Drug Misuse as an Epidemic: A Focus on the Synthetic Opioid Fentanyl

The spread of illicitly manufactured fentanyl has the potential to greatly increase fatal overdoses in many places in the world. In 2015, Estonia and the USA ranked first and second, respectively, among the world’s wealthy nations in men’s drug overdose deaths. Evidence from various resources document illicitly produced fentanyl as a major contributor to the Estonian and US overdose death epidemics. The purpose of this chapter is to analyze the dynamics of fentanyl use based on a drug epidemics approach. We contrast the fentanyl epidemic in Estonia to that in the USA and propose applications for other areas. In areas faced with fentanyl epidemics, we prioritize large-scale implementation of naloxone distribution to reduce mortality, syringe service programs to provide for safer injecting, and links to other services (high frequency of fentanyl injection creates a high risk for HIV and HCV transmission). Further, means of identifying and responding to emerging substances should fit the increasingly dynamic illicit drug markets. Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.