Experts: Missing fentanyl is a major threat to the public

Dr Joel Teelucksingh -

THREE hundred unaccounted vials of fentanyl could pose a serious public health risk if they hit the streets, medical experts warn, as they worry it could make its way into other illicit drugs or be used in human trafficking.

According to the United States' Drug Enforcement Administration (DEA), fentanyl is a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and an anaesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic.

Because of these properties, internal medicine specialist Dr Joel Teelucksingh said it is a great drug in a clinical setting, like in advanced cancer care, major surgery, or for patients with chronic pain who are tolerant to other opioids.

"Fentanyl is part of standard hospital pharmacy stocks in Trinidad and Tobago, especially in operating theatres, ICUs, and palliative care units. However, its use is strictly controlled, logged, and monitored because of its potency and abuse potential. Outside of medical settings, there is no legitimate reason for anyone to possess fentanyl."

Dr Teelucksingh said mere microgrammes separate a dose from being therapeutic or lethal. According to the DEA, drug dealers often mix fentanyl with other drugs because of its potency and relatively low cost, which increases the likelihood of a fatal dose.

"In illicit use, especially when mixed with other drugs like cocaine or heroin, users often have no idea fentanyl is present – leading to accidental overdoses," Dr Teelucksingh said.

University of the West Indies pharmacology lecturer Dr Arlene Williams-Persad said the drug was also highly addictive.

In the US, fentanyl, especially illegally manufactured, is the leading cause of drug deaths among those 18 to 45 years old and accounts for nearly 70 per cent of its 107,000 drug overdose fatalities.

Newsday could not find any publicly available record of the drug leading to fatality in TT. However, on March 18, a panel of representatives from regional law-enforcement agencies agreed that the influx of synthetic drugs such as methamphetamines and fentanyl is a growing concern in TT and the Caribbean.

Dr Teelucksingh warned that while the drug going missing was a concern, the quantity posed a real threat.

"The impact depends on whether the fentanyl is diverted for medical misuse, illicit street sales, or personal abuse. Even a single vial – depending on its concentration – could contain dozens or even hundreds of lethal doses if injected or mixed into street drugs. Three hundred vials in the wrong hands is a serious public-health and law-enforcement threat."

He added, "If the lethal dose for an average adult is about two milligrams, the number of potential deaths depends entirely on the concentration in each vial. Medical vials often contain hundreds or thousands of micrograms per millilitre, and multiple millilitres per vial. This means the theoretical death toll could be far higher than 300 if all of it were misused – but in real-world terms, the risk is amplified by street-level contamination, unpredictable dosing, and lack of user awareness."

'Young people in parties should be vigilant'

Pharmacy Board of TT president Ricardo Mohammed shares Dr Teelucksingh's belief that if the drug ends up on the street, it is a danger to society. Apart from the risks to drug users, he said the drug also posed a threat to innocent people, especially in crowded settings, as it could be absorbed through the skin. He warned those in crowded spaces to be alert for any sensation that someone was rubbing something on their skin.

"This is a drug that could put somebody to sleep very fast, in a short space of time. We know for a fact that in certain human trafficking rings, this is a drug that is used for that, to sedate persons and really transport them to different parts of the world and the public needs to be very careful."

He added: "It is a serious cause for concern for national safety and, knowing what we know with regards to crime in this country, we have to ask all young persons who are going out there to party and have a good time to really be vigilant and keep your eyes opened and look out for anybody suspicious who may be looking to get involved with your group or offering this as a form of ultimate high as they would say."

He said the side effects of fentanyl exposure included shallow, difficult breathing and confusion. He said anyone who suspected they might have been exposed to the drug must get to their nearest medical facility. Mohammed hoped the drug was simply misplaced and was not stolen.

Dr Williams-Persad noted that if the drug was improperly stored, its composition could be compromised, making it less potent, "so that might be a good thing."

Dr Teelucksingh believes the authorities should treat the incident as both a medical security breach and a potential criminal matter. He believes there should be immediate public-health and law-enforcement alerts, tracing of the supply chain and reviewing storage and access logs, notifying hospitals, pharmacies, and border agencies to watch for diversion or trafficking attempts and public education on the dangers of fentanyl, especially if there’s a risk of it entering the illicit drug supply.

The vials were left unaccounted for during a delivery to one of the public health facilities and was brought to the Ministry of Health's attention on August 6.

Given the drug's risks, the Ministry of Health said it launched an immediate investigation, which would include site inspections at the dispatch and delivery locations, verification of delivery records, stock documentation and package markings and requests for detailed reports and video footage from the relevant facilities.