9:51 pm - February 12, 2025
The Evolving Opioid Crisis: A Fourth Wave and the Emergence of a New Threat
The opioid crisis in the United States continues to evolve, and experts are now warning of a potential "fourth wave" of the epidemic, characterized by the increasing presence of illicit fentanyl laced with other substances. Among these, an unexpected and alarming additive has emerged: BTMPS, an industrial chemical commonly used in the production of plastics, has been found in significant quantities within the illicit fentanyl supply across the country. This discovery has raised serious concerns about the health and safety of those using illicit drugs, as well as the unpredictable nature of the unregulated drug supply.
BTMPS: The Unidentified Danger in the Fentanyl Supply
BTMPS, which stands for bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate, is a chemical primarily used to protect plastics from ultraviolet (UV) light. Its presence in the fentanyl supply was first identified in June 2023 by harm-reduction programs on the West Coast. Researchers at UCLA, led by Dr. Chelsea Shover, conducted a study published in the Journal of the American Medical Association (JAMA), which tested samples from nine community-based drug-checking programs across the US, including locations in Los Angeles and Philadelphia. Shockingly, BTMPS was found in every sample over a four-month period, often in amounts exceeding the fentanyl itself, with an average of 8.6% BTMPS by mass and some samples containing over 56% BTMPS.
The implications of this discovery are dire. BTMPS is not approved for human use, and while limited research exists on its effects in humans, animal studies have shown significant health risks, including skin irritation, cardiotoxicity, reproductive defects, vision problems, and even death. Experts also worry about potential lung damage, as BTMPS can be inhaled. Morgan Godvin, a project director at Drug Checking Los Angeles and co-author of the study, described the situation as one of the largest mysteries of her career, emphasizing the unknown long-term effects of BTMPS exposure, particularly for fentanyl users who may unknowingly ingest large quantities of this toxic chemical.
The Mystery of BTMPS: How Did It Enter the Fentanyl Supply?
The exact manner in which BTMPS entered the fentanyl supply remains unclear, but researchers have proposed several theories. Dr. Chelsea Shover suggests that the chemical may have been introduced intentionally or accidentally at the manufacturing level, possibly as a result of changes in synthesis methods or as a diluent to cut the fentanyl. The presence of such large amounts of BTMPS in the samples suggests that it is not merely a byproduct of plastic packaging but is being actively added to the drug. The sudden and widespread emergence of BTMPS across multiple regions further supports the idea that it was introduced at the production stage.
The discovery of BTMPS in the fentanyl supply raises critical questions about the resilience and adaptability of drug manufacturers. As law enforcement and public health officials attempt to curb the fentanyl crisis, illicit producers may be experimenting with new methods or additives to evade detection or increase profitability. However, the inclusion of BTMPS—a substance with no known benefit to drug users—highlights the reckless and dangerous nature of the unregulated drug market.
Fentanyl Remains a Leading Cause of Overdose Deaths
Despite the emergence of BTMPS, fentanyl remains the primary driver of the opioid crisis. According to data from the U.S. Centers for Disease Control and Prevention (CDC), synthetic opioids, primarily fentanyl, account for approximately two-thirds of overdose deaths in the country. A recent report from Millennium Health, a drug testing laboratory, revealed that while the presence of fentanyl in the illicit drug supply may be declining—12% fewer samples tested positive for fentanyl compared to 2022—poly-drug use is on the rise. Nearly 93% of fentanyl users had at least one other drug in their system, with more than half having three or more drugs present.
This "flux" in the fentanyl supply, as described in the report, underscores the unpredictable and ever-changing nature of the illicit drug market. The varying amounts of fentanyl analogs found in different geographic regions further complicate efforts to address the crisis. For example, Dr. Nabarun Dasgupta, a senior scientist at the University of North Carolina’s Injury Prevention Research Center, has tracked the presence of BTMPS in over 850 drug samples across 14 states since April 2023. His team found that while BTMPS appears to be declining in the drug supply, its presence remains a significant public health concern.
The Broader Implications: The Unregulated Drug Supply and Public Health Risks
The discovery of BTMPS in the fentanyl supply serves as a stark reminder of the dangers of an unregulated drug market. As Dr. Dasgupta noted, "The biggest public health message is that an unregulated drug supply will always surprise you." The inclusion of BTMPS, a toxic industrial chemical, in fentanyl highlights the lack of quality control and the disregard for user safety in the illicit drug trade. Users who unknowingly consume fentanyl contaminated with BTMPS face not only the immediate risks associated with fentanyl use but also the potential long-term health consequences of BTMPS exposure.
Moreover, the presence of BTMPS in the fentanyl supply adds another layer of complexity to the opioid crisis. Researchers are particularly concerned about the impact of BTMPS on fentanyl tolerance. Users who consume fentanyl laced with high levels of BTMPS may develop a lower tolerance to fentanyl, increasing their risk of overdose in the future. As Morgan Godvin explained, "When we’re talking about fentanyl, where the margin of error for fatal overdose is so slim, these inconsistencies and volatilities can literally mean death."
Moving Forward: Awareness, Research, and Solutions
The findings of the UCLA study and the ongoing tracking of BTMPS by researchers like Dr. Dasgupta underscore the urgent need for increased awareness, research, and action to address the opioid crisis. Harm-reduction programs play a critical role in identifying contaminants like BTMPS and informing users about the risks associated with the drugs they consume. However, the long-term effects of BTMPS exposure remain unknown, and further research is essential to understand its impact on human health.
Additionally, the opioid crisis highlights the need for comprehensive public health strategies that address not only the supply of illicit drugs but also the demand. Expanding access to evidence-based treatment, such as medication-assisted therapy (MAT), and increasing funding for harm-reduction initiatives are critical steps toward reducing overdose deaths and improving outcomes for individuals struggling with addiction. At the same time, policymakers must work to address the root causes of the crisis, including poverty, lack of access to healthcare, and the stigma surrounding addiction.
Ultimately, the discovery of BTMPS in the fentanyl supply is a wake-up call for the nation. It reminds us that the opioid crisis is far from over and that new challenges will continue to emerge as long as the drug supply remains unregulated. By prioritizing public health, investing in research, and advocating for compassionate and equitable solutions, we can work toward a future where individuals struggling with addiction receive the support they need, and the dangers of the illicit drug market are mitigated.