Years ago if you asked the average American what fentanyl was, odds are they wouldn’t be able to tell you. Most would probably assume it was some important medical compound found only in hospitals. It almost sounds like the name of some edgy chemical you’d associate with either Breaking Bad or the Unabomber. Sadly, gone are the days of such blissful ambivalence.
Today, America has a more realistic idea of what fentanyl is.
Most adults and young people have at the very least heard the horror stories about this now intensely infamous drug. If you have a television or a smartphone, odds are you have at least glimpsed the headlines. Because in the last few years the devastation caused by this powerful synthetic drug has spread all over the country, and cost countless lives.
Using data from the National Vital Statistics System, researchers have shown an involvement of fentanyl in opioid overdose deaths has quickly skyrocketed:
- 2010- 14.3% of opioid overdoses involved fentanyl
- 2016- 46% of opioid overdoses involved fentanyl
With nearly half of opioid-related overdoses, fentanyl is now involved in more deaths than:
- Prescription opioids- 40 % in 2016
- Heroin- 36.6 % in 2016
More than one drug is commonly involved in many of these deaths. Therefore, in some cases heroin and fentanyl are both accounted for. However, we can see how fentanyl has a growing presence that can definitely be felt, as dozens of thousands of Americans are dying every year due to exposure to this deadly drug.
So if you’re still unclear as to what exactly fentanyl is, let us look at how to better understand where it comes from and why it is so lethal.
Pain Medication Origins
Some people were indeed ahead of the curve when it comes to understanding fentanyl because it has actually been around for a very long time. The synthetic opioid is used as a pain medication, and in some cases combined with other medications for anesthesia. It has been used for years by hospitals, doctors, and even veterinarians to treat patients and puppies.
- 1960- Fentanyl was first created by Paul Janssen
- 1968- Fentanyl was approved for medical use in the United States
- 2015- 1,600 kilograms/3,500 pounds of fentanyl were used globally
- 2017- Fentanyl was the most widely used synthetic opioid in medicine
On its own, the substance typically looks like a white powder. As a medicine, fentanyl is available in a number of forms, including:
- Skin patch
And it may be hard for some to believe, but it’s true that one of the deadliest chemicals on the street today can actually be found in lollipop form for medical use.
The drug is such an effective painkiller because it is typically considered to be approximately 75% stronger than morphine for a given amount. However, there are fentanyl analogs such as carfentanil (carfentanyl) which can actually be as much as 10,000 times stronger than morphine. When translated to the illicit drug world, that means fentanyl and its derivatives blow heroin out of the water when it comes to potency and risk.
As a medication, fentanyl can be useful in treating chronic pain patients when utilized correctly. Pre-surgical and post-surgical use of powerful pain management medications is sometimes a necessary step to helping patients recover. In fact, fentanyl patches are on the World Health Organization’s List of Essential Medicines, meaning it is considered one of the most effective and safe medicines needed in a health system.
Black Market Poison
Despite the seemingly altruistic intentions behind the invention of fentanyl, it has been used illicitly since the mid-1970s. Now, there are more than 12 different analogs of fentanyl that have been identified as being illegally made and used recreationally. The synthetic opioid is used through:
- Taken orally
Some people who abuse opioids do seek out fentanyl. Fentanyl is sometimes sold on the black market after being diverted from legitimate medical supplies. Recently drug manufacturers have also been accused of racketeering in order to boost sales of fentanyl. Even the gel from inside the transdermal patches may be ingested or injected. Those fentanyl lollipops have also made their way into the illegal drug trade.
But a large number of people who end up using fentanyl do it unintentionally. It has been used to adulterate or ‘cut’ heroin, and it has been pressed into counterfeit pain pills and sedatives sold on the illicit drug market. More recently there has been a rise in overdose deaths among cocaine users involving the drug, which suggests that fentanyl is being heavily cut into cocaine as well.
So why are dealers using it? To name a few reasons:
- As mentioned before, it is extremely potent
- It is easier to smuggle into the U.S.
- The drug is very cheap to produce
In China, carfentanil was not a controlled substance until March of 2017, meaning it had been legally manufactured and sold over the internet up until barely a year ago.
While it is a profitable move for drug traffickers, it is a life-threatening variable for drug users. Variations of the compound can be so strong they are incredibly poisonous. Simply breathing air with atomized fentanyl in it, or touching a contaminated surface can kill you.
Because of the massive reach of the outbreak, it is important than ever to be aware of the symptoms of fentanyl overdose. These warning signs can include:
- Difficulty thinking, speaking, or walking
- Excessive drowsiness
- Frequent fainting spells (nodding off)
- Throwing up
- Pale face
- Blue- or purple-colored lips, fingernails, or extremities
- Choking sounds
- Pupil size reduced to small black circles in middle of eyes
- Low blood pressure
- Slowed heart rate
- Difficulty breathing
- Hypoventilation (slow, shallow breathing)
- Respiratory arrest
Adding to the terrible risk of coming into contact with illicit fentanyl or one of its derivatives is that opioid overdose antidotes like naloxone are not as effective when trying to reverse the effects. Sometimes an individual will require multiple doses of naloxone to be revived, ance revived a new overdose can actually occur when the initial dose of naloxone wears off. It is critical that someone who experiences an overdose received medical treatment immediately.
The nation has been caught up in a growing opioid crisis for years now, serving a shock to the healthcare system and public health officials everywhere. As the death toll climbs and more people are suffering and dying every day it is crucial that we raise awareness and take action to address drug abuse and addiction. One of the essential tools to fighting back is effective and innovative treatment options. If you or someone you love is struggling, please call toll-free now.
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Author: Justin Mckibben
It hasn’t even been one week since I wrote about the Center for Disease Control and Prevention (CDC) reporting opioid overdoses increased by 30% in only one year, and already a new story from The Washington Post suggests that these numbers are actually being highly undercounted! So in reality, the increase could be skewed by the fact that the real rates of overdose deaths are tragically misrepresented.
This new study reveals that the government has actually been undercounting opioid overdose deaths by anywhere between 20% and 35%!
So how is this happening? How much worse is the overdose outbreak?
A Closer Look at Coroner Reports
The reason the study says this underreporting is happening is due to how the current numbers are actually determined. In order to estimate national trends in opioid overdose and opioid-related death, the federal Centers for Disease Control and Prevention amasses data from over 3,000 coroner’s offices across the US.
However, the issue is that coroners function independently, so their available resources vary from case to case. The same goes for their reporting practices.
Christopher Ruhm, a professor at the University of Virginia, took a closer look at tracking trends and found that a lot of coroners do not specify the drug when documenting a fatal overdose. Ruhma states that from 1999-2015, of all fatal overdoses 23.1% did not have a drug specified on the death certificate.
The CDC cannot control local coroners, so it is the states and counties responsibility to improve their overdose reporting practices. If we want a more accurate reading of how opioids are harming a community, there has to be efficient documentation.
Unfortunately, the political incentives are not very supportive of accurate reporting. Officials may be concerned that by spending money on better overdose recording, they will have paid for the chance to look like their opioid problem is actually getting worse. The incentive just isn’t there from a political stance. However, that isn’t a good enough reason to botch the records. Communities still deserve to have a comprehensive idea of the issues they are facing.
Tracking Overdose Death Trends
The inference of coroners not including the drug in the report is that there are a lot more overdoses that do not get included in the official figures released at the federal level. There could be thousands of more deaths from opioids that go unaccounted for. To take a shot at tracking trends, Ruhm studied the records of coroners who did record specific drugs for overdose deaths. Based on this tracking, he was able to attribute a “corrected count” of opioid overdoses. In his report, Ruhm states:
“Corrected rates were obtained by using information from death certificate reports where at least one drug category was specified to impute involvement for cases where none was specified.”
There are many elements to how Ruhm came up with her corrections, and I encourage everyone to read the full analysis, which is published by the Society for the Study of Addiction (SSA). The report makes some pretty intense claims about what overdose deaths opioids should account for. For example in 1999 the CDC figures show:
Yet, Ruhm’s corrected count shows 1999 saw:
- 10,232 overall opioid deaths
- 3,421 synthetic opioid deaths
In 2015, the CDC figures say:
- 33,091 overall opioid deaths
- 19,884 synthetic opioid deaths
But Ruhms count pushes that up to:
- 39,999 overall opioid deaths
- 23,857 synthetic opioid deaths
Finally, when we look at the 2016 CDC figure, it said 42,249 opioid overdose deaths nationwide. But the corrected count figure puts 2016 at 49,562 opioid overdose deaths nationwide
What we can take away from Ruhm’s research is simply that the severity of the opioid crisis is being underestimated. From 1999-2015, Ruhm’s corrected counts for overdose deaths were 21% to 35% higher for all opioids. With corrected counts involving heroin and synthetic opioids were 20% to 30% higher.
So when we look at these stats, even if we leave some room for calculation errors, it is still a troubling thought. Since 2009, the leading cause of injury-related death in America has been drug overdoses. For years now, opioids have been public enemy number one concerning drug policy. Everything from prescription painkillers to synthetics being shipped halfway across the world has contributed to this crisis. If all we know about the true devastation of this epidemic is merely our best guess that still doesn’t take it all in, now is truly the time to urge officials and community leaders to take significant steps toward real, lifesaving solutions.
One of the most important resources that we need to take advantage of is providing safe and effective treatment to those who are struggling. Palm Partners Recovery Center has offered innovative and holistic treatment options for over two decades. If you or someone you love is struggling, please call toll-free now. We want to help.
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Author: Justin Mckibben
These days it is pretty much impossible to In case you missed it, the latest news concerning opioid overdoses in America is not good. Just this week a report was released by the Center for Disease Control and Prevention (CDC) that only reminds us of just how horrific the opioid epidemic is. In most of the country, this crisis continues to get worse.
While we still don’t have a complete picture of the death toll in 2017 concerning opioids, the most up-to-date data shows that overdoses have spiked nationwide. Examining reports from hospital emergency rooms, the report compares the overall increase in opioid overdoses from the third quarter of 2016 up until the third quarter of 2017.
According to this data, opioid overdoses to increase by 30% in only a year.
Rising Overdose Rates by Region
In every age group, with both men and women, opioid overdoses are increasing, according to CDC Director Anne Schuchat. The Midwest has been the hardest hit region in that 12 month period. According to the CDC report:
- 7% increase in opioid overdoses in the Midwest
- 3% increase in the West
- 3% increase in the Northeast
- 2% increase in the Southwest
- 14% increase in the Southeast
All this may not come as much of a surprise for many Midwesterners. When you look at the last few years, the opioid crisis has not been kind to these communities. Of the counties with the highest overdose death rates per capita over the last few years, we consistently find some of the top spots going to states like West Virginia, Ohio, and Kentucky.
Needless to say, these devastating figures aren’t exclusive to the Midwest. A few more examples include:
- 109% increase of opioid overdose in Wisconsin
- 105% increase in Delaware
- 6% increase in Pennsylvania
- 34% increase in Maine
Luckily, not all areas are experiencing record highs. Some states are actually fortunate enough to see a slight decrease in overdoses, including:
- New Hampshire
- Rhode Island
Even in Kentucky, which has been a Midwestern state hit pretty hard over the years, the CDC analysis saw a 15% drop.
The CDC report does not specify as to why certain regions are experiencing overdoses differently, but one factor experts say has most likely played a key role is the availability of more potent opioids. The synthetic opioid fentanyl has been making its way onto the streets more and more over the last couple years, and supply of drugs like fentanyl has increased much faster in certain areas, which probably has a lot to do with the difference in overdose rates per region.
Analyzing Opioid Crisis
The recent report was meant to take a closer look at the opioid crisis by analyzing overdose reports in emergency rooms instead of opioid deaths like the CDC had previously focused on. CDC Director Anne Schuchat said these numbers lag behind the emergency room reports, and that the agency wanted “more timely information” to work with.
The data utilized for this analysis came from:
- Approximately 90 million emergency room visits
- Reports from July 2016 to September 2017
- 52 jurisdictions in 45 states
- 142,577 suspected opioid overdoses
That survey found an increase of 29.7% in opioid overdoses. The research also analyzed:
- 45 million emergency department visits
- Reports from July 2016 to September 2017
- 16 States
- 119,198 suspected opioid overdoses
This analysis shows a 34.5% increase during the same period, but those increases vary drastically from state to state.
At the end of the day, there are a lot of opinions on how to look at this mountain of information and see a way through it. But many experts are convinced that so far we have been failing those who are suffering the most. Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University, states:
“It is concerning that 20 years into this epidemic, it is still getting worse. The number of Americans experiencing opioid overdoses is still increasing.”
Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum, is one of many voices who are advocating for a more compassionate and supportive system. Those like Nickel believe that the key element to changing the opioid crisis is better integration of addiction treatment into a more comprehensive and effective healthcare system. Some, including Nickel, believe even emergency room staff should be better prepared to help get follow-up addiction treatment for people with substance use disorder.
Addiction isn’t going away anytime soon, and perhaps one of the most tragic parts of the problem is that so many people never get the help they need. Too many are afraid to ask for help, and plenty more still don’t know how to get help. Providing safe and effective substance use disorder treatment isn’t just useful, but vital to our future. So taking advantage of these programs and supporting expanded access to addiction treatment should be at the forefront of the conversation if we hope to break this trend and save lives. If you or someone you love is suffering from substance abuse or addiction, please call toll-free now. You are not alone.
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No one loves harder than a mother, and the pain a mother feels when a child suffers one cannot even imagine. So when a mother loses a child, the hurt can do a lot of things. For some mothers, it pushes them to action, and that is exactly what happens to a grieving mom in Ohio who recently launched a battle against drug overdoses with a roadside billboard after the loss of her son.
Following the overdose death of her son, Lenora Lada paid to put up a billboard in the Marietta, Ohio to raise awareness about the Good Samaritan laws. She takes this action in hopes that other mothers may not have to grieve as she does.
Trey’s Life Mattered
The sign Lada bought shows a picture of her son, Trey Moats, and reads,
“His Life Mattered: No Excuse For Not Calling 911 or taking someone to a hospital,”
Trey’s mother had known about his struggles with addiction but had felt helpless as her 26-year-old child was unwilling to get the help he needed.
Then one day at 3:26 in the morning, she got a call from her son’s friends. Trey had been in a car with these friends when his lips turned blue as he overdosed, so they had driven him to another friend’s house to ask a mother there to perform CPR. But because they were too afraid to call 911, they called Trey’s mother instead and told her to come and get him. Lenora Lada states that by the time she arrived, her son was on the ground already gurgling.
By the time Lada arrived at her son’s side, it had already been 20-25 minutes. When she asked if someone had called 911, she was told by the other mother,
“No, I don’t want the squad and the sheriffs coming to my house again.”
Lada demanded that the daughter call 911, but Moats ultimately died at the hospital of multiple organ failures due to cardiac arrest and polysubstance abuse. Ever since that tragic and heartbreaking moment, Lenora Lada is determined to make sure people know that her son’s life mattered, as do the lives of other victims of overdose. The billboard also states:
“3/10 Mile could have saved Trey’s life.”
Lada believes a call to emergency responders could have saved her son. The sheriff’s report, however, states it is unclear if her son would have survived even if he was taken to the hospital. Local news reports that one coroner said Trey would have been brain dead, but another coroner did not seem so sure.
One thing is for sure though, Trey’s life did matter. And whether or not it was certain to make a difference, something more should have been done to try and save this young man’s life. That is why now Lada is also focused on raising awareness for Good Samaritan laws in Ohio.
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Good Samaritan Awareness
According to the Good Samaritan law:
- Authorities cannot prosecute anyone who calls 911 to report an overdose
- Protects the person overdosing from prosecution
- Immunity is only good two times
- The law is not applicable to people on parole
Ohio’s Good Samaritan laws also require a survivor of an overdose to obtain a drug treatment referral within 30 days in order to avoid charges. This measure is in place with hopes to show more people who do suffer from addiction there are opportunities to seek help.
The intention of Good Samaritan laws is to reduce the hesitation to get help from bystanders who witness an overdose. These laws vary from jurisdiction to jurisdiction, with different interactions with other legal principals. But in essence, they are meant to prevent unnecessary overdose deaths by trying to take the fear of punishment out of the situation.
Lada also believes she would like part of the law to be changed, stating,
“I am asking for people to be accountable for not getting them help,”
What exactly that would look like is unclear, but for a mom who lost her son, it is an understandable sentiment. In many cases, there have been voices of support for charging drug dealers who sell to overdose victims with murder. So if this were to happen, what kind of punishment should someone face for not reporting an overdose?
Good Samaritan laws exist to help prevent deaths due to drug use, and there should be more of an effort to encourage people to report overdoses. Far too many sons and daughters are lost every day to drug overdoses. We should be taking every action we can to avoid more of the same. To defeat drug-related death requires prevention, education, and effective addiction treatment. If you or someone you love is struggling, do not hesitate. Please call toll-free now. We want to help.
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(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Justin Mckibben
You may remember back in early 2016 the pharmacy organization Walgreens announced two programs to address key issues in the opioid crisis.
- Safe medical disposal kiosks for unused prescription drugs
- Narcan expansion programs
By the end of 2016, Walgreens had expanded access to the opioid overdose antidote without the requirement of a prescription to 33 states and the District of Columbia. The Narcan opioid overdose antidote, also known by the generic name Naloxone, is a nasal spray that is utilized all over the country as a means to revive someone experiencing an opioid overdose.
Now, this life-saving compound is becoming even more accessible, as Walgreens is announcing the Narcan opioid overdose antidote will now be available at all of its over 8,000 pharmacy locations!
Pharmacies Stepping Up to the State of Emergency
This new move to combat the opioid epidemic comes at a crucial time. The epidemic continues to claim lives every day, with recovery advocates and government officials rallying for more resources to fight the problem.
Today, Thursday, October 26, 2017, the nation is expecting President Donald Trump to officially declare the opioid crisis a public health emergency at a scheduled White House event.
According to Rick Gates, Vice President of Walgreens,
“By stocking Narcan in all our pharmacies, we are making it easier for families and caregivers to help their loved ones by having it on hand in case it is needed.”
The company offers Narcan opioid overdose antidote without a prescription in 45 states and is willing to work with the remaining states to make to include them.
Of course, the fight for more availability of Narcan and Naloxone has been going on for some time. However, it seems as the country is calling for more sweeping action from government officials; pharmacies are taking it as a call to action themselves. Rick Gates went on to say,
“As a pharmacy, we are committed to making Narcan more accessible in the communities we serve.”
Walgreens also says it will inform customers about the Narcan opioid overdose antidote if they receive drugs with more than 50 morphine milligram equivalents (MME). This is actually a recommendation from the CDC.
It isn’t just Walgreens either. CVS pharmacy has expanded access to Narcan and other products that contain naloxone. CVS reportedly has been offering prescription-free naloxone in up to 43 states as of last month. CVS pharmacies have said that its locations “in most communities have naloxone on hand and can dispense it the same day or ordered for the next business day.”
Big Pharma’s Role
Big Pharma wholesaler AmerisourceBergen is also helping in these efforts. AmerisourceBergen is now distributing Narcan demo devices at no cost to Walgreens pharmacists. These demo devices will help with instructing patients on how to administer the medication safely and effectively.
Robert Mauch, Executive Vice President & Group President, Pharmaceutical Distribution & Strategic Global Sourcing for AmerisourceBergen, states,
“At AmerisourceBergen, we strive to provide our customers the highest quality care and support so they can ultimately enhance the lives of patients in their communities,”
“We recognize the important role we play in addressing the opioid epidemic, and our collaboration with Walgreens is another key milestone to supply our customers with access to lifesaving initiatives and emergency medications that can help keep individuals safe across the country.”
Ironically, AmerisourceBergen just so happens to be one of the three largest drug distributors that were mentioned in the recent 60 Minutes interview with ex-DEA agent Joe Rannazzisi. In the segment that has since caused a major uproar, Rabbazzisi said companies including AmerisourceBergen controlled probably 85%- 90% of drugs that went “downstream” and ended up on the streets.
This might not be what Mauch meant by “recognize the important role we play”, but at least it seems like AmerisourceBergen is taking steps to become part of a solution.
Meanwhile, Adapt Pharma, the manufacturer of Narcan Nasal Spray, celebrates this action by Walgreens to expand naloxone and Narcan access. Seamus Mulligan, CEO at Adapt Pharma states,
“This action is an important milestone and we applaud Walgreens initiatives to improve access to Narcan Nasal Spray in communities across the U.S.,”
“This effort, combined with the opportunity for patients and caregivers to obtain Narcan Nasal Spray without an individual prescription in 45 states, is critical in combating this crisis.”
America is working hard to find the right path on the road to recovery from the devastating opioid crisis. It is crucial that we make every possible resource available to help save lives. With opioid overdose killing an estimated 91 people every day, the need for this life-saving medication could not be more evident.
Beyond reversing the effects of an overdose, there is more we need to do. While having access to Narcan and naloxone can help tremendously, we also need to promote recovery and addiction treatment resources. Preservation of life is important, but giving people the help they need to live a happier and healthier life should also be a priority in the fight to overcome the opioid crisis. Palm Partners Recovery Center believes in actively providing the best in innovative and holistic treatment opportunities, to help transform lives. If you or someone you love is struggling with substance abuse or addiction, we want to help. Please call toll-free now.
CALL NOW 1-800-951-6135