Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl.

Physicians like me have seen a rise in unintentional fentanyl use from people buying prescription opioids and other drugs laced, or adulterated, with fentanyl. Heroin users in my community in Massachusetts came to realize that fentanyl had entered the drug supply when overdose numbers exploded. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often only had fentanyl present in their drug test results.

As the Chief of Medical Toxicology at UMass Chan Medical School, I have studied fentanyl and its analogs for years. As fentanyl has become ubiquitous across the U.S., it has transformed the illicit drug market and raised the risk of overdose.

Fentanyl and its analogs

Fentanyl is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.

For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states.

Despite the number and diversity of its analogs, fentanyl itself continues to dominate the illicit opioid supply. Milligram per milligram, fentanyl is roughly 50 times more potent than heroin and 100 times more potent than morphine.

Lacing or replacing drugs with fentanyl

Drug dealers have used fentanyl analogs as an adulterant in illicit drug supplies since 1979, with fentanyl-related overdoses clustered in individual cities.

The modern epidemic of fentanyl adulteration is far broader in its geographic distribution, production and number of deaths. Overdose deaths roughly quadrupled, going from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, more than 100,000 Americans died from a drug overdose, with over 64% of these deaths due to synthetic opioids like fentanyl and its analogs.

Illicitly manufactured fentanyl is internationally synthesized in China, Mexico and India, then exported to the United States as powder or pressed pills. China also exports many of the precursor chemicals needed to synthesize fentanyl.

Additionally, the emergence of the dark web, an encrypted and anonymous corner of the internet that’s a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through traditional delivery services, including the U.S. Postal Service.

During the 2023 Asia-Pacific Economic Cooperation summit, U.S. President Joe Biden and Chinese President Xi Jinping reached an agreement to combat fentanyl trafficking.

Fentanyl is both sold alone and often used as an adulterant because its high potency allows dealers to traffic smaller quantities but maintain the drug effects buyers expect. Manufacturers may also add bulking agents, like flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to cut a kilogram of fentanyl compared to a kilogram of heroin.

Unfortunately, fentanyl’s high potency also means that even just a small amount can prove deadly. If the end user isn’t aware that the drug they bought has been adulterated, this could easily lead to an overdose.

Preventing fentanyl deaths

As an emergency physician, I give fentanyl as an analgesic, or painkiller, to relieve severe pain in an acute care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery.

But even in the controlled conditions of a hospital, there is still a risk that using fentanyl can reduce breathing rates to dangerously low levels, the main cause of opioid overdose deaths. For those taking fentanyl in nonmedical settings, there is no medical team available to monitor someone’s breathing rate in real time to ensure their safety.

One measure to prevent fentanyl overdose is distributing naloxone to bystanders. Naloxone can reverse an overdose as it occurs by blocking the effects of opioids.

Another measure is increasing the availability of opioid agonists like methadone and buprenorphine that reduce opioid withdrawal symptoms and cravings, helping people stay in treatment and decrease illicit drug use. Despite the lifesaving track records of these medications, their availability is limited by restrictions on where and how they can be used and inadequate numbers of prescribers.

Other strategies to prevent overdose deaths include lowering the entry barrier to addiction treatment, fentanyl test strips, supervised consumption sites and even prescription diamorphine (heroin).

Despite the evidence supporting these measures, however, local politics and funding priorities often limit whether communities are able to give them a try. Bold strategies are needed to interrupt the ever-increasing number of fentanyl-related deaths.

This article was updated on Nov. 16, 2023 to note developments regarding fentanyl at the Asia-Pacific Economic Cooperation summit.

Kavita Babu, Professor of Emergency Medicine, UMass Chan Medical School

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cranberries can bounce, float and pollinate themselves: The saucy science of a Thanksgiving classic

Cranberries are a staple in U.S. households at Thanksgiving – but how did this bog dweller end up on holiday tables?

Compared to many valuable plant species that were domesticated over thousands of years, cultivated cranberry (Vaccinium macrocarpon) is a young agricultural crop, just as the U.S. is a young country and Thanksgiving is a relatively new holiday. But as a plant scientist, I’ve learned much about cranberries’ ancestry from their botany and genomics.

New on the plant breeding scene

Humans have cultivated sorghum for some 5,500 years, corn for around 8,700 years and cotton for about 5,000 years. In contrast, cranberries were domesticated around 200 years ago – but people were eating the berries before that.

Wild cranberries are native to North America. They were an important food source for Native Americans, who used them in puddings, sauces, breads and a high-protein portable food called pemmican – a carnivore’s version of an energy bar, made from a mixture of dried meat and rendered animal fat and sometimes studded with dried fruits. Some tribes still make pemmican today, and even market a commercial version.

Cranberry cultivation began in 1816 in Massachusetts, where Revolutionary War veteran Henry Hall found that covering cranberry bogs with sand fertilized the vines and retained water around their roots. From there, the fruit spread throughout the U.S. Northeast and Upper Midwest.

Today, Wisconsin produces roughly 60% of the U.S. cranberry harvest, followed by Massachusetts, Oregon and New Jersey. Cranberries also are grown in Canada, where they are a major fruit crop.

A flexible and adaptable plant

Cranberries have many interesting botanical features. Like roses, lilies and daffodils, cranberry flowers are hermaphroditic, which means they contain both male and female parts. This allows them to self-pollinate instead of relying on birds, insects or other pollinators.

A cranberry blossom has four petals that peel back when the flower blooms. This exposes the anthers, which contain the plant’s pollen. The flower’s resemblance to the beak of a bird earned the cranberry its original name, the “craneberry.”

When cranberries don’t self-pollinate, they rely on bumblebees and honeybees to transport their pollen from flower to flower. They can also be propagated sexually, by planting seeds, or asexually, through rooting vine cuttings. This is important for growers because seed-based propagation allows for higher genetic diversity, which can translate to things like increased disease resistance or more pest tolerance.

Asexual reproduction is equally important, however. This method allows growers to create clones of varieties that perform very well in their bogs and grow even more of those high-performing types.

Every cranberry contains four air pockets, which is why they float when farmers flood bogs to harvest them. The air pockets also make raw cranberries bounce when they are dropped on a hard surface – a good indicator of whether they are fresh.

These pockets serve a biological role: They enable the berries to float down rivers and streams to disperse their seeds. Many other plants disperse their seeds via animals and birds that eat their fruits and excrete the seeds as they move around. But as anyone who has tasted them raw knows, cranberries are ultra-tart, so they have limited appeal for wildlife.

Reading cranberry DNA

For cranberries being such a young crop, scientists already know a lot about their genetics. The cranberry is a diploid, which means that each cell contains one set of chromosomes from the maternal parent and one set from the paternal parent. It has 24 chromosomes, and its genome size is less than one-tenth that of the human genome.

Insights like these help scientists better understand where potentially valuable genes might be located in the cranberry genome. And diploid crops tend to have fewer genes associated with a single trait, which makes breeding them to emphasize that trait much simpler.

Researchers have also described the genetics of the cultivated cranberry’s wild relative, which is known as the “small cranberry” (Vaccinium oxycoccos). Comparing the two can help scientists determine where the cultivated cranberry’s agronomically valuable traits reside in its genome, and where some of the small cranberry’s cold hardiness might come from.

Researchers are developing molecular markers – tools to determine where certain genes or sequences of interest reside within a genome – to help determine the best combinations of genes from different varieties of cranberry that can enhance desired traits. For example, a breeder might want to make the fruits larger, more firm or redder in color.

While cranberries have only been grown by humans for a short period of time, they have been evolving for much longer. They entered agriculture with a long genetic history, including things like whole genome duplication events and genetic bottlenecks, which collectively change which genes are gained or lost over time in a population.

Whole genome duplication events occur when two species’ genomes collide to form a new, larger genome, encompassing all the traits of the two parental species. Genetic bottlenecks occur when a population is greatly reduced in size, which limits the amount of genetic diversity in that species. These events are extremely common in the plant world and can lead to both gains and losses of different genes.

Analyzing the cranberry’s genome can indicate when it diverged evolutionarily from some of its relatives, such as the blueberry, lingonberry and huckleberry. Understanding how modern species evolved can teach plant scientists about how different traits are inherited, and how to effectively breed for them in the future.

Ripe at the right time

Cranberries’ close association with Thanksgiving was simply a practical matter at first. Fresh cranberries are ready to harvest from mid-September through mid-November, so Thanksgiving falls within that perfect window for eating them.

Cranberry sauce was first loosely described in accounts from the American colonies in the 1600s, and appeared in a cookbook for the first time in 1796. The berries’ tart flavor, which comes from high levels of several types of acids, makes them more than twice as acidic as most other edible fruits, so they add a welcome zing to a meal full of blander foods like turkey and potatoes.

In recent decades, the cranberry industry has branched out into juices, snacks and other products in pursuit of year-round markets. But for many people, Thanksgiving is still the time when they’re most likely to see cranberries in some form on the menu.

Serina DeSalvio, Ph.D. Candidate in Genetics and Genomics, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The family of Samuel Lawrence, one of 10 people to die in Georgia’s Fulton County Jail in 2023, is fighting for answers and accountability.

“I got to think about him every day of my life and I don’t know when the pain stops,” Lawrence’s father, Frank Richardson, told a local TV station in October 2023. “I pray to God that he touches that jail and puts people in place to help the other ones that are left behind.”

Shortly before his death, Lawrence, 34, had filed a complaint about jail conditions, alleging that he was brutally beaten and isolated, with insufficient food and water.

But Fulton County Sheriff Patrick Labat largely blamed the jail’s “outbreak of violence” on “the long-standing, dangerous overcrowding and the crumbling walls of the facility.”

In order to “save lives,” Labat said, his county would be requesting a “replacement jail.”

The Georgia sheriff is among many law enforcement officials to claim that people like Samuel Lawrence would be safer if communities reduced overcrowding by building new jails or enhancing existing ones.

But recent research my colleague Weiwei Chen and I published on escalating jail mortality rates nationwide calls into question that rationale.

In an article published in the June 2023 issue of Health Affairs, we examined relationships between jail conditions and jail deaths, analyzing factors such as percent of jail capacity occupied, admission and discharge rates and population demographics.

Among the variables that appeared to be most significantly related to jail mortality were turnover rate – the number of people admitted to and discharged from a facility relative to its average population – as well as the percentage of Black people in the jail population.

Jail mortality

Jails are sometimes referred to as the “front door” of the criminal justice system. Unlike prisons, which are run by federal and state governments and hold convicted people serving relatively long sentences, jails are locally managed, and the majority of their populations are being detained pretrial while unconvicted.

Data on how many people die while incarcerated is notoriously inaccessible and often unreliable. Still, available reports on jail deaths from the Bureau of Justice Statistics offer some perspective.

In 2019, overall jail death rates were below the adjusted national average of 339 per 100,000, but leading up to that year, they had steeply increased. Between 2000 and 2019, jail mortality rose by 11%, from 151 per 100,000 to 167 per 100,000.

To conduct what epidemiologist Homer Venters referred to as an “apples-to-apples comparison” of circumstances and deaths in multiple jails during a period of escalating mortality, we relied on a combination of datasets.

For information about facility deaths, we turned to statistics compiled by Reuters news agency reporters, who submitted Freedom of Information Act requests to obtain mortality data from the largest jails across the U.S.

Our data on jail conditions – such as annual admissions and releases, facility capacities and demographics – came from the Bureau of Justice Statistics’ census and annual survey of jails.

Ultimately, we assessed mortality rates and conditions in approximately 450 U.S. jails between 2008 and 2019.

Some of our most robust findings about jail deaths had to do with two factors: turnover rate – the sum of weekly admissions and releases divided by average daily population – and demographics.

In the jails we examined, average turnover was 67% (slightly above the national average of 53%). Relatively high turnover rates, we found, were associated with higher death rates overall, as well as due to suicide, drugs and alcohol, and homicide.

In addition to revealing a relationship between turnover rate and mortality, our research showed that the presence of greater proportions of non-Hispanic Black people in populations of relatively large jails was associated with more deaths due to illness.

Race-based differences in illness-related deaths could be due to a variety of factors, including populationwide health disparities in the U.S.

Reliance on jails

Our findings about both turnover and racial disparities should be considered alongside the broader context of jail incarceration in the United States.

Roughly 4.9 million people are arrested and jailed each year, some of them multiple times. Overall, there were approximately 10.3 million admissions to more than 3,000 U.S. jails in 2019.

As of 2019, Black people were jailed at a rate more than three times that of white people.

People in jails have been found to be “significantly poorer” than people outside of jails, and more than 30 percent of those who are detained remain incarcerated because they cannot afford to pay bail.

Jailed people are also disproportionately likely to face health challenges. They are more likely to report having had chronic health issues, infectious diseases, mental illnesses and substance use problems.

The United States’ remarkably high population of incarcerated people – and the composition of that population – are related to decades’ worth of cuts in social welfare programs, structural racism, local and national political trends, and policing practices.

Research has shown that the cash bail system – a key driver of high jail turnover – “punishes the poor” by ensuring that they are more likely to be detained than their wealthier counterparts for the same crime. A reliance on cash bail also reportedly increases recidivism and undermines public safety.

Beyond incarceration

Our study suggests that ongoing initiatives geared at reducing incarceration – and by extension, jail turnover – could help achieve Sheriff Labat’s goal of saving lives.

Some communities, for example, have successfully limited the use of cash bail. Others have enhanced community-based services that address mental illness, drug use and homelessness without involving police, so jails are less likely to be sites of first resort for people with complex needs.

A year before Samuel Lawrence died, a report from the ACLU suggested that by adopting at least some of the above measures, Fulton County could “reduce its jail population significantly.”

It could also, our research suggests, save lives.

Jessica L. Adler, Associate Professor of History, Florida International University

This article is republished from The Conversation under a Creative Commons license. Read the original article.