Officials: Bill would proactively schedule fentanyl analogs

In early August, Cuyahoga County saw a surge of overdose deaths.

Over the course of five days, 16 people were killed by drug overdoses. Up to that point the Cuyahoga County Medical Examiner’s Office was projecting a slight decrease in the total number of such deaths for the year from a record-breaking 2017.

After the surge, the Medical Examiner’s Office projected the overdose deaths to be right on track with last year.

The main culprit in the deaths was no surprise: According to the office’s preliminary screenings, fentanyl was a contributing factor in at least 14 of them.

Fentanyl, a synthetic opioid is 50 times more powerful than heroin, and is a significant contributor to the rise in overdose deaths not only in Ohio but across the U.S. That includes fentanyl analogues such as acrylfentanyl, furanylfentanyl and carfentanil.

According to the Centers for Disease Control and Prevention, between July 2016 and June 2017 there were 11,045 opioid overdose deaths across the U.S. and 2,275 (20.6 percent) of decedents tested positive for any fentanyl analog. The CDC stated that 14 different analogs were detected in over that span. Among overdose deaths with the analogs detected, the analogs were determined by medical examiners or coroners to have contributed to the death in more than 95 percent of the cases.

Ohio reported the largest numbers and most substantial increases in deaths with any fentanyl analog detected over that span, according to the CDC.

In late August, attorneys general in 52 states and territories signed a letter urging Congress to support a bill that they argue will

help close a loophole that allows fentanyl traffickers to stay one step ahead of law enforcement.

“This measure would give DEA agents the tools they need to go after these back alley chemists and overseas dealers that think they can skirt the law,” Attorney General Mike DeWine said in a statement. “In Ohio we are committed to stopping the flow of opioids, getting those with substance use disorder the help they need, and ultimately saving lives.”

The bill that DeWine and the other attorneys general support is the Stopping Overdoses of Fentanyl Analogues Act, which has versions in both the U.S. House of Representatives and the U.S. Senate. Its supporters say the bill will allow the U.S. Drug Enforcement Administration to proactively schedule all newly-modified fentanyl analogues illegal as soon as they are manufactured.

Senate Republican Ron Johnson of Wisconsin introduced the bill in July 2017. In a speech on the Senate floor, Johnson said it was personal.

“The scourge of addiction and overdose deaths has devastated thousands of American families, including my own,” Johnson said. “In January 2016 I lost a nephew to a fentanyl overdose. The legislation I am introducing this afternoon is in memory of my nephew, of Archie, and of all of the families in Wisconsin and throughout America that have lost loved ones in this epidemic.”

Fentanyl is classified as a Schedule II drug, used legally to treat cancer patients. Johnson said by modifying one small piece of the chemical structure, a new chemical compound is created and under the existing laws, these new compounds — analogues — are legally sold around the world.

“Criminal chemists need to change only one small piece of the chemical bond to be one step ahead of the law,” he said. “The fentanyl analogues on the street today serve no known medical purpose and are contributing to the alarming overdose rates throughout the country.”

At a Lake County commissioners meeting this past April, county Crime Lab Supervisor Doug Rohde said there are about 400 types of fentanyl analogs and the county has seen about 50 of them. The lab tests substances that are seized by area law enforcement.

Rohde and the Crime Lab have some experience with the existing pace of the scheduling process. In 2016, they were the first lab in Ohio to have a positive test for U-47700. The drug originally was created by pharmaceutical company Upjohn in the mid-1970s, but was never released commercially.

According to a 2016 Rolling Stone article, the drug was intended to be used to treat severe pain associated with cancer, surgery or injury, but never ended up being tested on humans. The patent, however, remained publicly available for decades, with detailed instructions on how to produce the drug. In recent years, overseas labs have manufactured the drug and shipped it to America, where it ended up in places like Lake County where a 29-year-old Eastlake man was killed by an overdose in January 2016.

Authorities learned the man had the drugs shipped from China after purchasing them over the Internet. At the time of the purchase, U-47700 was legal. Rohde worked with the Lake County Sheriff’s Office and the Ohio Pharmacy Board, and in May 2016 Ohio Governor John Kasich signed an executive order authorizing the pharmacy board to make U-47700 a Schedule I controlled substance and subject to criminal drug penalties.

Schedule I drugs are considered to have a high potential for abuse and no currently accepted medical use.

It would be almost another half year before the drug was schedule federally. The DEA made U-47700 a Schedule I substance in an emergency order effective Nov. 14, 2016. The scheduling lasts for 24 months with a possible 12-month extension if DEA needs more data to determine whether it should be permanently scheduled.

The DEA received reports of at least 46 confirmed U-47700 overdose deaths in 2015 and 2016. Most notably, the drug was among those that contributed to the death of music legend Prince.

The group of attorneys general acknowledges in their letter that the SOFA Act alone won’t end the opioid epidemic. After its scheduling, the Lake County Crime Labs and other labs around the country still had positive tests of U-47700 for example. The group, however, said its passage will aid law enforcement’s efforts on the front end.

Source: Center for Disease Control and Prevention