How Oxycodone Gets Laced With Fentanyl

Late last month, news broke that singer Demi Lovato was rushed to a Los Angeles hospital after she experienced an apparent opioid-related overdose at her Hollywood Hills home. The 25-year-old pop star was revived after paramedics administered Narcan, one of the brand names for naloxone, a medication used to reverse overdoses.

At the time, it was unknown which opiate-derived drug Lovato had taken that led to the overdose. But sources close to the situation have claimed the “Cool for the Summer” singer reportedly used oxycodone — often called oxy — which, according to TMZ, may have been laced with fentanyl, a highly potent synthetic opioid.

Unfortunately that’s not really surprising — as the country continues to grapple with a deadly opioid epidemic, fentanyl finding its way more and more into other substances, experts say.

“We are finding fentanyl in everything from painkillers, heroin, cocaine — you name it,” Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum, tells Rolling Stone. “Even benzodiazepines that are counterfeit and coming off the street.”

There are two prevailing theories as to how fentanyl is ending up in so many different drugs. Either drug cartels are deliberating cutting fentanyl into their product because it’s a cheaper substance — smaller amounts can yield the same street price, Hulsey Nickel says. Or there’s cross-contamination, often accidental, where the synthetic opioid is mixed with other substances produced in the same location — in other words, dealers aren’t being careful with clean up.

But, no matter the reason, it’s often unknown to drug users that the product they bought has been laced with fentanyl, says Hulsey Nickel, which is what happened in Lovato’s case, sources told TMZ. And this can have fatal consequences: Fentanyl — a derivative of the painkiller found in hospitals manufactured illegally in places like China and South America — is 80 to 100 times more potent than heroin or morphine, according to the U.S. Drug Enforcement Administration. And the high lasts far longer, even longer than prescription fentanyl itself.

“Even if you are an opioid user, you can have an overdose from the first time fentanyl, carfentanyl or any of the synthetics is introduced to you,” Hulsey Nickel says. Because of its strength, more doses of naloxone usually need to be administered to reverse an opioid-related overdose if fentanyl is involved. “It is incredibly dangerous,” she adds.

Just take a look at the numbers: Data from the U.S. National Institute on Drug Abuse show that synthetic opioids, primarily street fentanyl, were behind in nearly 50 percent — or more than 19,000 — opioid-related deaths in 2016, surpassing prescription painkillers. That’s a dramatic uptick from 2010, when synthetic opioids were linked to only 14 percent of opiate overdose fatalities.

Overall, deaths from opioid overdoses increased five fold from 1999 to 2016, according to the U.S. Centers for Disease Control and Prevention. And, CDC estimates show, opioids — heroin, fentanyl and prescription painkillers — killed more than 42,000 people in the United States in 2016 alone.

Thanks to the rescue treatment, Narcan, Lovato survived her overdose and was able to recover. She was hospitalized for two weeks at Cedars-Sinai hospital in Los Angeles before being transferred to a out-of-state rehab last week, according to news reports.

But Hulsey Nickel calls what happened to Lovato “a warning sign.”

“This is a signal that we need to make sure that we’re being more careful and talking to about 2.1 million Americans that have an opioid use disorder that we need to make aware of this risk,” she tells Rolling Stone, “and while we are working to get them into treatment, make sure they are keeping themselves safe.”