The War
on Fentanyl

On February 22, White House Office of National Drug Control Policy Director Rahul Gupta visited the Camden County Correctional Facility to discuss the expansion of medication-assisted treatment programs in Camden and beyond. Rutgers University in Camden researchers have shown that breakthroughs in biology, sociology, and public policy could all play important roles in stemming the opioid crisis.

The features that make fentanyl such an effective pain reliever are also the key to its danger, said Nathan Fried, assistant teaching professor of biology.

“Fentanyl has a much higher affinity for opioid receptors than heroin or morphine,” Fried said. “Fentanyl relieves pain by binding to opioid receptors on neurons all throughout the body, including the fingertips, internal organs, and spinal cord. It also affects the reward system of the brain, which causes euphoria and creates the potential for addiction. When it reaches the brain stem, it reduces breathing rate, which can cause overdose death.”

Fried compares the effects of morphine and fentanyl to an old farmhouse door, where the top and bottom open differently. “With opioid receptors, the ‘top of the door’ controls pain relief and euphoria, while the ’bottom of the door’ controls respiratory suppression – the thing that causes overdose death,” Fried said. “When morphine binds, both the top and bottom open equally. But when fentanyl binds, it opens the bottom a lot more than the top. This makes fentanyl much more dangerous than other opioids.”

Researchers are working to develop a safer opioid that only opens the ‘top of the door,” which would still relieve pain while greatly reducing harmful effects on breathing. In Fried’s Rutgers–Camden biology lab, research is underway on the development of medications that could provide pain relief without opioids. 

“There are still so many unknowns about how pain works, why it’s different in every person, and why pain differs depending on its location in the body,” said Fried. “To reduce our reliance on opioids, we need to know more about pain.”

Fentanyl is such a pressing societal concern that sociologists and public-policy experts have joined biologists on the front lines. Sarah Tosh, an assistant professor of sociology, anthropology and criminal justice in the College of Arts and Sciences, has researched the effects of drug regulations and immigration policy on the prominence of fentanyl.   

“Fentanyl is the most deadly illegal drug in our country’s history,” Tosh said. “Fentanyl gained popularity within the context of drug prohibition for the same reason the drug is so dangerous: its intense potency in very small quantities. This makes it less risky and more profitable for traffickers than heroin. Crackdowns on popular and addictive drugs often breed more dangerous alternatives, and this is an extreme case of that.”

Tosh non-punitive treatments for fentanyl users, including the use of safer drugs like methadone and suboxone to help to reduce overdoses.

“Punitive action is not effective in reducing drug trafficking or overdoses,” said Tosh. “At the federal level, we must examine the key role of the War on Drugs, which has been waged for close to 40 years now, imprisoning millions while leaving us with the highest overdose rates in our country’s history.” 

Tosh believes local governments should embrace harm-reduction programs such as safe injection sites. Often proposed facilities must overcome opposition from neighbors’ concerns, and a lack of funding from local, state and federal levels.

“There has certainly been moral panic in the U.S. around drugs and drug use throughout our history, often tied to the racial and class background of those said to be using the drugs,” said Tosh. “This has only been furthered under the War on Drugs, with dangerous drug use treated as an individual moral failing, as opposed to a public health issue endemic to our society.”

Tosh believes learning how other communities handle drug overdoses as a public health issue can help to change opinions and open hearts.

“The extreme impact these facilities have on number of overdoses should be a central part of any argument,” Tosh said.