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'Shockingly Easy' To Order Deadly Fentanyl In Mail: Lawmakers

Patch logo Patch 8/26/2018 Lisa Finn
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New York has seen an uptick in overdoses linked to insidious fentanyl — and lawmakers said it's "shockingly easy" for Americans to have the deadly drug delivered right through the mail.

More than 72,000 Americans died from opioid overdoses in 2017, according to preliminary estimates released by the Centers for Disease Control and Prevention this month. The CDC cautions that the figures are an underestimate because of deaths for which an official cause remains pending.

A significant number of the overdose deaths were reported to be caused by fentanyl, with the CDC estimates attributing nearly 30,000 deaths in 2017 to the synthetic opioid. That represents a sharp increase over 2016, when just over 20,000 overdose deaths were reported to be caused by fentanyl, according to the preliminary data.

And what's most shocking is that the drugs are delivered through the mail right to a person's post office box, with little or no safeguards in place to keep the fentanyl from infiltrating communities across the proverbial board and cutting a deadly swath of destruction across all demographics — shattering lives and families.

In January, a Senate permanent subcommittee released an investigative report about how "shockingly easy" it is for Americans to order deadly fentanyl through the mail from overseas sites, many affiliated with China.

According to the report, the fentanyl is flooding the United States, sent from labs in China and sent to the United States through the mail. "It's shocking to people to find out that this is coming to people thorugh the U.S. mail system," said Rep. Sen. Rob Portman of Ohio, chairman of the Senate's permanent subcommittee on investigations.

Those sending the deadly drugs "exploit the vulnerability" of the American public and use the United States Postal Service to distribute fentanyl and other synthetic opioids, he said.

In June, the House passed legislation that would mean the United States would receive advance electronic data on international shipments; the measure is still before the Senate.

According to Portman, currently, the USPS received AED only on about 36 percent of 500 million packages it receives yearly from international locations; on the flipside, the U.S. provides that information to 90 percent of the packages it sends internationally.

Portman said the situation as it stands is "wholly inadequate." He added, "How many more people have to die?"

When kicking off the report, the subcommittee set out to discover how difficult it was to order the drugs online and found that it was "shockingly easy," Portman said. All it took was a quick search of the internet; of six websites surveyed and inquiries sent, those involved were "quick to respond, unafraid of getting caught" and offering discounts as well as other drugs, including carfentanil, as strong as an elephant tranquilizer, he said.

Of the sites surveyed, there were 500 payments tracked, with more than 300 payments from Americans in 43 states, and a street value of pills totaling $760,000 that would end up on United States streets in sleepy towns and urban centers.

"The Postal Service unknowingly or not allowed so much illicit fentanyl to be mailed into our country," said Drew Scott, who lost his beloved granddaughter Hallie to an opioid overdose and who c0-chairs the Southampton Opioid Addiction Task Force. "Now is the time for them to step up and seize every illegal package shipped here from China and Mexico to protect our children.”

USPS outlines efforts to stem the deadly tide

In January, Robert Cintron, vice president of network operations for United States Postal Service also testified before the Senate's permanent subcommittee on investigations of the Homeland Security and governmental affairs committee.

For international mail, he said network operations is responsible for the mail once it arrives at a USPC international service centers and after it is cleared by U.S. Customs and Border Protection, or CBP, up until it has been sorted and transported and is ready to be sent out for delivery.

"Together with our federal agency partners, we have committed to aggressively increasing data on inbound packages coming into the United States in order to improve the targeting of illicit drugs entering the country," he said.

The number of countries sending AED to the Postal Service has grown from 8 to 23 countries, he said.

"We currently receive data on a substantial amount of the overall inbound shipments, including a majority of those originating in China. We are testing data for untracked packets — lower value packages on which the sender has not paid to receive tracking information — received from China, which represent a substantial amount of inbound mail. Data for untracked packets from China are expected to be provided by the end of 2018. This will result in a significant increase in the amount of AED the Postal Service receives as a whole," he said.

He added: "In collaboration with federal agencies and state and local law enforcement, improved investigative techniques have increased our ability to interdict opioids such as fentanyl."

War on opioids

The CDC figures are released every month. The data released this week includes figures for December 2017, which provides a first-time look at the year as a whole.

At a cabinet meeting recently, President Donald Trump said he's directing Attorney General Jeff Sessions to file a federal lawsuit against certain companies that supply and manufacture opioids. Trump said he's directing Sessions to file a separate lawsuit, rather than joining existing lawsuits filed by states affected by the spread of the often-lethal, highly-addictive drugs.

It was not immediately clear if or when a federal suit would be filed. A barrage of suits have been filed nationwide against distributors and manufacturers in recent months amid the opioid epidemic.

In other startling news, the number of pregnant women using opioids such as heroin and fentanyl skyrocketed nationwide after 1999, and federal health officials say it now poses a "significant public health concern." Between 1999 and 2014, the national prevalence of opioid use disorder more than quadrupled from 1.5 cases per 1,000 deliveries all the way to 6.5, the federal Centers for Disease Control and Prevention reported this month.

In New York, that rate was 4.9 in 2014, the latest year that data was available. That's up from what it was in 1999, when the rate was 1.6 cases per 1,000 deliveries.

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The face of of fentanyl, close to home

Joann Piche is a well-coiffed professional, a psychotherapist who lives in Aquebogue and has an office in Westhampton Beach. She's a well-respected, successful member of the community — and no one would ever guess, at first glance, that for seven years, she was caught in the nightmarish grip of fentanyl, a drug that's now outpacing heroin as the deadliest drug on Long Island.

Fentanyl, according to the National Institutes of Health, National Institute on Drug Abuse, is a "powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent."

Fentanyl, often used for surgery, is typically used to treat patients with severe pain or to manage pain after surgery, or to treat patients with chronic pain.

The drug received a flurry of attention in 2016 when a toxicology report from the Midwest Medical Examiner's Office determined that Prince died from fentanyl toxicity.

New statistics on Long Island indicate that fentanyl has taken the lead over heroin in deaths: According to a New York Times report, fentanyl took the lives of at least 220 in 2016, according to medical examiners' records.

But for Piche, fentanyl statistics reflect a sad reality she fought against for seven long years.

She shared her story with Patch in recent months to shine the light of awareness that the drug's deadly grip is found in homes and communities in every corner.

For Piche, who was prescribed a fentanyl transdermal patch in 1998 for a chronic medical condition that requires pain management, the reliance upon the drug was never about getting high.

"I don't want to be misunderstood," she said. "The problem with the medication is that the withdrawal symptoms were agonizing and immediate. There was no 'high' involved for me. I was not a drug-seeking drug addict. I was prescribed this patch by a pain management physician."

In order to avoid the horror of withdrawal, Piche found herself carefully orchestrating her life so that she was scheduling her entire life around the drug, careful to be at her doctor's office exactly every 30 days as required, to receive her new prescription and make sure she had a new patch on before the old was removed.

"This medication is so potent and so addictive, even when you use it for the first time, your body experiences withdrawal immediately," she said. Withdrawal so excruciating that the symptoms were unbearable, she said, and included flu-like symptoms and vomiting.

And it was a dance with danger that she'd never even been warned to avoid.

"I was a young mother at the time," she said. "Nobody told me not to drive. Nobody told me anything about this medication; the transdermal patch was fairly very new at the time. No one ever said it was highly addictive. No one told me anything."

Her son, now 22, was only 3 or 4 years old when her long battle with fentanyl began, Piche said.

"I was sleeping all the time; it causes you to become even more debilitated," she said. "I was prescribed pain management medication in order to function and not be hospitalized, yet it was so potent that I was sleeping all the time and becoming more disabled because of it."

And even though she is a small woman, maybe 110 pounds at the time, she was able to take high dosages because she'd built up such a high tolerance to narcotics, she said.

Fentanyl, she said, "really changed my life; it took over."

After seven long years, Piche reached a point where she knew she had to wean herself off the medication. "It was really controlling my life. I had a moment of clarity, and I just said, 'I'm not living my life as fully as I would like to.'"

And so, she let go, weaning herself off fentanyl, going back to school and earning a master's degree in social work.

Piche was one of the lucky ones.

And today, she's set out to raise awareness, to show, firsthand, that those addicted to fentanyl can be anyone: professionals, moms, teens, neighbors, friends.

"If you see me, I am not what anyone would think could have been a drug-dependent person," she said. "Our society has such a limited belief of what a drug addict is, what they look like, where they live. And so today, if I can help one person, save one life, I want to share my story."

Experts weigh in

Fentanyl's rise in popularity isn't a surprise, said Jeffrey Reynolds, president and chief executive officer of the Family and Children's Association in Mineola.

"Fentanyl has become a major deal in Long Island and elsewhere, which frankly, isn't a shock. We all saw this coming a few years ago, and now many of the skyrocketing overdoses are attributable to drug combinations that include fentanyl," Reynolds said.

Fentanyl's allure lies in its potency, Reynolds said.

"The drug has become so popular precisely because it is so powerful. It's showing up in heroin but also in counterfeit Percocet, OxyContin and Vicodin," said Reynolds. "Heroin dealers will add some to batches as they look for a steady stream of customers in search of the most potent heroin. Of course, by the time the heroin travels through hundreds of hands, nobody can be sure what or how much of anything has been added to that bag."

He added, "There are literally thousands of heavily addicted folks in our region searching for the best and most cost-effective solution they can find, and the stakes continually get higher."

Other experts agree that shining the light of awareness only on the popular new drug of the day can be disastrous.

Kym Laube, executive director of Human Growth and Understanding, or HUGS, an organization focused on providing kids with healthy alternatives, weighed in on fentanyl.

Both Laube and Reynolds sit on a statewide task force to combat heroin convened by New York State Governor Andrew Cuomo.

"HUGS, along with other educators and experts, has continued to worry about the singular focus on one substance, as we know the reality of the dangers that presents," Laube said. "Fentanyl is deadly and dangerous when used non-medically and we are hearing of more overdoses." However, she added, "I caution that if our focus remains on the singular substance we will continue to remain in crisis. We thought heroin was the worst, now it's fentanyl — leaving one to ask, 'What is next?'"

Instead, Laube feels the focus must be on fighting back against addiction itself.

"If we do not change the culture of addiction, beginning with alcohol and especially underage drinking, we will continue to have the same results, and sadly, continue to lose our loved ones," she said.

As war on the deadly opioid epidemic rages across Long Island, in September 2017, then Suffolk County Police Commissioner Tim Sini joined Cuomo, who announced a proposal to add chemical variations or derivatives of synthetic drugs, including fentanyl, to New York State's controlled substance list.

The measure, Cuomo said, will help to increase law enforcement's ability to target and arrest the drug dealers who manufacture and sell different forms of fentanyl and other synthetic drugs.

Fentanyl can be up to 50 times more powerful than heroin and it can take multiple doses of naloxone to reverse a fentanyl overdose,; the new measure will ensure access to adequate doses of overdose reversal medication and save lives, he said.

Just a small amount of the deadly drug can be lethal, Cuomo said: Just .25 milligrams of fentanyl, or about the size of a head of a pin, can potentially result in death.

And, in the past three years, deaths from synthetic drugs such as fentanyl have increased by more than 500 percent, Cuomo said.

Meanwhile, locally on Long Island, overdose deaths involving opioids increased 27 percent between 2015 and 2016, Cuomo's release said.

A preliminary analysis conducted by the Department of Health identified more than 480 opioid-related deaths among residents across the region in 2016. However, fentanyl-related deaths among residents in Long Island increased at a much higher rate — nearly 175 percent, he said.

"Drug dealers and trafficking organizations are flooding our streets with addictive, deadly drugs that devastate families and destroy lives in communities across our state, and we must take bold action to close loopholes and hold these criminals responsible," Cuomo said.

Patch file photo of a prior Suffolk County drug bust of opioids, including fentanyl by Suffolk County District Attorney Tim Sini's office.

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