a powerful “sleeping gas” into the building, which not only left the rebels incapacitated, but also resulted in the death of some hostages.

“Combined, more than 100 of the rebels and theatre patrons died from the gassing.”

Nial Wheate, The Conversation&nbsp;

As no warning was issued by the military forces and no preparations were made to help those affected due to the Russian military’s move to release the fentanyl-based gas, the delay in taking those left gasping for breath stretched for more than an hour before ambulances could arrive.

Adding to the medical woes in the hospital was the reluctancy of military, who refused to divulge the name of the gas they had released, complicating the treatment further.

“It is widely believed the gas used was either fentanyl, or some other fentanyl-based drug, because some patients were found to have the sleeping effects reversed when they were administered naloxone.”

Nial Wheate, <a href="https://theconversation.com/weekly-dose-fentanyl-the-anaesthetic-that-may-have-been-used-as-a-chemical-weapon-on-chechen-rebels-62966">The Conversation </a>