SINGAPORE: A drug 50 times more potent than heroin that has caused hundreds of thousands of deaths in North America has reached Singapore's shores for the first time.
The Central Narcotics Bureau (CNB) announced on Mar 6 that it had seized 200 vials of fentanyl after anomalies were detected in a parcel from Vietnam that was declared as medicine.
Immigration and Checkpoints Authority officers had uncovered the vials containing a total of about 20mg of fentanyl, a Class A controlled drug in Singapore.
The intended recipient of the parcel, a 30-year-old female Singapore permanent resident, was arrested with two Singaporean men, aged 62 and 65, for suspected drug-related offences.
In response to queries from CNA, a CNB spokesperson confirmed that this was the "first detection of the importation of fentanyl into Singapore".
The National Addictions Management Service, at the Institute of Mental Health, said it has seen one case of fentanyl addiction in Singapore a few years ago, although nationwide data is not available.
Farther from home, fentanyl and its derivatives have caused more than 130,000 overdose deaths in the United States and Canada in the past five years, Reuters reported in May last year, citing government agencies.
Opioids like fentanyl, heroin, codeine and morphine can be deadly when abused, as their sedative effects might cause a person to stop breathing.
Fentanyl can be 50 times more potent than heroin and 100 times more potent than morphine, doctors told CNA.
"The abuse of fentanyl results in similar effects to other opioids, such as nausea, drowsiness and respiratory depression," the CNB spokesperson said.
"Due to its potency, fentanyl abuse brings with it a heightened risk of death as a result of overdosing.
"This is compounded by the involvement of organised crime groups in mispresenting fentanyl as other illicit opioids or adulterating fentanyl with other illicit opioids such as heroin, and trafficking the substance to unsuspecting users."
According to CNB statistics, 68.25kg of heroin was seized in Singapore last year, making it the most common drug seized by weight, after methamphetamine (44.87kg) and cannabis (43.12kg).
FENTANYL AS AN ADULTERANT
Dr Munidasa Winslow, senior consultant psychiatrist at Promises Healthcare, said drug dealers sometimes cut heroin with fentanyl to add potency.
Like all opioids, fentanyl is addictive as it gives a "euphoric rush", he said, although he warned that it is "a lot easier to overdose and have respiratory depression and die".
Dr Gomathinayagam Kandasami, senior consultant at the National Addictions Management Service, said fentanyl abusers commonly inject the drug, but in the process can frequently overdose and die due to its high potency.
"High incidents of reported deaths related to fentanyl abuse in the US have been linked to illegally made fentanyl which can be adulterated with other illegal drugs," he said.
THE SPREAD OF ILLEGAL FENTANTYL
While there have been no reports of widespread abuse of fentanyl in the region, Reuters reported that Myanmar had seized a huge haul of liquid fentanyl last May.
This was the first time the drug had been found in Asia's Golden Triangle drug-producing region, the report stated.
With the fentanyl seized in Singapore arriving from Vietnam, CNB was asked about the flow of illicit drugs from the region.
"The worrying regional drug situation, coupled with Singapore’s close geographical proximity to increased trafficking activities in the region, has adverse downstream implications for our local drug situation," the spokesperson stated.
"CNB will continue to partner our foreign law enforcement counterparts to conduct joint operations targeted at drug trafficking and manufacturing activities overseas, and work closely with the other Home Team departments on border control measures to detect and prevent the flow of drugs into Singapore."
Nevertheless, Dr Winslow highlighted that fentanyl has medical uses, noting that it could be used by pain specialists as patches for breakthrough chronic pain.
Dr Ong Say Yang, pain service lead at Alexandra Hospital, said doctors may add opioids to existing painkillers for severe pain that is "difficult to control", like cancer pain.
While morphine is more commonly used to treat severe pain, Dr Ong said fentanyl, in the form of a slow-releasing skin patch, can be prescribed if the patient's pain does not respond well to more commonly used opioids.
"Fentanyl can also be given in an injectable form by trained medical professionals for pain relief and sedation during procedures such as colonoscopy, or together with other sedatives to induce general anaesthesia for surgery," he said.
In 2018, Australian news channel 60 Minutes published a segment on the dangers of fentanyl in the country, highlighting that addicts looking for their fix simply had to get a prescription for fentanyl patches from their general practitioner.
In Singapore, Dr Winslow said pain specialists here "are pretty aware (about fentanyl) and keep a tight reign on the prescribing patterns, with supervision".
The Pain Association of Singapore had in 2013 published guidelines on how to prescribe opioids, including monitoring patients regularly through urine and blood tests to ensure they are taking the right doses.
Doctors should also look out for tell-tale signs of addiction, including the forging of prescriptions and requests for higher dosages.
Dr Ong said patients are carefully assessed on suitability before being started on opioids, and are given follow-up appointments at shorter intervals so that smaller quantities of opioids can be prescribed each time.
"We look out for signs that could suggest drug misuse, such as obtaining addictive medication from multiple healthcare providers or frequently asking for early refills of such medication, and refer such patients to our colleagues in addiction medicine for further management," he said.
The doctors said that fentanyl addiction is treated same way as any other substance use disorder.
"The person with fentanyl addiction would need to go through an inpatient detox programme to give up their dependence on the drug, followed by either community or residential-based long-term rehabilitation interventions to stay clean," Dr Kandasami said.