Variety of Drugs Are Contributing to Current Epidemic

Over the past several years, Virginia has experienced a substantial increase in drug related overdose and deaths resulting from misuse and abuse, replicating national trends.

The growing number of deaths and overdoses caused by fentanyl and other synthetics is one of the reasons why Virginia continues to advance its prevention efforts statewide.

Dr.  Mary McMasters, a Virginia physician who is board certified in addiction medicine and does consulting work for the Commonwealth as an addiction specialist, explains in part one of a two-part series the differences between the range of drugs contributing to the current epidemic.

What exactly is an opioid?

McMasters: Opioids are a class of medications originally derived from the poppy, and they have been around for thousands of years, used in many instances as a pain reliever. But like all medications, opioids do a variety of things, including triggering dopamine spikes, and can trigger the disease of addiction, particularly among people with a genetic predisposition.

They act on the opioid receptors in the nervous system to reduce pain. From opium, people derived a whole host of other drugs with similar properties: morphine, then heroin, and then prescription painkillers like Vicodin, Percocet and OxyContin. Opium, along with all of these derivatives, are collectively known as opiates.  There are a handful of compounds that act just like opiates but aren’t made from the poppy plant. Opiates along with these man made synthetic drugs — chiefly methadone and fentanyl — are grouped together into the category of substances called opioids.

What is fentanyl?

McMasters: Fentanyl is a synthetic opioid, completely manufactured from a nonorganic source. It is another pain medication but is problematic because of the intensity of the dopamine spike, making it very addictive. It is also a potent respiratory depressant; it tells your brain to stop breathing a lot sooner than other opioids do. People can die very quickly using a small amount of fentanyl.

What accounts for the rise in fentanyl use, which is also contributing to an increase in deaths?

McMasters: Fentanyl can be inexpensive. It takes a very small amount. In order to make other substances more attractive, fentanyl is often added: to marijuana, to cocaine, and as a substitute or filler for heroin. People don’t even necessarily know they are using it. I have patients who come in a test positive for fentanyl who had no clue they were using it; it was in something else they were using.

What is heroin?

Heroin is an illegal, highly addictive opioid drug. Heroin is typically injected but can also be smoked or snorted. Heroin is especially dangerous because it is often combined with other drugs, including fentanyl. This increases the risk of overdose. In addition, when people inject heroin, they are at risk of serious, long-term viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial infections of the skin, bloodstream, and heart.

McMasters: Heroin is another organic opioid. It’s not a very good pain medicine, but it also has a dopamine spike quality that makes it dangerously addictive.

Describe the risk of using other drugs or alcohol with an opioid.

McMasters: There is a much higher risk of respiratory depression.  If you add benzodiazepines or alcohol to an opioid, each of these substances is telling your brain to stop breathing. When you add them together, it’s not one plus one equals two, it’s one plus one equals one hundred! Result: you stop breathing.


This is part one of a two-part interview with Dr. McMasters. Part Two discusses differences between substance misuse and addiction, Naloxone, and more.