Blame Won’t Curb the Fentanyl Crisis

Blame Won’t Curb the Fentanyl Crisis

July 22, 2022 0 By Jennifer Walker

The U.S. continues to struggle with public health epidemics, with the gun violence crisis and COVID-19 case counts still grabbing many of the headlines. Meanwhile, another epidemic continues to kill people by the tens of thousands annually: substance use.

A research letter published in JAMA showed that 1,150 adolescents ages 14 to 18 died of drug overdoses in the first half of 2021. This is a 20% increase from 2020, and more than double the 2019 number. In total, more than 100,300 people in the U.S. died from drug overdoses during the 12-month period ending in April 2021. Additionally, according to a new report from the CDC, racial disparities in overdose deaths have widened significantly.

This uptick in overdoses is, in part, driven by a rise in overdoses of fentanyl, a synthetic opioid, which is being used as a cheap alternative to cut drugs. According to the CDC, fentanyl has played a major role in the increase of deaths from synthetic opioids, and the number of overdose deaths involving synthetic opioids in 2020 was 13 times higher than in 2013. Clearly, we’ve entered a new phase of the opioid crisis. It’s not just heroin that is cut with fentanyl, and it is not just individuals who use drugs on a regular basis who are dying. It’s counterfeit pills, it’s cocaine, it’s laced into marijuana, and it’s impacting individuals who use one of these drugs once in a blue moon, who have no intention or knowledge they are using opioids. Whether it’s the death of a consistent or one-time drug user, these are preventable losses of precious life.

While the landscape of substance use changes, the societal failures have remained the same. Rather than blaming people who overdose, society, including healthcare professionals, should advocate for better access to tools and interventions that can aid in the event of an overdose.

Semantics Matter

We too often refer to those who are afflicted with substance use disorders, including alcohol, as “addicts,” and in doing so, place the blame on their doorstep, solely with their individual choices. This attitude is isolating and ostracizing people, including our children, many of whom we are forced to say goodbye to prematurely after they use a drug laced with fentanyl.

These losses of life are all too common. Instead of placing blame, society should treat substance use the way we treat diabetes, cancer, heart disease, or any dangerous allergy. People are so much more than the illnesses they are suffering from. We need to understand that a substance use disorder isn’t a series of poor choices, but a series of physiological changes to the brain with physical and behavioral consequences. We need to reflect on the power our words hold.

Take, for comparison, the challenge of weight-control: we know how damaging it is to refer to people who have obesity in disparaging terms. Language can set back the self-esteem critical to garnering motivation for positive behavior change and serve as a barrier to getting the care needed to achieve those goals. Stigmatizing language accomplishes nothing beyond placing the fault of their health condition on those in crisis and their loved ones. It’s a failed and unfair way to deliver healthcare and build partnerships with those in need. Open, humanistic dialogue is needed.

Pushing for Change

Part of our failure to curb the rise in opioid deaths consists of our lack of action and control over the fentanyl crisis. We cannot shy away from openly speaking about this. We can create an environment that is informed and understanding. As healthcare professionals, we can make simple changes that would have a profound effect.

What we should be doing is providing education and resources, and capitalizing on every opportunity for prevention and safety. What we are doing is failing. However, with the smallest shift, we can make a difference.

For example, everywhere we turn, there are defibrillators in case of emergencies, which send an electric pulse or shock to the heart to restore a normal heartbeat. Using that same logic, shouldn’t healthcare professionals advocate for naloxone (Narcan) nasal sprays to be more accessible at schools, restaurants, malls, gyms, and houses of worship, and in people’s homes, cars, and pocketbooks?

A simple spray can counteract the effect of an opioid overdose and save lives by reaching the same receptors in the body that succumb to opioids. Think of it as part of a first-aid kit, a way to help someone in peril to start breathing again.

Naloxone is a remarkably effective and inexpensive way to save lives, and it’s easy to obtain. In New York and many other states, it’s also available at no cost for most people with insurance, including Medicare and Medicaid. If a person doesn’t have insurance, many community-based organizations, health departments, and hospitals provide education and will dispense rescue kits. These models should be even more widespread.

Doctors should also recommend that parents who are concerned about their children’s possible drug use purchase fentanyl test kits. Too often, kids face peer pressure to try a drug, which may or may not be what they think it is. These test kits, which cost very little and are available on sites such as Amazon, effectively detect the presence of deadly fentanyl. Imagine how many lives could be saved for $1. That’s right, a test kit costs $1.

Families and medical professionals can stand idly by as this crisis progresses or we can act. We aren’t going to stop all drug use. We don’t need to stop all drug use to make a difference in the health and safety of our communities. We can, however, save lives. It is our duty as a society.

Sandeep Kapoor, MD, is the director of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at Northwell Health, and assistant vice president of Addiction Services for the Northwell Health Emergency Medicine Service Line.