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When researching a topic for this blog, I will sometimes search for trending topics. I want to know what people are talking about. I hit on a statistic that stopped my brain cold. “Every 11 minutes, someone dies from a fentanyl overdose”. Wow.
This week, we are going to break it down. What is it, who invented it, how is it that kids are getting it, and how do we proactively stop it from killing our children? Let’s get at it…
Who invented Fentanyl and why?
According to PNNL, Fentanyl was created in 1959 by Dr. Paul Janssen as an intravenous surgical analgesic. The drug is 50–100 times more potent than morphine. Because of its strength, the drug was rarely used except in hospital operating rooms or on large animals.
In the 1990s, a new transdermal skin patch for fentanyl was developed to treat chronic pain. The non-surgical delivery mechanism offered some unique advantages over other drugs, including quick onset of action, relatively few cardiovascular risks, and low histamine release. These attributes made it a good prescription choice for some patients because it reduced some of the risks of medical complications that other pain relievers have.
Lozenge, lollipop, tablet, and nasal spray versions soon followed, under such names as Actiq®, Duragesic®, and Sublimaze®. The ease and effectiveness of these user-friendly delivery methods led to abuse, and the fentanyl analog market was born. Criminal manufacturers began creating designer drugs—analogs with modified chemical structures—to avoid identification as a controlled substance.
When did the deaths begin?
From 1999 to 2011, the death rate in the United States due to opioid analgesics nearly quadrupled, then began to skyrocket around 2013–2014. This timing coincided with the first detection of illicit pills containing fentanyl, fentanyl analogs, and other novel synthetic opioids such as U-47700.
I’m so confused…I thought it was pills like Percocet that were the problem…
In 2017, the President issued Executive Order 13784, establishing a Commission on Combating Drug Addiction and the Opioid Crisis. Many of the 45,000 drug-related deaths that year were determined to have resulted from abuse, addiction, and overdoses due to fentanyl.
A major contributor to the opioid drug crisis was availability, and not just from doctors. Modern internet e-commerce enabled individuals, small-scale drug trafficking organizations also known as DTOs, and large-scale DTOs with their own production facilities to flood the illicit drug market with fentanyl.
The drugs could be purchased and delivered through standard mail to the United States from places as far away as China. In many cases, drug users and mid-level dealers have no idea where or how their drugs are manufactured or what they might be cut with. This makes it a literal game of Russian roulette for our children.
That’s terrible, but it gets worse
Fentanyl analogs are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required.
Carfentanyl, a fentanyl analog, is an odorless white powder. It is one of the most potent opioids known and used commercially. According to the National Institute on Drug Abuse, carfentanyl is approximately 10,000 times more potent than morphine, 100 times more than fentanyl, and 50 times more than heroin. It is supposed to be used as a general anesthetic for very large animals.
In July 2016, carfentanyl was found cut into heroin, and fentanyl was sold on the streets of Ohio. In a span of three days, 35 overdoses and 6 deaths occurred there. In the same year, in Anoka County, Minnesota, six overdoses and two deaths occurred in a 12-hour period in October 2016. These instances and similar cases throughout the nation pointed to single batches of fentanyl-laced heroin as the culprit for dramatic spikes in overdose cases.
Why would anyone take such a thing, and why would a drug dealer purposely kill an addict? That doesn’t make sense.
Most opioid users do not intentionally seek out fentanyl. To unsuspecting people, the drugs can look like legal opioids or benzodiazepines for pain relief. Many pain patients have been cut off from their pain medications by well-meaning physicians, but seek relief regardless, because for some, living with pain means eventual death by suicide. They’d rather take their chances on the street.
They find a dealer, and once a person is exposed to a higher-toxicity drug, the brain chemistry alters further, and the user will seek out the most potent form of the drug.
At the height of addiction, some users lose their ability to discern risk and are willing to go to any length to obtain the drug, including boiling fentanyl patches to extract the drug for injection or ingestion.
If a user is new to taking opioids, the risk of overdose is even higher because their bodies have no tolerance to the drug. This also applies to someone who has gone through detox and has been clean for a time. When they come back to their habit, they will often overdose on the first hit, because they take as much as they took the last time they used it at the height of their addiction, and their body can no longer tolerate that amount.
What names are Fentanyl sold under on the streets?
Fentanyl analogs, including fentanyl-laced heroin, come in many flavors, with street names such as white heroin, Perc-O-Pops, Chiclets, Apache, China Girl, White China, Dance Fever, Jackpot, Murder 8, TNT, Tango and Cash, Friend, Goodfella, and Redrum (murder spelled backward). The sheer variety of the drug, including emerging combinations, makes toxicology testing and accurate death reporting extremely challenging. This means that the high numbers of people dying from an overdose of fentanyl are actually not as high as they should be. That’s terrifying to think about.
Busting the myths – can I die by touching someone who has used?
No, that is a common myth. Fentanyl cannot be readily absorbed through the skin, nor can you overdose on fentanyl by touching a doorknob or dollar bill. As a result, it is safe to help people who have overdosed on fentanyl.
There are fentanyl skin patches that are prescribed by a doctor in which a special formulation of the opioid can be slowly absorbed through the skin. Even then, it takes hours of exposure.
Please take a minute and listen to this doctor.
What do I do if I find my child has overdosed?
If you suspect that a child has been exposed to a fentanyl patch, or used illegal fentanyl, use naloxone (also known as NARCAN) if you have it, call 911, and seek emergency medical help immediately. Early signs of fentanyl exposure might be hard to notice in young children. You can get NARCAN over the counter.
If NARCAN fails, and you need to start CPR, remember that the accepted form is ONLY chest compressions, no breaths.
Can I really get NARCAN without a prescription?
YES. As of 2022, you can buy Narcan without a prescription from your healthcare provider in all 50 U.S. states. Washington D.C. and Puerto Rico also allow this. I know many people who carry it in their car, and keep it at their office and at home. It’s best to buy two at a time, as sometimes the first dose isn’t enough to revive the person before help can arrive.
What is Rainbow Fentanyl?
This is a newer marketing ploy in which fentanyl is mixed with dyes and either pressed into brightly colored pills or sold as a powder in various colors. Drug traffickers are using these dyes to avoid detection and to appeal to teens and young adults. Despite claims that certain colors may be more potent than others, there is no indication through laboratory testing that this is the case.
According to the DEA, bright-colored fentanyl pills designed to hook children have been spotted in nearly two dozen states. The DEA says they identified a deliberate new marketing scheme by Mexican cartels and street dealers who want the pills to “look like candy to children and young people.”
It is also a way for children to keep it around without parents growing suspicious (sorry, not sorry, kids…now the parents know).
Educate your children about Fentanyl
Nationally, overdose deaths among adolescents more than doubled from 2010 to 2021, according to a study published in JAMA, and rose another 20% in the first 6 months of 2021. Synthetic opioids like fentanyl are the primary driver of these deaths.
Kaiser Permanente weighs in
Sarah Leitz, MD, chief of addiction medicine for Kaiser Permanente in Portland gives us some good information about Fentanyl.
We don’t really know the lethal dose because pills and people are different. We do know that the smallest dose can be deadly, especially for someone who doesn’t take opioids regularly.
Most recent overdoses are not a result of pharmaceutical-grade fentanyl in prescription doses. Rather, the drug is being imported into pills that resemble prescription medication and include other substances such as heroin or Xanax, a brand of anxiety medication.
Thus, users who assume they’re taking prescription medication in a safe dose may end up consuming a mix of lethal drugs.
How can you identify a counterfeit pill?
According to the U.S. Drug Enforcement Agency, many counterfeit pills are made to look like prescription opioids such as oxycodone (Oxycontin, Percocet), hydrocodone (Vicodin), and alprazolam (Xanax); or stimulants like amphetamines (Adderall). Others are imprinted with “M30” and known as “Blues” or “Oxy 30s.”
Bottom line: Never trust yourself to determine if a pill is legitimate. The only safe medications are those prescribed by a trusted medical professional and dispensed by a licensed pharmacist.
Extra advice for parents
Tell your children that they should NEVER accept a pill at a party or from a friend, even a trusted best friend. Unless the medication has been prescribed, they have NO IDEA what they are really taking, and since one pill can equal death, it is simply not worth the risk.
While I wish it was as easy as saying, “no thanks” to those who would pressure our kids, that’s simply not true. Many kids won’t take no for an answer, and if your child is in a hot seat, you need to give them a verbal way of de-escalating the situation. Most kids don’t have enough inner strength to just say no past the first time.
Give your kids some one-liners to use when they are being pressured. Responses such as, “I’m good already, but thanks for offering” can leave things neutral between the peers, and even though it’s not a great idea to thank someone for offering you a pill that could kill you, we have to remember that the child is in the hot seat and we just want them out of it and alive.
Another “out” can be, “I feel sick…I need to go home before I start throwing up all over everything” which can also be a smooth ticket home and to safety. Nobody wants to smell puke.
I thought the opiate crisis was about kids stealing their parent’s pain pills…this is disturbing.
Well, that’s what we as a public were led to believe, for sure. You aren’t wrong. And to be fair, that does happen, but from what I researched, it’s happening more often that children/teens are getting their opiates from places other than home.
In the late 1990s and early 2000s, prescription-based opioids were the drug of choice. As guidelines became stricter and more doctors and dentists became aware of the opioid epidemic, they prescribed fewer opioids, so people turned to things like heroin and fentanyl.
It’s past time for us to review how we address people’s chronic pain. Turning them away at the clinical level is resulting in them seeking out dealers and that is, in turn, creating a wave of deaths that are involving the youngest of us. A Sarasota couple was arrested after deputies said their 8-month-old baby was found dead after overdosing on fentanyl.
We have taken the control away from the doctors and put it straight into the hands of dealers.
Illicitly used drugs don’t come in childproof packaging.
The reality is this
In the time it took you to read this blog, a child has died from a fentanyl overdose. We need to do better.
+++++++++++++
As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.
That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.
Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!