A bill to combat the abuse of opioids and the soaring number of overdoses and deaths does not include any reference to what is believed to be the key drug driving the increase.
The compromise bill, passed by the Senate Wednesday, is now on President Obama’s desk for signing, which the White House said he will do.
But the bill makes no specific reference to the drug, fentanyl, which appears to be behind the recent spike in deaths.
Fentanyl, on its own, mixed with heroin or, more recently, prescription pills, is 80 times more potent than morphine. It is a prescription drug meant for people in chronic pain, but much of fentanyl on the street now is manufactured illicitly.
States, particularly in the north east, but increasingly elsewhere, have seen huge increases in the number of deaths and seizures since 2013, in high double-digit, sometimes triple-digit, percentages.
The Comprehensive Addiction and Recovery Act (CARA), which passed both houses of Congress by overwhelmingly margins, does not specifically mention fentanyl.
That was deliberate, according to Jessica Nickel, executive director of the Addiction Policy Forum, the umbrella body for dozens of groups that helped draw up the legislation.
“Fentanyl is a huge issue. CARA does have a number of provisions, but does not specify one (drug) over the other,” Nickell told AMI Newswire. “It is designed to be nimble and flexible.”
Essentially, when work began on the bill three years ago, the focus was having a comprehensive one with the provisions designed to work years into the future. “If there is something else horrific that comes in 2017, it can stand to respond to that,” Nickell said.
In a statement, the White House said Obama would sign the bill while expressing disappointment that it failed to provide significant money to deal with the epidemic. "Some action is better than none," the White House said.
Republicans say they support additional funding, but want to deal with it through the regular appropriations process.
Nickel said there was a lot of politics played around the funding, but it comes down to arguments over authorization and appropriations.
The Drug Enforcement Agency, in its latest intelligence report published in June, found that there were 5,544 synthetic-opioid-related deaths in 2014. These include such drugs as oxycodone, as well as, crucially, fentanyl.
“The true number is most likely higher because of non-standardized reporting and because many coroners’ offices and state crime laboratories initially did not test for fentanyl or its analogs unless given a specific reason to do so,” the intelligence report concludes.
The most widely quoted figure for deaths linked to the use of fentanyl is from a nationwide alert issued March 2015 by the DEA, which estimated the number of people dying between the end of 2013 through 2014 at 700.
But a study of medical-examiner and other reports from eight of 10 states where the largest number of seizures of fentanyl were reported throws up much more larger and more frightening numbers.
More than 2,000 fentanyl linked deaths were reported in 2014 by medical examiners in those states, which include Ohio, Florida and Massachusetts.
In Ohio, in 2014, 502 died from fentanyl-linked overdoses, up from 92 the previous year, while 397 perished in Florida that same year, up from 185. In New Hampshire, the 2014 death toll stood at 261, up from 19 the previous year. Massachusetts reported 336 in the year up to the end of September, 2015. Pennsylvania revealed this week a 93 percent increase in deaths linked to fentanyl in 2015.
Originally designed as pain medication for stage four cancer patients and severe burn victims, fentanyl often is prescribed to those suffering from much lesser pain, which made it easier for some of the drug to leak onto the black market..
Now, Mexican drug cartels are in the game, with chemists hired to make illicit fentanyl, which is then either mixed in with heroin, or the packages are entirely made up of fentanyl, but marketed as heroin. It is also mixed with cocaine and is now appearing in tablet form.
The demographic of those dying from fentanyl is mixed, although a high proportion are young, white, and male, often from suburban or rural areas, according to the Centers for Disease Control. Many progressed from pain killers to heroin, then often unwittingly to taking fentanyl.