Fentanyl Education, Prevention Key to Ending Crisis in US

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For National Fentanyl Awareness Day, Drug Topics talked with Scott H. Silverman about how public health leaders can address the fentanyl crisis and the best ways to educate the public on the dangers of fentanyl use.

The opioid epidemic in the United States stretches back to the 1990s, when the synthetic opioid oxycodone hydrochloride was first introduced as a medication to treat moderate to severe pain and chronic pain. Since then, opioid overdose deaths in the country have skyrocketed, with data from the CDC showing there were over 109000 in 2022, with nearly 70% due to synthetic opioids.1

Fentanyl Education, Prevention Key to Ending Crisis in US / Darwin Brandis - stock.adobe.com

Fentanyl Education, Prevention Key to Ending Crisis in US / Darwin Brandis - stock.adobe.com

The primary driver behind the rise in synthetic opioid-related overdose deaths is fentanyl. Used to treat complex pain conditions and pain related to surgery, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine.2 That means even a small dose of the synthetic opioid can be potentially lethal for people who have no tolerance.

According to some research, while fentanyl use is now widespread, a majority of users do not intend to use it.This is largely because its introduction into other illicit substances has become pervasive. The synthetic opioid has been found in heroin, cocaine, methamphetamines, opioid analgesics, amphetamines, and benzodiazepines.3 Because of the increased threat of overdose fentanyl poses, it is critical to bring awareness to the drug and to implement harm reduction services to mitigate risk.

National Fentanyl Awareness Day, held annually on May 7, aims to educate the public about the dangers of fentanyl use. This year, Drug Topics talked with Scott H. Silverman, a crisis coach, behavioral health consultant, and team lead for the substance abuse recovery program Confidential Recovery, about how public health leaders can address the fentanyl crisis, challenges in accessing treatment and support, and the best ways to educate the public on the dangers of fentanyl use.

READ MORE: On the Front Lines: Pharmacists' Role in Combating America's Opioid Epidemic

Drug Topics: What do you believe are the most important priorities for policymakers, healthcare providers, and community leaders to address in the fentanyl crisis?

Scott H. Silverman:The most important priority for the fentanyl crisis is to make it as important as the COVID-19 pandemic. If we don’t, the morbidity rate will continue to grow and the fentanyl distributors will see that the US doesn’t really care, so they will continue to target us.

Real-time data is crucial to make changes. For example, the medical examiners should be communicating on a national level to share what percentage of the overdoses are solely from fentanyl or fentanyl-laced drugs. We need real-time demographics because we can’t wait 18 months to find out the statistics and what happened in 2022. We must find out as quickly as possible to address this crisis head-on. It must be made a priority by federal, state and local governments, because they are the only ones that can help put a stop to this. Overall, data-driven information in a time-sensitive manner is going to be critical.

Drug Topics: From your perspective, what are the most pressing challenges in accessing effective treatment and support services for individuals struggling with opioid addiction?

Silverman: I don’t believe the insurance industry understands what they’ve got in front of them. It’s a benefit-driven industry, and the industry needs to take a good look at themselves and figure out how they are going to really help people. We’ve seen the current President reduce the cost of pharmaceuticals and pharmaceutical companies are still doing fine, so they know how to create systemic change, but it needs to become a priority. 

Drug Topics: How can communities, organizations, and individuals work together to prevent opioid-related overdoses and deaths?

Silverman: Education and prevention. Right now, the big conversation is around [naloxone (Narcan)], the drug that reverses overdoses. The issue is we are giving a lot of people that drug after they overdose, but how do we work hard to educate and incentivize people who are making a conscious decision to not put something in their body? That’s going to require a ton of education and a ton of prevention, which social media could really help make the change that’s needed for young people specifically. Kids are getting iPhones and iPads now in the single-digit ages, so why not make social media a learning opportunity to educate and save lives?

Drug Topics: What do you think are the most effective ways to educate the public about the dangers of fentanyl misuse?

Silverman: Common sense messaging is the most effective way to educate the public. Using simple messages like, “one pill can kill,” can really make a difference. The DEA came up with that phrase knowing that it’s a poison and the people that make it don’t care if their consumer dies. The government is trying to tell people about this issue, but the real question for consumers is,“Are you listening and are you seeking the knowledge?” So, how do we incentivize and find creative ways to reach them? This commonsense messaging doesn’t need to be wrapped into your dinner napkin every night, but it should be a part of the discussion every week with the family. The education aspect really comes with family discussion.

Drug Topics: Looking ahead, what do you hope to see in terms of progress and awareness surrounding fentanyl misuse and overdose prevention?

Silverman: I hope the morbidity rate declines. I would love to stop going to funerals and we shouldn’t say, “That’s sad, but it’s somebody else’s kid.” The data shows that 42% of adults in the country know somebody or know of somebody who died of an overdose. There’s no other disease that has that high of a morbidity rate that people know about. If it's that high of a morbidity rate, why aren’t we doing more? Whatever that’s defined as and putting more strength at the border, although we have multiple borders, you can ship these drugs over in a parachute, float it in with a drone, bring it in through the mail and you can even make it now. There’s a lot of money around it too, a lot of young people are buying these materials on the dark web and making it themselves. 

READ MORE: Substance Use Disorder Resource Center

References
1. Tanz LJ, Gladden RM, Dinwiddie AT, et al. Routes of drug use among drug overdose deaths—United States, 2020-2022. MMWR Surveill Summ. 2024;73(6):124-130. doi: 10.15585/mmwr.mm7306a2
2. Fentanyl facts. CDC. September 6, 2023. Accessed March 8, 2024. https://www.cdc.gov/stopoverdose/ fentanyl/index.html
3. McKnight C, Weng CA, Reynoso M, et al. Understanding intentionality of fentanyl use and drug overdose risk: Findings from a mixed methods study of people who inject drugs in New York City. Int J Drug Policy. 2023;118:104063. doi:10.1016/j.drugpo.2023.104063
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