During the COVID-19 pandemic, there was another deadly epidemic on the rise: the synthetic opioid fentanyl. 71,238 died of synthetic opioid overdose in the U.S. in 2021 according to the Centers for Disease Control and Prevention. Thousands of Americans have been finding fentanyl hidden in rainbow Halloween candy, on social media and in counterfeit medications. Despite statistics referencing a decline in fatal drug overdoses, the United States must take a more active approach to this crisis.
Fentanyl is so potent that one injection can have disastrous effects. As an aspiring physician, I acknowledge the potential for fentanyl to be medically used as an anesthetic. However, as an EMT, I am trained to administer naloxone in frequent situations of opioid overdose. Fentanyl is a pervasive threat because it is being synthesized illicitly and pressed into pills proliferating through the U.S.
On one of my EMT clinical rotations, an elderly woman, maybe in her 70s, was refusing anesthesia before surgery.
“Ma’am, you don’t understand, you must consent to taking the fentanyl injection before the surgery,” the nurse I was shadowing repeats.
“No, I ain’t putting any of that stuff in my body. It’s the stuff they doin’ on the streets. Lemme talk to my PCP,” the patient retorted.
That was the first time I realized the intersection of the fentanyl crisis and patient confidence in the medical system. I stayed up researching the different types of fentanyl and cascades it activated in the body, how it would produce heroin-like effects and lead to strong dependence in users.
I was horrified by the statistics and preventable deaths, but the gravity of the situation eluded me until I met an old man at the VCU Massey Cancer Center. I was volunteering at the Family Lounge when I striked up a conversation with him. He confided in me about his previous job working with inmates and psychologically disturbed patients. His clients would often be lost to overdose as they scoured for a coping mechanism.
I told him of my interests in medicine and how it is difficult yet essential to draw the line between the acceptance of pharmaceutical drugs versus the dangers of illicit drugs. Fentanyl was developed to help cancer patients, but its misuse leads to countless deaths and mounting international pressures.
China supplies the majority of fentanyl which finds its way over to the U.S. from salespeople and smugglers from neighboring countries. Hence, the U.S. must make a greater effort to stringently regulate opioids that cross the border from Canada, Mexico and China. Although President Biden has discouraged Americans from using fentanyl and opioids through the “One Pill Can Kill” campaign, tensions with China regarding its militarization and occupation of Taiwan make it difficult for both countries to make significant strides together. China banned the exportation of some of this dangerous opioid, but does not strictly regulate the exportation of compounds that can be used to produce fentanyl. Cartels in Mexico obtain ingredients and sell manufactured fentanyl, perpetuating this epidemic.
We have a lot of work to do to ameliorate this situation. The U.S. Drug Enforcement Administration has started to take the proper first steps by contacting and speaking with families who have lost someone to fentanyl overdose this June. Beyond establishing fentanyl awareness day (May 10), we should fund and support studies like the FORECAST study spearheaded by Johns Hopkins, Brown and the Bloomberg American Health Initiative. Researchers identified strips that could check other drugs for fentanyl to support drug users in determining what they were consuming. Just as the U.S. has worked to make naloxone kits free and easier to obtain, administration should prioritize making fentanyl test strips available.
By taking a more accepting approach to this problem, we can use harm reduction techniques and awareness instead of stigmatizing repercussions to turn the tide of this epidemic. Americans struggling with addiction should have an opportunity to go through a formal fentanyl addiction program, as these programs support positive long-term outcomes through professional intervention. The stigma around fentanyl enforces barriers making it difficult for people to reach out for help in fear of incarceration or loss of employment.
An article from the LA Times cites that almost 680 families lost teenagers to fentanyl in 2020, significantly increasing from 253 deaths in 2019. The U.S. should educate communities about fentanyl addiction resources for youth through prevention programs such as Drug Abuse Resistance Education in elementary schools.
Fentanyl addiction is important to me because of its implications in healthcare and underserved communities I hope to practice in. I have interacted with patients shaken by the horrors of opioid overdose, and I am a proponent of a stronger inter and intranational response to quell the uproar caused by our inadequate response to this healthcare emergency.