Fentanyl is Killing, Still

The Guardian recently published an expose of drug overdose in America. The glacial pace at which we have come to grips with this crisis is intriguing and disappointing. The story is titled "How fentanyl is unfolding as one of America’s greatest tragedies." Fentanyl is a powerful synthetic opioid. Despite some voices alarmed with opioids, it is a pandemic that has run largely unabated. I have posted on the topic a few times, many of which are linked in Florida's 2018 Session - Opioids (March 2018). Drug overdose is killing Americans.
How many? In Contemptuous? (October 2021), I noted that drug overdose deaths are increasing. Forbes announced in November that deaths in 2020-21 are up 28.5% over a year prior. The overdose death toll in that period is thought to exceed 100,000 Americans. It says that roughly two-thirds of that, 64,000, are thought to be due to Fentanyl. Will the numbers matter? Forbes suggests that there are "some promising signs."
Forbes notes that following the investment of tens of millions of dollars, there has been:
"a 28% jump in the distribution of (Naxalone) medication in Pennsylvania."
"a new first-of-its-kind online portal to provide naloxone via mail order (in Michigan)"
"greater access to medical treatment for opioid use disorder, especially in prisons."
While 2020 "overdose deaths were up 16% in Michigan and Pennsylvania, these increases were significantly lower than the approximately 30% average increase seen nationally." Thus, there is progress or success seen in increased distribution of other drugs and overdose death increases of only 16%. The promising signs are that with huge investments, the growth rate in deaths could be cut in half?
The Guardian article features a 13 year old tragically taken by Fentanyl. A budding young life engaged in a community and preparing for an exciting school year. The young person had undergone a surgical procedure and was in pain. Rather than engaging a parent or the surgeon, this young person sent a "message on Snatchat" and sought marijuana. The dealer that responded offered "something better: Percocet." But, what the student received was "a counterfeit laced with fentanyl." It killed him.
The Guardian notes that supplies of fentanyl are up across the country. The contention is that the other pandemic, SARS-CoV-2, is driving demand. As Forbes puts it the COVID "pandemic uncovered and perhaps worsened a lot of underlying existing problems in society." Life, it seems, is hard and full of challenges. The onset of the SARS-CoV-2 fears, lockdowns, isolation, unemployment, and more exacerbated those challenges for many. Thus, bad situations were worsened by both infection and government reactions to it. The contention is that these stresses led to more drug use, and thus the perils of overdose. 
There is lamentation of the supply and potency of fentanyl, though heroin and pain pills are noted also. They are referred to as "a triple wave" of opioids. But, fentanyl has a primacy because it is so potent and so profitable for dealers. The Guardian article laments that a "single fatal encounter" by "people who have never used opioids" is killing people. Those folks "don't know that these drugs are contaminated" with fentanyl. It is difficult to understand how someone who has "never used opioids" makes a decision to turn to drugs obtained illicitly. Perhaps it is through some faith in the safety of what they believe is a prescription drug merely misdirected.
Further, even "those who are accustomed to taking opioids" may find it "difficult to judge a safe dosage of fentanyl." It notes "alarming numbers of people, even children, (are) taking what they think are legitimate Percocet or Xanax pills with friends." This suggests that there are repeat users of pills the obtain from sources other than pharmacies or physicians. Despite their experience, and their familiarity with what some pill is supposed to legitimately look like, they are being fooled into substitutes that are deadly. 
This is troublesome to some, tragic to many. People are literally dying because they chose to ingest substances that are dangerous. They are seeking some outlet for pain or discomfort. They lack the knowledge to judge a non-fatal dose. They are being preyed upon by dealers seeking profit at their expense. And, while there are many challenges in this world, few are both (1) killing over 100,000 Americans each year and (2) entirely preventable.
How is it that a thirteen year old can use Snapchat to seek marijuana? We hear of the perils of social media, but in this instance is it merely a medium for a conversation that could occur on a street corner instead? How is it that a child finds post-surgical pain and the immediate reaction is not a conversation with a parent or further care from whomever performed that surgery? How is the first reaction finding some marijuana for the pain? Has society's posture on recreational pharmaceuticals influenced a generation? How is the focus on how authentic the fake medication looks, and not on the real question of why people are putting any opioid into their system? More importantly, how many people will die before this crisis ends?
The Guardian concludes that the crisis is "causing devastation.” It notes that help may come to "those who are addicted" from taking other medications. Or, that overdose may be reversed by administration of medication that reverses opioid effects. There are even "test strips" to detect "fentanyl in other drugs." Is is rational to believe that those who find their personal path leads to illegally obtained pills will take the time to use test strips? Will we generate enough publicity that teenagers will know to use such test strips? Will the dealers take the time to verify the safety of their product with test strips?
The Guardian concludes that drug overdose will continue because it is a symptom of an inequitable society. One source cited advocates for overcoming "instabilities," warning that "civilizations do fall if they don't." The sentiment of the article is that if people had more, did not have to work hard, and could enjoy the easy life that resort to such substances would decrease. The bad news is that there is no easy life. Certainly, some lives are easier than others, but all of them are full of stressors, complications, disappointments, and worse. 
I do not pretend to know what the answers are. But, it seems like we are reaching a tipping point. You can only suffer 28.5% increases annually for so long. At that rate of increase, Opioid overdose will be killing a million Americans a year within the next decade. Without knowing the answer, it seems fair to suggest that we need to find some answer. In the meantime, the vulnerable in society will likely keep looking for answers on Snapchat and finding solutions that are way too permanent. 
By Judge David Langham
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    About The Author

    • Judge David Langham

      David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.

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