Fentanyl, Opioids, and Overdoses: An American Epidemic

Media provided by Randy Laybourne, Unsplash

A couple of months ago, Suzanne L. Roberts, D.O., M.P.H., an attending physician in the Division of Pediatric Emergency Medicine at Jacobi Medical Center, had an infant being rushed into the emergency room. She described him as being “sleepy, lethargic, … non-responsive, and his oxygen level was extremely low.” 

Dr. Roberts administered two rounds of Narcan, the treatment for an opioid overdose, and was able to save the baby’s life. Because the substance does not show up on the standard drug test, it wasn’t until later that the doctors discovered that he had somehow consumed fentanyl.

In an interview with The Gazette, Dr. Roberts confirmed that there is no way to know, at the moment, how much brain damage the drug intake and lack of oxygen caused the baby. “We really are lucky whenever we can save people that have overdosed or have gotten poisoned by fentanyl. With all these new [drugs like fentanyl] circulating, it is getting harder.”

The majority of recent fentanyl overdoses are associated with illegally manufactured fentanyl (known as IMF), which is distributed on illegal drug markets for its heroin-like effect. Because of its immensely powerful effects, it is frequently mixed with other drugs to reduce costs, increase potency, enhance addiction, and heighten risks.

Fentanyl is available in various forms on the drug market, such as powder and liquid. Powdered fentanyl has a similar appearance to several other drugs and is frequently combined with heroin, cocaine, and methamphetamine to create counterfeit prescription opioids. These counterfeit drugs are extremely dangerous, and users often consume them without knowing that they contain fentanyl.

IMF can also be found in liquid form, where it can be used in nasal sprays, eye drops, or applied to paper or small candies.

Just two milligrams of fentanyl, an amount that fits on the tip of a pencil, is potentially lethal. According to the CDC, 107,622 Americans died of drug poisoning in 2021, with 66% of those deaths caused by fentanyl. In the US, a fentanyl overdose kills an average of one person every seven minutes. The drug kills more Americans than car accidents, gun violence, or suicide.

Other drugs may contain deadly doses of fentanyl, which is undetectable by sight, taste, or smell. A filler is usually an inactive substance (such as corn starch) that is added to a product to increase its size or improve its manageability. Fillers are frequently used in the production of pills or capsules as the quantity of the active drug is too tiny to be handled easily.

Fentanyl is more frequently used in place of a filler because it multiplies the effectiveness of opioids like heroin. It is nearly impossible to tell whether drugs have been mixed with fentanyl without using fentanyl test strips, which are extremely hard to access in most states.

A drug called naloxone (commonly known by the brand name Narcan) saves lives by reversing the effects of an opioid overdose. In simple terms, an opioid “slows down” your system, while naloxone blocks the effects as a temporary countermeasure until you can be taken to a hospital emergency room. Because of fentanyl’s strength, multiple doses of naloxone are often needed to reverse an overdose. It is accessible in all 50 states in the form of an injectable or a nasal spray. The majority of naloxone forms may be bought from a neighborhood pharmacy without a prescription. 

Chris D. Clark, Press Officer at the NYC Department of Parks & Recreation, said, “all of our Parks Enforcement Patrol (PEP) officers are equipped with naloxone, which is used to treat overdoses from opioids, including fentanyl.” Since their training regarding the use of naloxone about four years ago, PEP officers have successfully reversed numerous overdoses.

In an interview with The Gazette, Dr. Suzanne Rosenfeld, M.D. of West End Pediatrics, said, “We often see high school and college students using another student’s Adderall to help get through a test. … These days, it is just too dangerous because you really don’t know what else is in it.”

Dr. Rosenfeld carries Narcan in her purse and takes it everywhere with her. “Every high school needs Narcan. If they are going to carry EpiPens, they need to be carrying Narcan also.”

Vikki King, Grace’s high school nurse, said she could not comment on whether the Grace healthcare team has access to Narcan, but “Grace is currently reviewing the State and City requirements in order to administer naloxone (Narcan). When we have determined our course of action, the Administration will share the news.”

Grace’s preparedness in the face of the opioid crisis is critical.  

In the 1990s, an epidemic began. According to the Centers for Disease Control and Prevention (CDC), the Opioid Epidemic can be sketched out in three unambiguous waves. 

The first wave was triggered by the increase in and soaring rate of opioid prescriptions in the 1990s under the medical industry’s mistaken impression that opioids are not addictive. Since then, the rates of overdose casualties concerning prescription opioids (natural and semi-synthetic opioids and methadone) have risen tremendously.

In 2010, the second wave started, characterized by a rapid surge in deaths induced by heroin overdoses. The rates of heroin-induced deaths were four times higher in 2020 than in 2010.

The third wave emerged in 2013, marked by significant rises in synthetic opioid-caused deaths, particularly those that involve illegally produced fentanyl. The market for illicit fentanyl is still evolving today, and it is often combined with heroin, fake pills, and cocaine.

The number of drug overdose deaths grew by virtually 30% from 2019 to 2020, a number that is five times what it was in 1999. Nearly 75% of the 91,799 drug overdose deaths in 2020 involved an opioid. Between 2019 and 2020, there were considerable rises in opioid-involved death rates:

Opioid-involved death rates increased by 38%.

Prescription opioid-involved death rates increased by 17%.

Synthetic opioid-involved death rates (excluding methadone) increased by 56%

Fentanyl is a synthetic opioid. It is 50 times more potent than heroin and 100 times more than morphine. It is a significant factor in both fatal and nonfatal drug overdoses in the United States. 

There are two types of fentanyl: pharmaceutical fentanyl and illegally produced fentanyl. Doctors prescribe pharmaceutical fentanyl to help patients manage severe pain, particularly after invasive surgeries and for advanced-stage cancer.