# data[].attributes.body
A person who is prescribed and is taking Fentanyl for a extended period of time, will become dependent on the drug for pain relief. Depending on a drug and an addiction can be two different things though. These people are taking them periodically while others who are addicted may want more than one dose within an hour. Since the euphoria and pleasure that fentanyl offers only lasts for a short period of time, heavy users want another dose once the feeling they are looking for goes away. Since fentanyl is mixed with other drugs such as heroin and cocaine, users can easily be addicted without even knowing what exactly they are addicted to.

# data[].attributes.body
Fentanyl is prescribed to positively impact patients when they use it in a monitored medical setting. The effects of fentanyl often vary depending on the persons size, weight, and overall state of health. Even though the drug was prescribed for beneficial health reasons, there are groups that illegally manufacture fentanyl for the specific use of euphoria. This is when using the drug turns into abusing the drug. Common side effects of fentanyl include a slow heart rate, confusion, fatigue, and vomiting.

# data[].attributes.body
Common forms of treatment for fentanyl addition are inpatient rehab, detox programs, and medication therapies. It can be very hard for fentanyl addicts to successfully receive treatment because of how difficult the withdraws can be. Fentanyl withdraws can vary between marked irritability and chills to sweating and restlessness.

# data[].attributes.body
Fentanyl is a synthetic opioid, meaning that the drug is made in laboratories. Unlike drugs such as morphine, fentanyl does not rely on opium poppy. Rather it is produced through a number of chemical reactions that require specialized skills. In the end, fentanyl is derived from piperidine, an organic compound.

# data[].attributes.body
Everyone who is involved with the drug fentanyl is ultimately looking for the same outcome, a short-lived euphoria or an intense feeling of happiness. Illegal dealers know what their customers are looking for and strive to make it happen. This means that when they can't deliver the product in demand, mixing potent fentanyl into heroin, meth, cocaine, or other drugs, will meet market demand while keeping prices for dealers manageable. Unlike heroin, there is no shortage of fentanyl.

# data[].attributes.body
As of 2020, Michigan is one of 26 states to either introduce or pass legislation aimed at decreasing the amount of fentanyl deaths and other synthetic opioids. Michigan also has a naloxone portal, designed to get Narcan into the hands of those most at risk of a fatal overdose. The portal provides naloxone to communities statewide. Over 180,000 naloxone kits have been distributed across Michigan at no cost.

# data[].attributes.attachment_link.readable_text
PATRICK T. FALLON/AFP via Getty Images

For the first time in history, the United States hit a milestone last year when more than 100,000 Americans died of drug overdoses over a 12-month period, about two-thirds of which were linked to fentanyl and other synthetic drugs, according to the U.S. Centers for Disease Control and Prevention.

Fentanyl can be 50 to 100 times more potent than morphine, heroin or prescription opioids, according to the Associated Press. Just 2 milligrams of fentanyl is considered a lethal dose, compared to 30 mg of heroin.

About 20.5 Michiganders per 100,000 died of a drug overdose due to fentanyl between November 2020 and October 2021, the AP found, higher than some neighboring states like Wisconsin (20) and Illinois (20.4) but lower than others like Ohio (35.4) and Indiana (27.8).

The problem

Broken down by county, during that same time frame, Midland County saw 14 overdose deaths while Mecosta County saw six, Huron County saw three and Manistee County four, according to Michigan.gov data.

In 2020, Michigan saw an increase in drug and opioid overdose deaths after two years of decreasing fatal overdoses, Lynn Sutfin, the public information officer for the Michigan Department of Health and Human Services, wrote in an email. There were 2,738 overdose deaths among Michigan residents, 2,171 of which were opioid-related. Preliminary data for 2021 show increases over 2020, Sutfin wrote.

Total overdose deaths in 2020 increased by 16% from 2,354 in 2019 to 2,738 deaths in 2020 and opioid deaths increased by 23% from 1,768 in 2019 to 2,171 in 2020. The largest drug overdose monthly increase in 2020 was in May, according to HHS data, with a 41% increase over April, and the age-adjusted overdose death rate among all Michigan residents increased from 18.2 deaths per 100,000 residents in 2019 to 22.7 deaths per 100,000 residents in 2020.

The greatest increases in all drug and opioid overdoses were seen among Black and Hispanic Michiganders, Sutfin wrote, "widening an already concerning health disparity."

The age-adjusted all-drug overdose death rate for Black residents was 43.4 per 100,000 residents and 27.7 per 100,000 for Hispanic residents, in comparison to 26.4 for white residents in 2020.

The age-adjusted opioid overdose death rate for Black residents increased from 29.1 deaths per 100,000 residents in 2019 to 37.5 deaths per 100,000 residents in 2020. The age-adjusted opioid overdose death rate for Hispanic residents increased from 15 deaths per 100,000 residents in 2019 to 22.3 deaths per 100,000 residents in 2020. Overdose deaths increased among Hispanic residents by 52% in 2020, from 91 in 2019 to 138.

"In addition to increases in opioid deaths in 2020, increases in the involvement of fentanyl and psychostimulants with abuse potential (such as methamphetamine) were seen," Sutfin wrote. "In 2020, synthetic opioids including fentanyl were involved in 88% of all drug overdose deaths. The involvement of psychostimulants, not including cocaine, increased by 82% in 2020 from 2019; that increase is likely driven by methamphetamine."

The Michigan Department of Health and Human Services "cannot definitively state" what is causing the increases in overdose deaths in Michigan after a decrease in 2019, Sutfin wrote. However, HHS does know that in 2020, COVID-19 led to increased social isolation, which continued in 2021, as well as worse mental health outcomes.

In addition, many of the usual supportive activities for Substance Use Disorders are still virtual, and this continues to limit those personal interactions that are important for sustained recovery, Sutfin wrote. COVID has also created hesitancy to seek medical care for various conditions, including substance use and overdose.

Michigan is one of 26 states to either introduce or pass legislation aimed at stemming the toll of fentanyl deaths and other synthetic opioids since last year, the National Conference of State Legislatures found. The conference also found 12 states with fentanyl-specific drug trafficking or possession laws as of last year with similar measures introduced or considered since the start of 2021 in at least 19 states. More synthetic opioids have also been added to controlled substance lists to mirror federal law in many states.

In 2021, the U.S. Department of Justice filed about 2,700 cases involving crimes related to the distribution of fentanyl and similar synthetic drugs, up nearly tenfold from 2017, AP reported.

What Michigan can do about these deaths

MDHHS and the Michigan Opioids Task Force continue to prioritize improving equity across the state's seven pillar opioid strategy including prevention, treatment, harm reduction, criminal-justice involved and pregnancy and parenting, with foundational pillars of data and equity, Sutfin wrote.

The state seeks to address the growing overdose crisis and racial and ethnic disparities. and during the summer of 2021, the Michigan Opioids Task Force voted to create a Racial Equity Workgroup aimed at ensuring an equity lens in brought to all opioid-related work.

The state of Michigan also has a naloxone portal, designed to get Narcan into the hands of those most at risk of a fatal overdose. The portal provides no-cost, mail-order naloxone to community organizations statewide, Sutfin wrote, and has distributed over 180,000 naloxone kits across Michigan to date.

Expanding the availability of naloxone and access to syringe service programs is part of the harm reduction component of the state strategy, Sutfin wrote, as naloxone can save lives by reversing the effects of opioid-related drug poisonings or overdoses.

"Syringe service programs are agencies that offer clients compassionate, judgment-free and person-centered care to reduce the harms associated with substance use," Sutfin wrote.

MDHHS and its EMS partners in 2021 launched the EMS Leave Behind Portal that allows EMS providers to leave behind a kit with an individual, family and friends or bystanders at the scene of a nonfatal overdose, which now covers over 60% of Michigan's population and is continuing to expand.

MDHHS is continuing its efforts among all pillars of the state strategy, Sutfin wrote, in order to assist individuals, families and communities. Those efforts include:

Maintenance of the statewide Overdose Data to Action Dashboard, providing regularly updated data to the community on the impacts of and work associated with the overdose crisis.

Expanding access to medication to treat opioid use disorder in hospital emergency departments.

Creating the Michigan Basic Opioid Overdose Skills Training, the first naloxone distribution program for state employees, with an initial pilot taking place among frontline workers within the Children's Services Administration.

Launching a naloxone portal to increase naloxone access statewide.

Supporting the expansion of the statewide Naloxone Standing Order to allow for community-based organizations to purchase naloxone, the life-saving overdose reversal medication.

Creation of the Recovery Community Collective, a group of Recovery Community Organizations and other recovery support service providers aimed at elevating voices with lived experience and the long-term needs of those in recovery.

Creation of a Narcotics Workgroup focused on improving data sharing between public health and public safety.

Participation in the National Governors Association Policy Academy on State Strategies to Improve Care for Stimulant and Polysubstance Use, a year-long technical assistance program sponsored by the NGA Center for Best Practices, to help equip states to respond to the accelerating stimulant and polysubstance crisis.

Release of the annual report of the Michigan Opioids Task Force early next year, highlighting the wide range of Michigan's response efforts.

MDHHS, aiming to help address misconceptions and destigmatize harm reduction services, partnered with Vital Strategies to launch a media campaign to promote the "critical importance" of harm reduction services in Michigan's response to the opioid epidemic, Sutfin wrote.

MDHHS staff also work to promote harm reduction programs and address misconceptions at conferences with local health partners and others.

Additional information on opioids and the overdose crisis can be found at Michigan.gov/Opioids. For those struggling with substance use or know someone who is, the SAMHSA Helpline can be contacted 24/7 at 800-662-HELP (4357) or local Access Lines can be reached by visiting MDHHS - Get Help Now - Behavioral Health at michigan.gov.

# data[].attributes.attachment_link.title
Stopping the deaths: Here's what Michigan is doing to prevent fentanyl overdoses

# data[].attributes.attachment_link.description
For the first time in history, the United States hit a milestone last year when more than 100,000 Americans died of drug overdoses over a 12-month period, about two-thirds of which were linked to fentanyl and other synthetic drugs, according to the U.S. Centers for Disease Control and Prevention.

# data[].attributes.body
“Fentanyl Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Feb. 2022, https://www.cdc.gov/stopoverdose/fentanyl/index.html.

“Fentanyl: Uses, Dosage, Side Effects & Warnings.” Drugs.com, https://www.drugs.com/fentanyl.html.

Lebow, Hilary I.

“Can You Become Addicted to Fentanyl?” Psych Central, Psych Central, 11 Aug. 2021, https://psychcentral.com/addictions/all-about-fentanyl-addiction#fentanyl-use-disorder.

“What Is Fentanyl Made of? Ingredients & Cutting Agents.” Desert Hope, 14 Dec. 2022, https://deserthopetreatment.com/opioids/fentanyl-addiction/how-its-made/.

“What Is Fentanyl? Uses, Abuse, and Side Effects.” Medical News Today, MediLexicon International, https://www.medicalnewstoday.com/articles/308156#uses.

# data[].attributes.body
Besides the fact that it is impossible to tell the exact quantity of fentanyl coming into the U.S, it is clear that a considerable amount is coming from China. China's officials do not exactly believe these statistics yet are still taking steps to address the problem. China now has restricted more than 150 chemicals that can be used to create synthetic drugs.

# data[].attributes.attachment_link.readable_text
Amid tension between China and the US over trade, there's also friction over another issue - the illegal trade in synthetic drugs.

The US believes factory-produced opioids - powerful painkillers increasingly abused by US citizens - are being made in China and sold from there too.

One of the main ones is fentanyl - 50 to 100 times stronger than morphine - which is only approved in the US for severe pain arising in cases like treatment for cancer.

President Trump has called out China publicly.

China, while not denying there's a problem, has hit back at claims that most illegal fentanyl is from China.

A senior Chinese official, Yu Haibin of the National Narcotics Control Commission, said there was "no proof" of this, and described President Trump's comments and "unacceptable" and "irresponsible".

Mr Yu had earlier spoken about growing drug demand in the US as the real problem, and suggested there should be better intelligence sharing with China.

There's no doubt a lot of these chemicals are produced in China - although in exactly what quantities is impossible to tell.

And despite the rhetoric, China has been taking some steps to address the problem.

Dangerous chemicals

These synthetic drugs are cheap to make, are sold on the internet and supplied by post.

On arrival at their destination they can be mixed in very small amounts with other drugs, especially heroin, to increase their potency.

"Fentanyl is potentially lethal, even at very low levels. Ingestion of doses as small as 0.25mg can be fatal," states the US Drug Enforcement Agency (DEA).

It's also relatively easy to alter its chemical structure to produce similar substances - known as fentanyl analogues - to bypass legal controls.

"The countless possibilities to create new compounds by small changes in chemical structures pose a growing challenge to international control of the opioid trade," states the UN Office for Drugs and Crime.

Growing concerns - not just in US

The US authorities are increasingly worried about opioid abuse, and have now put all fentanyl-related products into the most dangerous class of drugs.

In testimony before Congress, Assistant Secretary of State Kirsten Madison described the situation as the most "severe drug crisis" the US has ever faced.

She said that in 2017, more than 40% of the 72,000 drug overdose deaths in the US involved synthetic opioids like fentanyl.

Health statistics from Canada show that last year, 72% of deaths related to opioid abuse were believed to involve fentanyl or related substances - up from 55% in 2016.

Europe's drug monitoring agency the EMCDDA, which covers the EU plus Turkey and Norway, said in a report this year that "the number of synthetic opioids has grown rapidly in Europe since the first substance was reported in 2009".

The China connection

US officials are unequivocal that China is the main source for fentanyl and similar drugs.

In October 2017, the US authorities announced the first ever indictments against two Chinese individuals for conspiracy "to distribute large quantities" of fentanyl as well as other opioids.

Katherine Pfaff, spokesperson for the US Drug Enforcement Agency, told the BBC that interceptions from the US postal system, information from people on the ground, and tracking cyber footprints, leads them to believe a "significant amount" comes from China.

The European drug monitoring agency report states: "It appears that most shipments of new fentanyls coming into Europe originate from companies based in China."

However, it added that there have also been some examples of illegal production by laboratories in Europe.

And, although the Chinese authorities don't officially accept that most fentanyl is produced in China, they have taken some action.

Martin Raithelhuber, an expert on synthetic drugs with the UN Office on Drugs and Crime, says China now has restricted more than 150 chemicals that can be used to create synthetic drugs.

"They have been quite active in introducing national controls," he adds.

The DEA's Pfaff told Reality Check that China is "recognising the problem" and that there's an "on-going, strong working relationship" with the Chinese.

Regulation and corruption

But do the Chinese have a problem regulating their large and rapidly growing pharmaceutical industry?

Drugs policy expert at the Rand Corporation in the US, Bryce Pardo, describes their regulatory capacity as "limited".

"Gaps in regulatory design, the division of responsibility between provincial and central governments, and lack of oversight and government and corporate accountability, increase opportunities for corruption," he says.

"I think it is fair to say that a lack of regulatory capacity, perhaps regardless of the letter of the law, certainly limits their ability to control the industry," says John Collins, head of the International Drug Policy Institute at the London School of Economics (LSE).

The other problem is that as more controls are introduced, new chemical substances are produced to get around them.

"The lessons from other countries suggest that effective regulation and enforcement does not ensure the absence of an illicit market," adds Collins.

"In the presence of a demand, supply finds a way."

He believes a more comprehensive approach to managing the overdose crisis in the US is needed, not simply relying on control of supply from abroad.

And that is also part of China's argument - that the US needs to address its growing demand for such drugs, rather than just blaming Beijing.
Read more from Reality Check Send us your questions Follow us on Twitter

# data[].attributes.attachment_link.title
Fentanyl crisis: Is China a major source?

# data[].attributes.attachment_link.description
Amid tension between China and the US over trade, there's also friction over another issue - the illegal trade in synthetic drugs. The US believes factory-produced opioids - powerful painkillers increasingly abused by US citizens - are being made in China and sold from there too.