On April 19th, an article detailing the growing scourge of fentanyl-induced deaths appeared in one of my favorite health reporting publication in North Carolina, the North Carolina Health News a factual, objective “just the facts” type publication. The article,”Report: Fentanyl Overdoses Jumped in 2016,” was sobering reading indeed. The author was
It documented the extremely rapidly increasing rate and number of fentanyl related overdose deaths in NC with data from the North Carolina State Medical Examiner’s office in Chapel Hill based at the University of North Carolina at Chapel Hill.
To illustrate: The following factoid shows the dramatic escalation highlighted in this article: 2 deaths in 2013, 28 in 2014, 71 in 2015, and then 156 in 2016!
As Ms. Hoban very accurately wrote fentanyl is incredibly more potent that ‘your average narcotic,’ in that it is “as much as 100 times stronger than morphine.” Further in her article what I consider one of the more malignant aspects of this epidemic. That circumstance is that once again like unto the LSD age of the late 1960’s and the early 1970’s, the “chemists” are coming out of the woodwork and generation analogues, biochemical close cousins of the fentanyl faster than legislatures can identify, classify and outlaw them.
Amd it is now well known that most of the sources of the “fentanyls” as one almost has to speak of them in the plural, are coming from outside the country, much of the on the street supply coming from Mexico. Economic incentive to manufacture, smuggle in, cut and distribute and then finally sell on the street is massive motivating. While a kilo of heroin is worth at least a thousand dollars on the street, a kilo of fentanyl is worth a million dollars!
One of the subtle but constant and ‘reliable’ characteristics of fentanyl is that it is rapid acting, fast in its time from ingestion to onset of effect. Simply put, this means that this drug gives the ingestee very little time to signal for help if they detect that the dose they have guesstimated for themselves is too large, they have almost no time to get life saving treatment.
Several years ago, the NC Medical Society did a brave thing and started providing free, no questions asked, EpiPen-injectors of naloxone, the narcotic antagonist or “reverser” drug. One county that had a rising and alarming amount of opiate related deaths was selected. The injector pens were given to families with opiate addicts in clinics, medical offices in a nonjudgmental manner in that no law enforcement figures were called, no recipients were arrested. It became clear over time that the program was saving lives in unprecedented numbers.Use of opiate-reversal drug naloxone has become more accepted over the past decade as law enforcement agencies, social service agencies and even the state health director have promoted its use as a harm reduction agent nationwide now.
As the authors of this article pithily phrased the lesson learned: “Dead people can’t find recovery,” demonstrating the all too obvious circumstance that if a drug abuser is save from death, recover can start and have a change of turning a life around.
Still use of naloxone to give to an unresponsive fentanyl often requires many times the doses of the same drug naloxone when dealing with a heroin overdose. Counties in many many locales are finding that their budgets are ballooning almost out of control posing another perhaps partially unforeseen problems.
Pen and Psychiatrist 