Fentanyl

AUSTIN (Nexstar) – Fentanyl poisonings continue to kill thousands of people across Texas. But the latest statistics from the Centers for Disease Control and Prevention show an encouraging sign. The numbers show a slight decrease in deaths in Texas, mirroring a nationwide decline that started showing up earlier this year.

Part of the credit for the decline can be attributed to increased awareness of the dangers of the drug, DEA officials say.

Last year, Texas took a new step towards fentanyl awareness when Gov. Greg Abbott signed a bill known as Tucker’s Law that requires school districts to educate students in grades 6-12 about the drug. The bill is named after Tucker Roe, a 19 year old who died from fentanyl poisoning.

His mom, Stefanie Roe, helped push for the legislation. She founded the nonprofit Texas Against Fentanyl after Tucker’s death. Tucker was Stefanie’s firstborn and only son.

“He was born with just an adventurous little spirit, a lover of people, and just a real light in our family and in others,” Roe said.

After she lost her son in 2021, Stefanie founded Texas Against Fentanyl, a 501C3 founded to increase awareness, support and legislation surrounding the drug.

“In 2021 when I lost Tucker, I had no knowledge of illicit fentanyl. I had never heard of press pills. I did not know that teens were selling to teens, and seven out of 10 pills were lethal. And as a mom, that just struck me that I didn’t have the information to safeguard my son and give him knowledge of that poison,” Roe said.

Tucker’s Law took effect last year. Since then, Roe says schools have reached out to Texas Against Fentanyl to organize assemblies and bring in the Tucker Project to their school programming. Roe believes that knowledge about the drug is essential to save lives.

“If a student understands that, this is what it looks like. You can’t see it, you can’t taste it, you can’t smell it. It can be added to these things. This is the impact it has on the body. It’s not a just say no campaign. It’s to get educated so you can make better decisions,” Roe said.

Roe said there has been some confusion over how to teach the topic calling it an “unfunded mandate” for schools. She said Texas Against Fentanyl has been developing a curriculum alongside the Texas Education Agency to help schools.

With the next legislative session looming in January, Roe said there are changes to be made. She plans to push lawmakers to make improvements to Tucker’s Law along with implementing new legislation to improve testing at hospitals to increase accurate reporting on fentanyl deaths.

Roe said her group is also working to decriminalize fentanyl test strips. The test strips allow people to detect whether fentanyl is in the drugs they use. Texas is one of a few states where the strips are illegal, considered to be drug paraphernalia. Last session, a bill to decriminalize test strips passed the Texas House but failed to advance in the Senate.

Roe said Texas Against Fentanyl is relentless and will pull every stop to get legislation passed to help save lives. She compares the group to Mothers Against Drunk Driving, which leveraged the power of parents to make significant policy changes.

“We’re mad moms who have lost our children to something that we did not have education on, and we’re not backing down,” she said.

Source: https://www.kxan.com/state-of-texas/newsmaker-interviews/texas-mom-who-lost-son-not-backing-down-in-fight-for-fentanyl-education/

by William P. Barr & John P. Walters – 23 Jan 2025 | Hudson Institute

(This article forwarded to NDPA by Drug Free Australia)

 

Just weeks after the election, President-elect Trump announced that he would

impose a 25% tariff on all Mexican products, and an additional 10% tariff on

all Chinese products, until the flow of illegal narcotics from those

countries is stopped. These measures will do more to choke off the growing

scourge of illegal drugs than all steps taken in the “drug war” to date.

 

Over the past few years, the flow of illegal narcotics into our country has

become a tsunami, with seizures of fentanyl pills skyrocketing from 4

million in 2020 to 115 million last year. The devastation inflicted on

American society by this traffic is catastrophic.

 

The opioid crisis alone costs us over 100,000 overdose deaths and $1.5

trillion annually, while the flood of potent methamphetamine from Mexico

fuels a new wave of meth addiction, ravaging lives, families and

neighborhoods in its wake.

 

This deadly traffic happens by weakening our border defenses and ignoring

opportunities to choke off the supply chain for illicit drugs, now centered

in China and Mexico.

 

The U.S. policy has focused on “harm reduction” inside the U.S. – deploying

overdose medications, like Naxolone, and funding more treatment for

addiction. While these steps are unobjectionable in themselves, they are an

inadequate response to the flood of poison we are confronting. It is like

addressing violent crime by offering more bandages.

 

Real progress requires eliminating the drug supply at its source. Here the

U.S. has a golden opportunity because the supply chain for drugs poisoning

America has become highly concentrated and vulnerable. It depends entirely

on illegal activities in two countries – the manufacture of illicit drugs in

Communist China, and drug processing and distribution operations in the

cartels’ safe havens in Mexico.

 

All these illegal activities are carried out with – and indeed require – the

connivance or willful blindness of the host governments. As Trump’s

announced tariffs show, the U.S. has the tools and leverage to compel China

and Mexico to shut down these operations. Doing this would strike a decisive

blow: once these operations are dismantled, it would be impossible to

replicate them elsewhere at anywhere near their current scale.

 

China has become the hub of illegal drug production because illegal

narcotics are increasingly synthesized chemically, rather than made from

grown plants. China offers the two prerequisites needed to supply the U.S.

market: a large chemical industrial base, and a government willing to allow

its factories to make illegal narcotics and their precursors on a large

scale.

 

Chinese factories make the essential ingredients for virtually all the

fentanyl and other synthetic opioids, as well as 80% of the methamphetamine,

that come into the U.S. and are producing a new wave of drugs worse than

fentanyl, like nitazenes and xylazines (“tranq”). Simply put, without

China’s production, America’s drug problem would be mere fraction of what it

is.

 

Communist China could easily stop this activity if it wanted to. But a

recent report by the bipartisan Select Committee on the Chinese Communist

Party (CCP) shows that China’s participation in the illegal drug trade is a

deliberate policy.

 

According to the report, the Chinese government and the CCP has been

granting tax subsidies to encourage their drug companies to produce and

export – for consumption in the U.S. – fentanyl and other death-dealing

drugs that are illegal in China, the U.S. and throughout the world.

 

This is an intolerable situation. The U.S. must compel China to stop

producing these drugs by imposing an escalating series of consequences on

those involved.

 

The initial tariff announced by Trump is a critical first step. If it

doesn’t get results, further tools are available – imposing higher tariffs;

targeting sanctions against the Chinese drug companies involved, and

potentially indicting and seizing assets of those companies; sanctioning

Chinese banks found to be involved in laundering drug money; and

facilitating private lawsuits by fentanyl victims against Chinese companies

making the drugs.

 

The second major chokepoint in the drug supply chain lies in Mexico. The

Mexican cartels have become the “one-stop-shop” for processing and

distributing nearly all the illegal drugs coming into the U.S. – the

synthetic drugs made in China, as well as the cocaine from coca plants in

Latin America. Experience eliminating the Colombian Medellin and Cali

cartels in the early 1990s shows that the U.S. can dismantle these

organizations when it becomes directly involved, works jointly with the host

governments and local forces, and uses all available national security and

law enforcement tools.

 

But Mexico poses a particular challenge. Using bribery and terrorist

tactics, the cartels have cowed and co-opted the government to the point

that it is unwilling to confront them nor allow the U.S. to take effective

action against them. And, even if the Mexican government was willing to

tackle the cartels, their military and law enforcement is so rife with

corruption they are incapable of effective action by themselves.

 

Our country cannot tolerate a failed narco-state on our border flooding

America with poison. The only way forward is for the U.S. to use its massive

economic leverage to compel the Mexican government to take a stand against

the cartels. President Trump’s announced tariff does just this.

 

Because the Mexicans cannot do the job themselves, eliminating the cartels

will require a joint campaign through which the U.S. engages in direct

action against the cartels, using a range of our law enforcement,

intelligence and military capabilities. The Mexican cartels are more like

foreign terrorist groups, like ISIS, than they are the American mafia – and

it is heartening that President Trump has signed an executive order

designating them as such. It is time to confront them as national-security

threats, not a law-enforcement matter.

 

Attacking the source of the problem overseas does not mean we should pull

back from trying to dismantle trafficking operations inside the U.S. But

progress abroad will produce exponentially greater results than anything we

do at home. Trump’s tariff initiative shows, that, rather than dither with

America’s stubborn drug crisis and passing it on to his successor, Trump is

willing to tackle it head on with decisive action.

Source: https://drugfree.org.au/index.php

Over the last weekend of April 2024, something in Austin’s drug supply went horribly wrong. The first deaths passed largely unnoticed by anyone other than the families and friends of those who consumed the tainted substances. An 8-year-old girl who’d been playing outside her apartment in northeast Travis County on the evening of Sunday, April 28, came home to find her 50-year-old father dead in bed. In a homeless encampment in a wooded area of East Austin, paramedics revived two people with naloxone, the overdose reversal drug known commonly as Narcan. But, hours later, one of them, a 51-year-old woman, was found dead inside her tent—a short walk from a 53-year-old man who likely died around the same time.

A clearer picture wouldn’t emerge, however, until 911 calls began flooding in the following morning.

Most Mondays, the Sixth Street entertainment district would be quietly nursing the hangover from another rowdy weekend, the only souls on the street those who sleep in the shelters, alleys, and sidewalks. But emergency dispatchers were getting repeated reports of people in distress.

The first call came in just after 9 a.m. from someone calmly describing an overdose in an alley. But, as the minutes dragged on, panic crept into the caller’s voice. “I’m scared,” she blurted out. “Oh, my gosh, I’m so fucking scared. Somebody’s going to die because of these people.”

“What happened?” asked the operator.

“Somebody tried to say ‘Don’t call the ambulance,’” the caller responded. “Oh, my God. Oh, my God.”

A little before 10 a.m., a security guard flagged down one of the Austin police officers flooding the district. Two men were sitting on the ground next to a trash bin in an alley near Sixth and Red River Street, slumped forward. Only 20 minutes earlier, both men had been walking and chatting. Now, they weren’t breathing.

The officer administered naloxone and began performing CPR. Paramedics took one to a hospital. The other, 51-year-old Benjamin Arzo Gordon, couldn’t be revived.

The alley where Gordon died had become the epicenter of a mass casualty event. During a two-hour span that Monday morning, at least six others overdosed and were revived with naloxone in a four-block radius in downtown Austin. Over 72 hours, Austin police reported more than 70 overdose calls. Records from Travis County, which includes most of Austin, and neighboring Williamson County indicate that as many as 12 may have died. The culprit: a bad batch of crack cocaine.

Through dozens of open records requests and interviews, the Texas Observer and Texas Community Health News have pieced together what happened during those deadly days—and how changes to state law might have saved lives. Across the capital city, people who consume crack, a stimulant, were suffering symptoms consistent with poisoning from opioids like heroin or fentanyl, the incredibly potent prescription painkiller.

The adulterated crack impacted Central Texans from many walks of life. Among the people who died were a construction worker from Honduras and a young man from Wimberley, who passed away in his parked truck with the engine running. Crack rocks found at the scene of some of the deaths tested positive for fentanyl.

A small, inexpensive item might have averted some of these deaths. Fentanyl testing strips can be used to check for the presence of the synthetic opioid. With an appearance similar to an at-home COVID-19 test, the strips are dipped in water in which a small amount of the drug has been dissolved. A line indicates if fentanyl is present.

But such testing strips are illegal in Texas. They’re considered paraphernalia, and possessing one is a Class C misdemeanor. While the Texas House passed a bill that would have legalized them in 2023, the Senate declined to vote on it.

In general, Texas has been reluctant to embrace the strategy of harm reduction, a broadly defined term for helping people who use drugs without stigmatizing or imposing strict parameters, while also involving drug users in planning and implementation. Harm reduction has been promoted in the United States since at least the 1980s. A classic early example is teaching people who inject drugs to clean needles with bleach, preventing the spread of HIV. The overall approach is sometimes pitched as a means to keep people alive long enough to get off drugs, but many practitioners simply seek to keep substance users safe and healthy, regardless of plans to enter treatment.

Under the administration of President Joe Biden, the federal government embraced aspects of harm reduction. Some states have as well. But policies favored by many Texas officials reflect the singular goal of making it as difficult as possible to use drugs. As it turns out, research and interviews with both experts and users of drugs show, making drug use more difficult also makes it more dangerous. Though Texas ranks low among states in fatal overdose rates, federal data shows the Lone Star State’s rate stayed nearly flat from 2023 to 2024, while overdose deaths fell significantly nationwide.

Among those calling for more humane drug policies in Texas and beyond is a coalition of academics, activists, service providers, and people who use drugs who argue criminalization endangers people with little benefit. Some members of this coalition identify as harm reductionists, while others identify as advocates for drug user health. Some argue that stigma and marginalization do more harm than drugs themselves; many believe that, while kicking drug habits should be the ultimate goal, the best tactic is to meet people where they are. These advocates push for more access to naloxone, legalized drug checking, and reduced stigma so that policymakers, service providers, and drug users and their families can have real conversations about how to stay alive.

In recent months, top Texas officials have not only rejected harm reduction but have also openly antagonized those who practice it.

The prevailing attitude in the state is, “Why should we try and save their lives? They’re just going to use again,” said Joy Rucker, a nationally known advocate who launched Texas’ largest harm reduction nonprofit. In California, where she used to work, harm reduction organizations get robust public funding and operate openly.

“Texas was just a rude awakening,” she said.

A tall, thin Houston native with a quick sense of humor, Benjamin Arzo Gordon had been living on the streets of Austin for years. A January 2024 photo in the Austin American-Statesman shows him with a close-cropped white beard and a gray beanie, at Central Presbyterian Church downtown, looking pensive as he discusses harsh winter weather.

Andi Brauer, who oversees the church’s homeless outreach programs, said Gordon was a regular at weekly free breakfasts, cracking jokes with her and other volunteers and taking a genuine interest in her wellbeing.

“He’d always say, ‘You need to sit down and eat,’” Brauer recalled. “Or, if somebody was sometimes threatening or rude to me, he would say, ‘Don’t mess with Andi.’” She once printed out a photo of the two of them and used it to make a card for him.

In the alley where he died, Gordon was known to stop by with meals from the nearby food truck where he worked. “He used to help people in the alley,” said Loretta, a 55-year-old Austinite who herself suffered an overdose after Gordon.

Bokhee Chun, a Central Presbyterian volunteer, remembered Gordon would sing her hymns. Some months before he passed, Brauer said, Gordon came in to fill out a volunteer application.

Like many who died last April, Gordon was an experienced drug user. His drug of choice, crack, put him at little risk of sudden death by itself. But the crack he smoked that spring day was laced with a substance that has become synonymous with America’s failed drug policies.

In the latter half of last century, as states and the federal government increased penalties for drug sale and use, overdose death rates stayed relatively flat. That raised questions about whether deterrence policies did anything to reduce drug use. Then, this century, overdose rates skyrocketed, driven by synthetic opioids including fentanyl. Fentanyl had been around for decades, but in the 2010s it increasingly caused deaths in northeastern states. As it moved west, the nation’s drug supply transformed.

Initially, fentanyl was used alone or to boost the potency of other opioids and depressants like heroin and prescription pain pills. But, in recent years, people killed by fentanyl are increasingly found to have stimulants like cocaine or methamphetamine in their systems. Explanations for this vary. Stimulants may be intentionally adulterated to hook users on fentanyl. A stimulant user might take opioids to come down. An unsophisticated dealer with a small stimulant supply may add fentanyl to stretch it. And failure to clean scales or surfaces can also mix fentanyl with another drug.

In Texas, overdose rates increased dramatically starting in 2020. From June 2023 to June 2024, more than 5,000 people died of an overdose in the state, with Travis County recording the highest fentanyl-related death rate among Texas’ most populous counties in recent years. Though Texas has one of the lower overdose rates in the nation, deaths in the state declined by less than 3 percent from 2023 to 2024, while the rest of the nation saw a drop of nearly 15 percent, per the federal Centers for Disease Control and Prevention. In October, the Texas Department of Health and Human Services (HHS) announced that it recorded a 13-percent drop in the state over the same period—but its figures include only those overdoses deemed accidental, not those labeled intentional, suicide, or of undetermined cause.

Experts also question the general accuracy of Texas’ numbers. In much of the state, underfunded and under-trained justices of the peace are charged with death investigations. Overdoses, which require costly autopsies and toxicology reports, are easy to overlook.

In response to the overdose increase, HHS in 2017 launched the Texas Targeted Opioid Response (TTOR) initiative. HHS is also part of a state awareness campaign using billboards and social media ads focused on cautionary tales of young Texans who overdosed. At the same time, state leaders have doubled down on criminalization.

In 2023, the Legislature passed a law allowing prosecutors to bring murder charges in fentanyl overdose cases. Critics say this discourages people from reporting emergencies, and research shows such laws harm public health. Some who overdosed in Austin last April had shared drugs, putting survivors at risk of being charged. In 2021, the Legislature passed a good samaritan law ostensibly meant to protect people who call 911 to report an overdose. The law created a defense for people arrested for low-level possession, but it has so many caveats—you can only use it once in your life, it doesn’t apply if you’ve been convicted of a drug-related felony, you can’t use it if you’ve reported another overdose in the last 18 months—that you’d need a flow chart to understand it. Critics say the statute’s of little use.

“The fentanyl-induced or the drug-induced homicide laws, that jacks up the consequences and the intensity so much more,” said Alex White, director of services at the Texas Harm Reduction Alliance, an Austin non-profit that does street outreach, operates a drop-in center, and provides supplies including for hygiene and wound care.

Some states, like Maryland and Vermont, make a point of prioritizing input from people who use or have used drugs while crafting policy. Harm reduction advocates say this is lacking in Texas, though HHS does have a low-profile advisory committee that is required to include members who’ve received mental health or addiction treatment.

“If you’re thinking that you know how to serve folks, and you don’t have those folks at the table when you’re trying to serve them, it’s not going to work,” said Stephen Murray, a paramedic and overdose survivor on Massachusetts’ Harm Reduction Advisory Council.

Rapid changes in the drug supply can make it difficult to conclusively track policy impacts. Critics blame Texas’ persistent overdose rate at least partly on punitive laws, but a few western states including liberal Oregon—which famously passed a drug decriminalization ballot measure in 2020—actually saw overdoses increase between 2023 and 2024. To this, some experts and at least one study counter that fentanyl’s delayed arrival on the West Coast has distorted the death rates, and that Oregon specifically did not implement sufficient services alongside decriminalization.

Texas Governor Greg Abbott’s office did not respond to a request for comment for this story.

Loretta woke up on the morning of Monday, April 29, in the alley where she often goes to smoke crack and sometimes spends the night. She grew up in East Austin, only blocks away.

Loretta said she lent her pipe that morning to a friend who’d just purchased drugs. Then she heard someone ask, “What’s wrong?” and saw the friend staring up, trance-like.

“He stayed looking at the sky,” Loretta said, reclining and rolling back her eyes to demonstrate. “The next thing I know he just went like this,” she said, as she pantomimed slumping limply to the side. “I was shaking him, and I said, ‘What’s wrong, what’s wrong?’ And after that he just didn’t answer.”

Despite fear she’d be held responsible, Loretta yelled to a friend to call 911. Police and paramedics swarmed the area. Loretta watched as someone else collapsed. “She hurt herself hard on the concrete and I said, ‘Oh, my God, hell no, this is not happening.’”

Soon, an acquaintance ran up to say Loretta’s boyfriend had also collapsed in a nearby portable toilet. “He was slurring like a baby, like a little boy,” Loretta said. “He started to lose consciousness. I slapped him hard. It hurt my hand. And I shook him and I started praying.”

Around the time that Loretta was calling out for help for her boyfriend, and EMTs were trying unsuccessfully to save Gordon, Adam Balboa showed up to work at an Austin-Travis County EMS (ATCEMS) station in south Austin. A case manager for a unit focused on substance use, Balboa heard the overdose reports and symptoms being described and knew what would save the most lives. “We needed to flood the downtown area with as much Narcan as possible,” he said.

Opioids in the bloodstream bind to receptors in the brain, creating euphoria. But by a quirk of physiology, excessive opioids bound to those receptors interfere with the body’s ability to measure its need for oxygen, slowing breathing—to the point where it can be fatal. Mouth-to-mouth resuscitation can keep someone alive. Narcan temporarily blocks the receptors to opioids, essentially short-circuiting an overdose if delivered in time.

The medics and police officers in downtown Austin were running out of naloxone, but Balboa didn’t just want to get them more. He also wanted to get it in the hands of people who use drugs, along with their friends, family, and neighbors. So he and colleagues began throwing together kits containing Narcan, a CPR mask, and instructions, and he hurried downtown with his SUV loaded up with the blue zippered pouches. “Everybody was super receptive,” he said. “They were clipping it to their belts and … going about their normal business.”

As common-sense as that response seems, it’s one strongly associated with harm reduction. By handing out naloxone downtown, Balboa was helping those most vulnerable to the tainted drugs help one another. It’s also a response that would have been impossible a few years ago.

Balboa’s unit is the brainchild of Mike Sasser, a 51-year-old ATCEMS captain who’s been in recovery for 21 years. A longtime paramedic who often worked with Austin’s unhoused population, Sasser became friends in 2018 with Mark Kinzly, a lion of the Texas harm reduction movement. Kinzly, who passed away in 2022, had helped start the Texas Overdose Naloxone Initiative, which was getting grants to distribute the medication. He had a seemingly simple idea for Sasser: ATCEMS could use grant money to buy Narcan, pass it out, and train people how to use it.

“My mind was blown,” Sasser said. “Why have I never thought about this? That would save so many lives.”

ATCEMS doctors then wrote prescriptions that allowed medics to hand out naloxone (today, it’s available over the counter). Sasser’s unit also began reaching out directly to overdose survivors and administering a maintenance drug that reduces opioid cravings, and it now includes two full-time case managers who run an overdose reversal education program called Breathe Now.

All of this fits under the philosophy of harm reduction, which can also include teaching people to use drugs more safely and providing supplies like clean glass pipes, which help prevent disease and infection. Providing food, water, hygiene products, or wound care to people who feel stigmatized in doctor’s offices is another tenet.

“We want to provide people with what they need, so we can build that trust,” said Em Gray, whose NICE Project provides supplies to Austinites, many of them unhoused, and stocks Narcan vending machines. “That’s how we show that we are there for them; we’re there to improve their quality of life, there to reduce their overdose death rates.”

There’s little funding available in Texas for the nonprofits and mutual aid groups that do this work. Across the state, harm reductionists often operate out of backpacks or car trunks.

To the state’s credit, Texas has taken some steps to increase naloxone distribution. TTOR does this with an annual federal grant of about $5.5 million. In 2019, TTOR, whose Narcan distribution program is administered by the University of Texas Health Science Center at San Antonio, gave about 40 percent of its naloxone to law enforcement agencies—even as research shows it’s more effective to give the medication to laypeople, who are typically first on the scene and present no threat of arrest—an analysis by Texas Community Health News found. By 2022, TTOR’s emphasis had shifted, with law enforcement making up only about 15 percent of its distribution.

But police are still prioritized in Texas’ long-term naloxone plan. Under a different state program started in April 2023, the Texas Department of Emergency Management (TDEM) began distributing $75 million worth of the medication over 10 years. That naloxone, donated by a pharmaceutical company as part of a court settlement over opioid deaths, is largely earmarked for first responders. Of the more than 150,000 doses that TDEM distributed from April 2023 to September 2024, 118,000 went to law enforcement agencies, mostly sheriff’s offices. Many of these offices cover areas that lack other harm reduction infrastructure, but records provided by TDEM show sheriffs aren’t using the naloxone. Of 13 counties in which agencies reported using doses from TDEM by September, the highest rate of use was 3 percent. Much of that naloxone will expire later this year. In an email, a TDEM spokesperson said the agency had “yet to turn down a request for naloxone” and that “Administration or disposition of distributed naloxone is up to the receiving entity how they see fit, in accordance with manufacturer’s guidance.”

When it set the state’s two-year budget in 2023, the Legislature allocated an additional $18 million in opioid settlement funds to UT Health San Antonio, but it’s not clear the appropriation will be renewed.

In the meantime, harm reductionists rely on a patchwork of naloxone sources, including local governments.

“Had we not saturated Austin with Narcan leading up to [the April] event, then that event would have been a lot more detrimental than it was,” said Sarah Cheatham, a peer support specialist with The Other Ones Foundation, an Austin nonprofit serving the unhoused. “Even when it was hard to get in our hands, we were out there doing this communication for months before this happened.”

By late morning on April 29, the Austin Police Department (APD) had some idea what was happening. Crack rocks and pipes had been found at the scene of a number of overdoses in an area known for its use, and officers had interviewed some who’d been revived with naloxone. They began looking for people seen on surveillance cameras and suspected of selling the tainted crack. While responding to an overdose, detectives found one suspect standing in front of a tent, just a block from police headquarters.

While cops made arrests, harm reductionists tried frantically to figure out what was going on. A little after noon that Monday, Claire Zagorski, a graduate research assistant at the University of Texas at Austin who’s worked in harm reduction for years, messaged a group chat: “Austin folks there’s a bad batch downtown as of this AM. Not sure on specifics but it does respond to naloxone.”

Groups started handing out Narcan and warning the communities they serve, but without any official information from local governments. “We were really just kind of going in blind,” Cheatham said. “We were all talking to each other about, ‘Who’s going to these camps? Where is it happening? Is it happening downtown?’ And I was mainly reaching out to the people that I know.”

Research shows that, given the chance, drug users will reduce their risk of overdose—including by carrying naloxone, not using alone, or taking a small tester dose. But, lacking detailed information, harm reduction workers in Austin were constrained. “It’s distressing that the thing that got everyone activated was me being notified by a backchannel,” Zagorski said.

When local officials finally made public statements hours after the flood of 911 calls, they only addressed some questions. Whatever was killing people was responding to Narcan, officials said, in a news release and press conference. But they were vague about which drug was adulterated, and there was no mention of test strips.

“It was a very chaotic scene at first,” APD Lieutenant Patrick Eastlick told the Observer. “Something we can look at in the future is, if this happens again, that we reach out to these different groups where we can spread the word.”

Open conversations about drugs are difficult in a state where top elected officials are cracking down on services for people who use them. In late November, state Attorney General Ken Paxton filed a headline-grabbing lawsuit to shut down a homeless navigation center at a south Austin church. The suit specifically blames the Texas Harm Reduction Alliance’s needle exchange program for “the prevalence of drug paraphernalia, including used needles, littering the surrounding area.” Drug use around the church “fuels criminality, and creates an environment where nearby homes and businesses are at constant risk of theft,” the complaint states.

Critics say efforts like Paxton’s just push drug use out of sight, creating greater risk. “It sends the message to people who use drugs that they should hide it, they should be kept in the dark and in the closet,” said Aaron Ferguson of the Texas Drug User Health Union. “The closet is a very dangerous place for people who use drugs. It’s where overdoses happen. It’s where stadiums full of people die every year.”

At least two who died in the Austin overdose outbreak were found alone. Family members of at least two others who perished at home told police they didn’t know their loved one had used drugs that day.

How state officials talk about drug use, critics note, also suggests that only some lives matter. For example, in a 2023 legislative hearing, GOP state Senator Drew Springer—in a successful attempt to woo conservative support for requiring school districts to stock naloxone in middle and high schools—distinguished between different groups of Texas children. “I think the general public, when they hear ‘overdosing,’ they think ‘That’s just a druggie, and that’s a druggie kid’s problem,’” he said. “No, it’s your kid’s [problem], because he may be taking a Xanax or an Adderall” without knowing fentanyl was present.

Claudia Dambra, who runs Street Value, a drug user health organization in Houston, criticized messaging that condemns certain substance users. “All it’s doing is creating more separation,” she said. “It feels like this weird, forced social Darwinism. … It feels like they’re picking us off.”

In an email, an HHS spokesperson said the agency does not discriminate: “[HHS] substance use programs offer treatment and recovery support for people, regardless of substance use duration.”After the horror of watching her boyfriend taken away in an ambulance, Loretta wandered through downtown Austin. Near APD HQ, in the area where police had arrested their suspect earlier, she was offered crack that her friend insisted came from a reliable source. Stressed and scared, she took a hit.

“I started getting a headache right away, like oh, my God, I’ve got a migraine or something. And I started throwing up,” she said. “I said, ‘Call the police, I’m sick.’”

Loretta didn’t lose consciousness, but she was vomiting as police questioned her. Eventually, she was taken to a hospital. She would be among the survivors.

Today, Loretta says that she gets test strips from harm reduction organizations, which quietly distribute them despite state law, and she gives them to friends. But, at the time, she knew little about them. Organizations that distribute strips generally can’t use grant money for their purchase, and government agencies, like ATCEMS, don’t distribute them.

Back in 2023, it seemed Texas was poised to legalize the strips. Before that year’s legislative session, Abbott said he supported allowing the tests, and legislators in both chambers introduced bills to legalize equipment for checking a range of drugs. One by Houston-area Republican Tom Oliverson, which was limited to fentanyl strips only, sailed through the House.

Oliverson, an anesthesiologist who has prescribed fentanyl to patients, said he’d heard from family members of people who purchased black-market pills without knowing they included the powerful opioid.

“That’s literally like stepping on a landmine,” Oliverson told the Observer. “You heard a click and the next thing you know, you were gone.  Nothing you could have done could have saved you. You didn’t know it was there, right? Except for the fact that there are test strips.”

The bill received tepid support from harm reductionists, who were frustrated by its narrowness. The drug supply is constantly changing: Today, the dangerous veterinary tranquilizer xylazine is increasingly used to supplement other drugs. “We’re really trying to craft language that’s inclusive,” said Cate Graziani, former head of the Texas Harm Reduction Alliance and current co-director of a spinoff advocacy group, Vocal TX. “We don’t want to go back to the Legislature every time we have a new overdose prevention tool.”

Oliverson said the bill only applied to fentanyl “because it is that much more dangerous, because it is that much more powerful. … People say to me, ‘I don’t like the idea of giving people test strips because it gives them confidence in the illegal drugs that they’re buying, and I want to discourage people from using illegal drugs,’” he said. “Well, I want to discourage people from using illegal drugs too, but having them insta-killed by a mislabeled pill that they bought, the first time they took it, is not an effective strategy for recovery.”

While other drug-checking legislation failed that session, Oliverson’s bill passed the House 143-2—but it never received a hearing in the Senate Criminal Justice Committee. “They just could not get over the idea that you are making it safer for people to use illegal drugs and that we shouldn’t make it safe for people to use illegal drugs,” Oliverson said, “because they shouldn’t be using illegal drugs at all.”

Oliverson said he’ll introduce a similar bill this session and may rewrite it to include xylazine, but he made it clear he doesn’t support other harm reduction measures like needle exchanges. Such a bill will simply fizzle again, though, barring a change of heart in the Senate, which is run with an iron fist by Republican Lieutenant Governor Dan Patrick, whose office did not respond to arequest for comment for this article.

“It’s so demoralizing to live in a state where your elected leadership is so unwilling to do something so small as legalizing fentanyl test strips, because there’s so much stigma around drug users,”  Graziani said.

By the afternoon of April 29, the tainted crack had made its way to south Austin. Loretta Mooney, another ATCEMS case manager in the substance use unit, was off work but rushed in. Dispatchers could see a new cluster of calls developing on Oltorf Street, east of Interstate 35.

By the time Mooney responded to her first call, at an apartment complex, medics had administered naloxone and revived a woman. Mooney handed out a few doses, then responded to another call from a fast food restaurant across the street. Someone had flagged down police, concerned about a man collapsed against the restaurant’s wall. Officers began CPR and administered Narcan. Mooney gave the man an additional dose and continued life-saving measures. Still, the 53-year-old died.

The situation was starting to look similar to downtown earlier in the day. Teenagers at another apartment complex began waving down Mooney and the officer. They ran over. Mooney administered naloxone to an unconscious woman and helped the officer deploy a breathing bag and mask. After a few minutes, the woman began breathing on her own again.

With Balboa now on his way to meet her and most of the calls near her covered, Mooney came to the same conclusion Balboa had that morning. “I was like, ‘Bring me all the Narcan you have and we’re going to start teaching these kids,’” she said.

On the lower level of a terraced parking lot, Mooney and the officer spread out naloxone kits and gathered the teenagers who had flagged them down.

“I’m telling the kid that came to get me specifically … ‘Because of you, this woman is alive,’”  Mooney said. “We’re on the side of [the road] with, you know, ages 10 to 16, teaching them how to use Narcan.”

While Mooney and then Balboa, too, instructed people in the neighborhood how to use naloxone, a new crisis emerged. Some of the people who had bought the tainted crack were now behind the wheel. First responders were rushing to car wrecks and stalled vehicles.

Responding to the new calls, Mooney and Balboa saw the results of their impromptu training. As Balboa headed to a pawn shop where someone was overdosing, he got stopped in traffic. With his lights and sirens going, trying to weave through vehicles, he saw the teenagers they’d trained earlier.

“Before I can clear an intersection, they’d already sprinted over, pulled out a kit, and started giving Narcan,” he said. “Not only were they excited and ready to help and empowered to be able to do so, but when that opportunity finally came for them, they ran at it.”

As evening fell, the dying slowed. Behind closed doors, away from passersby armed with naloxone, however, it wasn’t through yet. A woman staying at a motel on Oltorf woke up during the night and called her 61-year-old husband, only to hear his phone ringing in the bathroom, then find him lying on the floor. The partner of a 57-year-old man got out of bed to get him warm milk after she noticed his nose bleeding, but, when she came back, he wasn’t breathing. A 36-year-old parked his truck in a lot in north Austin; when a security guard called 911 hours later, he was already dead. Around midnight, a son found his 63-year-old father deceased in an Oltorf apartment.

Later that same Tuesday, Loretta was released from the hospital. Downtown again, she found out her boyfriend had also survived and been released.

The following day, a man in southeast Austin woke up in the afternoon to find that a friend he’d let stay in his apartment had died while he slept. After agonizing for nearly two hours, he called the cops. That afternoon, a 34-year-old resident of Williamson County, just north of Austin, was found on the floor of his bedroom, where police found crack laced with fentanyl. Between April 28 and May 6, nine people in Travis County died from the toxic effects of fentanyl and cocaine, according to Travis County Medical Examiner records, in addition to the Williamson County death. At the request of APD, the Travis medical examiner withheld the cause of death in two other fatal overdoses that may have been related.

In the aftermath, APD made a handful of arrests. In some cases, police affidavits show, detectives were following information about who may have sold the tainted crack; in others, undercover officers simply went to known drug markets and arrested anyone who would sell to them. Eastlick, the APD lieutenant, said investigators believe the crack was adulterated at the local level, not higher up the drug supply chain, but that police had been unable to prove anyone intentionally sold tainted drugs. “It was a short surge … so our thinking is that it was not intentional,” he said.

As the tainted substance faded from the Austin drug supply, Cheatham said she and others heard stories of people who overdosed and were revived by naloxone without the authorities ever being alerted. In Austin’s camps and alleys, anonymous drug users helped one another.

Many of those who died remained anonymous as well, victims of an event whose details remained unclear and which took its toll mostly on the sort of people society tends to lose in its cracks.

Brauer and Chun, with the Central Presbyterian church, didn’t learn of Benjamin Arzo Gordon’s death until months afterward, when contacted for this story. In early November, the pair traveled to the indigent burial cemetery in northeast Travis County. In the wide, level graveyard, rows of nondescript markers rested flush to the ground. By Gordon’s, they left a bouquet of artificial flowers and a potted plastic plant.

“Just being able to picture him so clearly, knowing him as somebody that I value, that I enjoyed seeing, that was full of life and laughter despite the situation he was in—to hear about the way that he died of a drug overdose, probably fairly anonymously, just was incredibly sad to me,” Brauer said. “So because I didn’t get a chance to say goodbye … it just felt like something we needed to do to honor him.”

Editor’s Note: This article was produced in collaboration with Texas Community Health News and Public Health Watch. Daniel Carter contributed reporting.

Source:  https://www.texasstandard.org/stories/texas-war-on-drug-users-fentanyl-overdoses-narcan-austin/

 

New York Times    DNYUZ        December 26, 2024

The cartel operatives came to the homeless encampment carrying syringes filled with their latest fentanyl formula. The offer was simple, according to two men living at the camp in northwest Mexico: up to $30 for anyone willing to inject themselves with the concoction.

One of the men, Pedro López Camacho, said he volunteered repeatedly — at times the operatives were visiting every day. They watched the drug take effect, Mr. López Camacho said, snapping photos and filming his reaction. He survived, but he said he saw many others who did not.

“When it’s really strong, it knocks you out or kills you,” said Mr. López Camacho of the drugs he and others were given. “The people here died.”

This is how far Mexican cartels will go to dominate the fentanyl business.

Global efforts to crack down on the synthetic opioid have made it harder for these criminal groups to find the chemical compounds they need to produce the drug. The original source, China, has restricted exports of the necessary raw ingredients, pushing the cartels to come up with new and extremely risky ways to maintain fentanyl production and potency.

The experimentation, members of the cartels say, involves combining the drug with a wider range of additives — including animal sedatives and other dangerous anesthetics. To test their results, the criminals who make the fentanyl for the cartels, often called cooks, say they inject their experimental mixtures into human subjects as well as rabbits and chickens.

If the rabbits survive beyond 90 seconds, the drug is deemed too weak to be sold to Americans, according to six cooks and two U.S. Embassy officials who monitor cartel activity. The American officials said that when Mexican law enforcement units have raided fentanyl labs, they have at times found the premises riddled with dead animals used for testing.

“They experiment in the style of Dr. Death,” said Renato Sales, a former national security commissioner in Mexico. “It’s to see the potency of the substance. Like, ‘with this they die, with this they don’t, that’s how we calibrate.’”

To understand how criminal groups have adapted to the crackdown, The New York Times observed fentanyl being made in a lab as well as a safe house, and spent months interviewing several people directly involved in the drug’s production. They included nine cooks, three chemistry students, two high-level operatives and a recruiter working for the Sinaloa Cartel, which the U.S. government blames for fueling the synthetic opioid epidemic.

The people connected to the cartel spoke on the condition of anonymity for fear of retaliation.

One cook said he recently started mixing fentanyl with an anesthetic often used in oral surgery. Another said the best additive he had found was a sedative for dogs and cats.

Another cook demonstrated for Times reporters how to produce fentanyl in a cartel safe house in Sinaloa State, in northwest Mexico. He said that if the batch was too weak, he added xylazine, an animal tranquilizer known on the street as “Tranq” — a combination that American officials warn can be deadly. “You inject this into a hen, and if it takes between a minute and a minute and a half to die, that means it came out really good,” the cook said. “If it doesn’t die or takes too long to die, we’ll add xylazine.”

The cooks’ accounts align with data from the Mexican government showing a rise in the use of fentanyl mixed with xylazine and other substances, especially in cities near the U.S. border.

“The illicit market gets much more benefit from its substances by cutting them with different things such as xylazine,” said Alexiz Bojorge Estrada, deputy director of Mexico’s mental health and addiction commission.

“You enhance it and therefore need less product,” said Ms. Bojorge, referring to fentanyl, “and you get more profit.”

U.S. drug researchers have also noticed a rise in what one called “weirder and messier” fentanyl. Having tested hundreds of samples in the United States, they found an increase in the variety of chemical compounds in fentanyl on the streets.

“It’s just a wild west of experimentation,” said Caleb Banta-Green, a research professor at the University of Washington School of Medicine, who helped coordinate the testing of more than 580 samples of drugs sold as fentanyl in Washington State this year.

He called it “absolute chaos.”

The Experiments: The synthetic opioids that reach American streets often begin in cartel labs, where precision is not always a priority, cooks say. They mix up vats of chemicals in rudimentary cook sites, exposing themselves to toxic substances that make some cooks hallucinate, wretch, pass out and even die. The cartels are actively recruiting university chemistry students to work as cooks. One student employed by the cartel revealed that to test their formulas, the group brought in drug users living on the street and injected them with the synthetic opioid. No one has ever died, the student said, but there have been bad batches. “We’ve had people convulse, or start foaming at the mouth,” the student said.

Mistakes by cooks were met with severe punishment, she added: Armed men locked the offenders in rooms with rats and snakes and left them there for long stretches with no food or water.

The cooks and high-level operatives described the Sinaloa Cartel as a decentralized organization, a collection of so many disparate cells that no single leader or faction had complete control over the group’s fentanyl production.

Some cooks said they wanted to create a standardized product that wouldn’t kill users. Others said they didn’t see the lethality of their product as a problem — but as a marketing tactic.

In a U.S. federal indictment against the sons of the notorious drug lord Joaquín Loera Guzmán (known as El Chapo) who lead a powerful faction of the Sinaloa Cartel, prosecutors said the group sent fentanyl to the United States even after an addict died while testing it in Mexico.

Instead of scaring people off, cartel members, drug users and experts say that many American users rush to buy a particularly deadly batch because they know it will get them high.

“One dies, and 10 more addicts are born,” said one high-level operative for the cartel. “We don’t worry about them.”

The Boss: The boss knew something was wrong when the hens stopped keeling over. He said he’d been in the drug business since he was 12, when he started apprenticing at a heroin processing site.

Now a soft-spoken 22-year-old, the boss said he taught himself how to produce illicit drugs by studying the older, more experienced men he worked with. Eventually, he started his own business with a friend.

The boss said his business grew so fast that soon he was running three fentanyl labs. The drug has made him millions, he said.

Every time he goes to one of his labs, he said he brings four or five rabbits from the local pet store. If the fentanyl his people make is potent enough, he has to inject and kill only one to be sure it is fit for sale.

Two pet store employees in Sinaloa, who spoke on the condition of anonymity for fear of retaliation from cartel members, confirmed that the cheapest rabbits are known to be purchased for drug testing.

The boss’s other test subjects are hens from a nearby ranch. Many fentanyl cooks test their product on chickens, according to the two U.S. Embassy officials.

Until recently, the boss said every time he injected the hens with fentanyl they would either die, fall over or stumble around as if they were drunk. All the locals knew not to eat the chickens or the eggs from the ranch.

But recently, the animals weren’t having a strong reaction to the drug, even though his process hadn’t changed.

His employees were logging the same hours at the same modest lab in the mountains, starting at 5 a.m. and sleeping there for days on end. They were working with the same equipment — laboratory shakers, trays, large containers and a blender to mix up the final product.

The boss said he eventually concluded that the culprit was a “very diluted” supply of the chemical ingredients from China. The result was a bunk product. “It’s too weak,” he said.

To fix the problem, the boss first tried combining fentanyl with ketamine, a short-acting anesthetic, but said users didn’t like the bitter taste that came with smoking the mix. It worked much better to add procaine, he said, a local anesthetic often used to numb small areas during dental procedures. When asked whether he felt guilty about producing a drug that causes mass death, the boss said all he was doing was giving his customers what they wanted.

“If there weren’t all those people in the United States looking to get high, we wouldn’t sell anything,” he said. “It’s their fault, not ours. We just take advantage of the situation.”

The Cook

One cook we spoke with said he got into the fentanyl business a few years ago to pay off growing debts. At first, the former shop owner regularly got sick from the exposure to the fumes. He said the armed cartel members in charge had no patience for it.

“You may throw up at the beginning when you start, and you take a quick break and take some air,” said the cook, but soon enough “one of them will scream at you to get back to work.”

A boss once shot him just because he didn’t answer a question quickly enough, he said, pulling up his shirt to reveal a stomach scar.

He is constantly experimenting with ways to make fentanyl stronger, tweaking his formula and testing it on his lab assistants, many of whom have become addicted in the process, he said. If the product comes out strong, he passes it on to his supervisors to try.

The cook said he knows all the improvisation adds up to an unpredictable product. Each batch he makes is different, he said, meaning clients who buy the exact same fentanyl pills may get wildly different doses from week to week.

He’s never fully disclosed his job to his family, simply saying he’s off to work and then returning weeks later with a lot of cash. He believes the money and the fear evident in his expression deter any questions.

“There is no retirement here,” the cook said, adding that the cartel would likely kill him for trying to stop. “There is just work and death.”

 

Source: https://dnyuz.com/2024/12/26/how-mexican-cartels-test-fentanyl-on-vulnerable-people-and-animals/

__


www.drugwatch.org
drug-watch-international@googlegroups.com

 December 19, 2024 / 73(50);1147–1149

Yijie Chen, PhD1; Xinyi Jiang, PhD1; R. Matthew Gladden, PhD1; Nisha Nataraj, PhD1; Gery P. Guy Jr., PhD1; Deborah Dowell, MD1

Summary

What is already known about this topic?

From 2020 to 2022, among overdose deaths with only illegally manufactured fentanyl (IMF) detected, those with evidence of smoking IMF increased by 78.9%, and those with evidence of injection decreased by 41.6%.

What is added by this report?

From July–December 2017 to January–June 2023, the percentage of persons injecting IMF sharply declined across all U.S. Census Bureau regions, with region-specific differences in magnitude; correspondingly, IMF snorting or sniffing increased in the Northeast, and IMF smoking increased in the Midwest, South, and West regions.

What are the implications for public health practice?

Whereas avoiding injection likely reduces infectious disease transmission, noninjection routes might still contribute to overdose. Provision of locally tailored messaging and linkage to medical treatment is important among persons using IMF through non-injection routes.

During 2019–2023, U.S. overdose deaths involving fentanyl have more than doubled, from an estimated 35,474 in 2019 to 72,219 in 2023 (1). From 2020 to 2022, overdose deaths with only illegally manufactured fentanyl (IMF) detected and evidence of smoking IMF increased by 78.9%; deaths with evidence of injection decreased by 41.6% (2). Smoking, however, could not be linked specifically to IMF use when deaths involved multiple drugs (e.g., methamphetamine co-used with IMF). To characterize IMF administration routes among all persons who use IMF, with or without other drugs, IMF administration routes were examined among adults assessed for substance use treatment who used IMF during the past 30 days.

Investigation and Outcomes

The National Addictions Vigilance Intervention and Prevention Program’s Addiction Severity Index-Multimedia Version (ASI-MV) tool* includes a convenience sample of adults aged ≥18 years assessed for substance-use treatment. CDC analyzed treatment assessments conducted between July 1, 2017, and June 30, 2023, which were restricted to 14 states with at least 100 assessments reporting past 30-day IMF use (16,636)§ and stratified by administration routes (swallowed, snorted or sniffed, smoked, and injected). The percentage of persons reporting each administration route was calculated for 6-month periods by U.S. Census Bureau region.** Significant (p-value <0.05) trends by administration route were identified using Joinpoint (Joinpoint version 5.1.0; National Cancer Institute) and Pearson correlations. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.††

In the Midwest, South, and West U.S. Census Bureau regions, increases in smoking (from 7.8% during July–December 2017 to 38.2% during January–June 2023 [Midwest]; from 15.4% during January–June 2020 to 54.0% during January–June 2023 [South]; and from 45.7% during January–June 2018 to 85.7% during January–June 2023 [West]) were strongly negatively correlated with decreases in injection (Pearson correlation coefficient [r] = −0.96; p<0.001 [Midwest]; −0.98; p<0.001 [South]; and −0.74; p<0.01 [West]). Injection decreased from 75.2% during January–June 2020 to 41.2% during January–June 2023 in the Midwest U.S. Census Bureau region; from 54.2% during July–December 2020 to 30.3% during January–June 2023 in the South; and from 65.6% during July–December 2018 to 9.1% during January–June 2023 in the West, but timing of changes across each census region varied (Figure). In the Northeast, increases in snorting or sniffing (from 18.9% during July–December 2017 to 45.5% during January–June 2023) were strongly negatively correlated (r = −0.89; p<0.001) with a decrease in injection (from 83.8% during July–December 2017 to 63.4% during January–June 2023).

Preliminary Conclusions and Actions

Consistent with other fatal overdose investigations (2), the percentage of persons injecting IMF sharply declined across all U.S. Census Bureau regions between 2017 and 2023, although the magnitudes of these declines were region-specific. Some persons who use IMF reportedly believe that smoking is safer than injecting IMF (3). Whereas avoiding injection likely reduces the risk for acquiring bloodborne viruses (e.g., HIV or HCV) and soft tissue infections (2,4), noninjection routes might contribute to overdose or other health problems (e.g., orofacial lesions associated with snorting) (5). Compared with injection, smoking IMF is associated with a higher frequency of use throughout the day and potentially higher daily dosages consumed (3). Substantial shifts to smoking IMF in the Midwest, South, and West, and sniffing or snorting IMF in the Northeast (i.e., Massachusetts) highlight the need to understand local trends in drug use and tailor local messaging, outreach, and linkage to medical care, including effective treatment for opioid use disorder in persons using IMF through noninjection routes.

Corresponding author: Yijie Chen, mns7@cdc.gov.

Source: https://www.cdc.gov/mmwr/volumes/73/wr/mm7350a4.htm?s_cid=mm7350a4_w


1Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

CDC warns of carfentanil, an opioid that’s 100 times more potent than fentanyl
by Fox News – Published Dec. 10, 2024, 11:13 a.m. ET
Originally Published by Centers for Disease Control

Fentanyl has made headlines for driving overdose deaths, but the and Prevention (CDC) is warning of the rise of an even deadlier drug.
Last year, nearly 70% of all U.S. overdose deaths were attributed to illegally manufactured fentanyls (IMFs).
One of those was carfentanil, an altered version of fentanyl that is said to be 100 times more potent, the CDC warned in a Dec. 5 alert.
Deaths from carfentanil rose by more than 700% in the past year, according to the same source — there were 29 deadly overdoses between January and June 2023, and 238 in that same time frame in 2024.
This data came from the CDC’s State Unintentional Drug Overdose Reporting System (SUDORS).
The numbers could actually be higher, as the 2024 data is preliminary and not all overdose deaths have been reported, the agency noted.
Since an outbreak of carfentanil-linked deaths in 2016 and 2016, the drug had “largely disappeared” until this recent reemergence, the CDC noted.
Based on the increase in fatal overdoses, the CDC is calling for “rigorous monitoring” of carfentanil and other opioids more potent than fentanyl.
Fentanyl has made headlines for driving overdose deaths, but the Centers for Disease Control and Prevention (CDC) is warning of the rise of an even deadlier drug.MOLEQL – stock.adobe.com
As with other illicit drugs, its “high profitability” likely drives its prevalence, according to Dr. Chris Tuell, clinical director of addiction services at the University of Cincinnati College of Medicine.
“Very small amounts can produce thousands of doses,” he told Fox News Digital.
“Synthetic opioids like carfentanil are relatively easy to manufacture in illicit labs,” Tuell went on. “Since the drug is a synthetic, it is easier to produce — unlike heroin, which is dependent on a plant like opium.”
Why is carfentanil so dangerous?
Carfentanil is 10,000 more times more potent than morphine and 100 times more potent than fentanyl, Tuell confirmed.
“Even a small amount can be fatal, as it can cause respiratory failure,” he said.
Last year, nearly 70% of all U.S. overdose deaths were attributed to illegally manufactured fentanyls (IMFs).Seth Harrison, The Journal News
One of the major concerns with carfentanil and fentanyl is that they are frequently mixed with other drugs, such as benzodiazepines, cocaine and opioids, which can lead to accidental overdoses, according to Tuell.
“Carfentanil can also resemble cocaine and heroin, so it blends right in with the other drugs,” he warned.
“Even a tiny amount can increase the potency of a drug mixture, leading to a stronger and longer-lasting high.”
Carfentanil often appeals to drug users who have a high tolerance to opioids because they seek a stronger substance, “making the drug attractive despite the risk,” Tuell noted.
How is the drug administered?
Carfentanil can be injected and is frequently mixed with other opioids or heroin, Tuell said. In a powder form, it can be inhaled.
“Inhaling the drug can be quickly risky because it can enter the bloodstream, resulting in an overdose,” Tuell warned. “This can happen intentionally or accidentally, as the drug can become easily airborne.”
Carfentanil can sometimes be in the form of “pressed pills” that resemble prescription medications, the expert said.
“Carfentanil can be lethal at the 2-milligram range depending on the route of administration,” he cautioned.
What parents should know
“Children are now the generation of artificial intelligence and deepfakes, as illicit drugs are posing like regular prescription medications,” Tuell cautioned.
To help protect kids from the dangers of illicit drugs, the expert emphasized the importance of open communication and education.
“Educate your child about the dangers and risks of drug use, including synthetic opioids like carfentanil,” he advised.
Parents should provide monitoring and supervision of their children, be aware of their social circles and limit unsupervised online activities, Tuell recommended.
“I also believe it is important that parents realize that 84% of individuals with a substance use disorder also have a co-occurring mental health issue,” he added.
Carfentanil often appeals to drug users who have a high tolerance to opioids because they seek a stronger substance, “making the drug attractive despite the risk,” Tuell noted.luchschenF – stock.adobe.com
“Seeking out mental health services for your child could help address the underlying issues that may have led to a substance use disorder.”
The CDC called for specific efforts in preventing deaths from illegally manufactured fentanyls, “such as maintaining and improving distribution of risk reduction tools, increasing access to and retention of treatment for substance use disorders, and preventing drug use initiation.”

Source: https://nypost.com/2024/12/10/us-news/cdc-warns-rise-in-opioid-thats-100-times-more-potent-than-fentanyl/

We targeted drug cartels to stop fentanyl. Now, overdose deaths are dropping. | Opinion


Anne Milgram  |  Opinion contributor

This fight may seem daunting, and it is unbearable for the families who have lost a loved one. The opioid epidemic has led to tragic deaths across the nation for decades.

In recent years, however, we’ve witnessed Americans being poisoned by fentanyl. Two Mexican cartels are responsible for almost all the fentanyl found in the United States. These cartels press fentanyl into pills to look like prescription medications and they hide fentanyl powder in other drugs like cocaine.

This deception drives addiction, leading to more sales and profit. Of the more than 107,000 drug-related deaths last year, 69% of them involved fentanyl. That is about 200 American lives lost every day to fentanyl.

But today, we are making significant progress in this battle.

Drug deaths decline by more than 14%

According to new provisional data from the Centers for Disease Control and Prevention, drug deaths in the United States have fallen for the first time in five years. The United States has seen a more than 14% decrease in deaths between June 2023 and June 2024.

While several contributors led to the decline, this marks an important milestone in DEA’s fight to save lives.

When I joined DEA more than three years ago, it was clear that this unprecedented threat required a new approach. We transformed our operations to meet the moment and quickly built a plan to attack the cartels.

We launched counter threat teams focused on a whole network approach to disrupt and defeat the Sinaloa and Jalisco cartels, the Mexican gangs responsible for the deadly influx of fentanyl and methamphetamine into the United States.

While the harm is felt in the United States, the global fentanyl supply chain spans more than 65 countries. Our goal is simple: Take action across the entire supply chain and make it impossible for the cartels to do business.

DEA’s investigations have resulted in charges against Chinese chemical companies and Chinese nationals responsible for the production and sale of chemicals used to manufacture fentanyl; the leaders, money launderers, transporters and enforcers of the Sinaloa and Jalisco cartels; thousands of individuals across the United States who work for the cartels and pedal fentanyl on social media and on our streets; and the money launderers moving billions of dollars in drug money across the globe.

DEA is proud to lead this fight to stop deadly drugs from coming into our communities. Our agency has some of the most highly skilled professionals in the world – special agents, intelligence analysts, data scientists, cyber specialists, social media analysts and forensic scientists – working together to take down these multinational criminal drug networks.

Top drug cartel leaders arrested

Working with our law enforcement partners, our approach has led to the arrests of top cartel leaders and record drug and money seizures.

Last year, DEA seized 80 million fentanyl pills and 12,000 pounds of fentanyl powder, which is the equivalent to 390 million doses. That is enough to kill every single American.

DEA has disrupted global drug trafficking operations from China to Mexico by arresting and indicting cartel members at the highest levels of leadership ‒ including Joaquin Guzman Lopez, son of notorious drug kingpin “El Chapo,” and Ismael Zambada García, or “El Mayo.”

Since 2021, four out of the seven top Sinaloa cartel members have been taken into custody, and three will soon face justice in the United States. DEA has also uncovered and taken down significant global money laundering operations, cutting off funding to the cartel’s operations.

Since launching DEA’s One Pill Can Kill campaign in 2021, we have focused on raising awareness about the dangers of fentanyl.

We also have partnered with families who have lost loved ones to fentanyl. This has been a game changer. The families have been key to sharing lifesaving information and resources in communities across the country. These parents, children, grandparents and siblings continue to turn tragedy into action by working to prevent other families from experiencing their pain.

Recently, at the National Family Summit on Fentanyl, I was thrilled to share with the families another major step in our progress in this fight. We have seen a significant drop in the lethality of counterfeit pills seized in our communities this past year. In 2023, DEA found that 7 out of 10 pills contain a deadly dose of fentanyl. Today, 5 out of 10 pills are potentially deadly.

Seeing a decline in the number of deadly pills on the streets of America is further proof that our efforts are working.

While DEA is proud of the progress we are seeing, we are focused on the work that still needs to be done. Every life lost is one too many. DEA and our partners will continue to fight every day to protect our communities and save lives.

This fight is winnable, but it requires everyone pulling in the same direction. We need everyone to educate themselves, their loved ones and their communities on the dangers of fentanyl.

Anyone can use DEA’s One Pill Can Kill resources to spread the message about the dangers of fentanyl and to educate themselves.

DEA also has recently launched a new resource for families. The Together For Families Network will serve as a one-stop shop to connect advocates and share information, because we know each of us can make a difference.

This recent news shows that together we can save lives, and that it takes all of us working together to win this fight.

Anne Milgram is the administrator of the U.S. Drug Enforcement Administration.

 

Source: https://eu.usatoday.com/story/opinion/2024/11/26/dea-drug-deaths-fentanyl-mexican-cartels/75487168007/

by Chloe Marklay, Katie Amrhein, WKRC

CINCINNATI (WKRC) – A local mother who lost her son to fentanyl has spearheaded an initiative to bring a powerful billboard to Cincinnati.

The billboard is located in the Northgate area. It includes pictures of 20 people who lost their lives to fentanyl, many of whom are local. The billboard reads: “Synthetic opioids kill over 150 people every day” and “fentanyl steals families.”

 

(WKRC)

Tamara Bohl lost her son Brian when he was 33 years old. Bohl wrote a book titled “My Child Died, Now What?” to help parents like her and to honor those who have lost their lives.

“These are real people, not just a statistic—real people that had lives, dreams, aspirations, families, friends, and kids,” said Bohl.

Bohl worked alongside Rachel’s Angels to create the sign and bring it to Cincinnati. The nonprofit is focused on providing drug education, prevention resources, and support to families affected by addiction.

The billboard dedication is set for Wednesday. The event will include speeches from city leaders, the Center for Addiction Treatment, and other parents like Bohl.

Bohl also featured the names of more than 900 people who lost their lives to fentanyl in her poetry book. One of them is Jason Durkin. At 21 years old, Durkin died from the drug in 2018. His mother Jennifer Bishop attended the billboard dedication.

“It’s gut-wrenching to see him up there, but I feel good that I’m putting him out there because he mattered,” said Bishop.

The event will also include the distribution of Narcan kits and educational resources on drug prevention and harm reduction.

Bohl also taped additional photos of fentanyl victims around the billboard pole. The billboard will stay up throughout November.

 

Source: https://local12.com/news/local/fentanyl-steals-families-new-cincinnati-billboard-spreads-awareness-opioid-epidemic-northgate-joseph-chevrolet-tamara-bohl-book-brian-drug-drugs-addiction-education-rachels-angels

From: thinkon908 via Drug Watch International
Subject: FROM DAVE EVANS WHAT TRUMP GOT WRONG PLEASE WRITE TO SENATOR VANCE ABOUT THIS

In a message dated 9/3/2024 6:52:58 AM Eastern Daylight Time:

President Trump and Senator Vance have recently come out in favor of marijuana legalization. This is a big mistake.

Here is what President Trump had to say

As everyone knows, I was, and will be again, the most respected LAW & ORDER President in U.S. History. We will take our streets back by being tough & smart on violent, & all other types, of Crime. In Florida, like so many other States that have already given their approval, personal amounts of marijuana will be legalized for adults with Amendment 3. Whether people like it or not, this will happen through the approval of the Voters, so it should be done correctly. We need the State Legislature to responsibly create laws that prohibit the use of it in public spaces, so we do not smell marijuana everywhere we go, like we do in many of the Democrat run Cities. At the same time, someone should not be a criminal in Florida, when this is legal in so many other States. We do not need to ruin lives & waste Taxpayer Dollars arresting adults with personal amounts of it on them, and no one should grieve a loved one because they died from fentanyl laced marijuana. We will make America SAFE again!

We will address these four statements made by President Trump.

1. As everyone knows, I was, and will be again, the most respected LAW & ORDER President in U.S. History.

If he supports legalization of marijuana he is not in favor of law and order. Marijuana use causes violence in general and violence against women and children. See the attached paper on marijuana and violence. Data also shows that marijuana use is the primary drug involved with child deaths by their caretakers. See the attached power point on child deaths.

2. We need the State Legislature to responsibly create laws that prohibit the use of it in public spaces, so we do not smell marijuana everywhere we go, like we do in many of the Democrat run Cities.

He got it right that marijuana smoking should be banned in public places including apartment buildings. Attached is the Cannabis Industry Victims Education Litigators paper “Marijuana Smoke Carries High Risks to the Health of Users or to the Health of Other Individuals or of the Community” that was sent to the DEA on the rescheduling issue. It covers the science on topics such as:

Relevant Facts about Marijuana Smoke – 9
Marijuana smoke has dangerous levels of particulate matter – 10
California Environmental Protection Agency Declares Marijuana Smoke a Carcinogen – 11
Marijuana Smoke is More dangerous than Tobacco Smoke – 12
Second Hand Marijuana Smoke Is Dangerous to Individuals and the Community – 13
Cannabis Smoke and Pollen Are Known Allergens – 18
Marijuana Is Addictive and Marijuana Smoke and Odor Can Trigger Relapse – 22
Marijuana Smoke May Trigger Relapse in Those Suffering from Cannabis Use Disorder – 24

3. We do not need to ruin lives & waste Taxpayer Dollars arresting adults with personal amounts of it on them.

 

President Trump got that wrong. I have been a criminal defense attorney since 1974. Attached is the AALM paper on social justice and marijuana arrests. It is a myth that there are many minorities in prison due to possession of small amount of marijuana. Most states treat this as a civil offense or a very minor offense and records can be expunged. An arrest can help get marijuana users evaluated and treated. See the attached paper on Compassionate Justice.

4. “no one should grieve a loved one because they died from fentanyl laced marijuana. We will make America SAFE again!

President Trump got that wrong

I was an EMT for 10 years and President of a rescue squad and also an EMT on a mountain fire company. Here is what first responders have to say about “fentanyl laced marijuana” in their Journal of Emergency Medical Services

Fentanyl-laced cannabis products are a malevolent myth that has appeared multiple times in law enforcement press releases and subsequent media reports. These rumors began as early as 2017 when a county coroner in Ohio erroneously stated that he had seen evidence of marijuana laced with fentanyl. It was later determined that his remarks were unsubstantiated and were based on third-hand hearsay. To-date, there are no scientifically verified reports fentanyl contamination of cannabis products. Writer and drug researcher Claire Zagorski notes that in addition to the paucity of evidence associated with the rumors, fentanyl is destroyed and rendered inert when it is burned. Meaning that even if it made its way onto cannabis flower, it would not have any effect on the individuals who inhaled it when smoking. Additionally, fentanyl is not well absorbed through the gastrointestinal tract, which is why there are no oral preparations of the medication which minimizes the risk of its impact if it were to end up in edible products. Finally, it is worth noting that it is possible that fentanyl could be vaporized (heated to its boiling point as opposed to burning). However, it requires much higher temperatures than are found in vaping devices that are used to consume tobacco and cannabis products.

There are, of course, a few different ways to consume cannabis. The method most of us probably think of is smoking. In the case of cannabis flower, smoking involves loading the material into a pipe or roll paper, lighting it on fire, and inhaling the smoke. Burning fentanyl with flame destroys it, so even if someone smoked cannabis contaminated with fentanyl, the fentanyl would not be active in the smoke. In fact, burning drugs in an incinerator is a common way to dispose of them, both for prescription medications and for illegal drugs seized by law enforcement.

David G. Evans, Esq.
www.ncagainstmarijuana.org

Source: www.drugwatch.org

 

By  BRUCE SCHREINER

Kentucky Attorney General Russell Coleman unveiled plans Tuesday to create a statewide drug prevention program, saying the youth-focused initiative would fill a hole in the Bluegrass State’s fight against an addiction epidemic that has claimed thousands of lives.

Coleman presented the plan’s details to a state commission, which unanimously approved his request for a $3.6 million investment over two years to implement it.

“With over one million Kentuckians under the age of 18, we are going to put every single dollar to good use,” Coleman said. “Our parents and grandparents schooled us that an ounce of prevention is worth a pound of cure. I fully believe this initiative lives up to that age-old sentiment.”

Substance abuse is a deadly scourge in Kentucky though there are signs of progress in fighting back.

A total of 1,984 Kentuckians died last year from a drug overdose, down 9.8% from the previous year, Gov. Andy Beshear announced in June, citing an annual report. Fentanyl — a powerful synthetic opioid — remained the biggest culprit, accounting for 79% of overdose deaths in 2023, according to the report.

While conceding the fight against drug abuse is far from over, officials credited recent gains on expanded efforts to treat addiction, plus illegal drug seizures by law enforcement.

Source:  https://apnews.com/article/drug-abuse-kentucky-a23d7452851a18aa2420c93ff99cdf34

 

The programs touch on various topics, including drug use and decision-making skills that could help youths avoid behaviors that put them at risk for substance use

NBC Universal, Inc.
Programs educating students about drug abuse and drug overdose prevention are now at San Diego schools, reports NBC 7’s Todd Strain.

Amid a rise in fatal fentanyl overdoses, a San Diego County task force convened to identify substance abuse prevention solutions for local youths. It released a report Monday outlining its recommendations for drug prevention programs at schools.

The report entitled “School-based Interventions for Substance Use and Overdose Prevention” was drafted by the San Diego County Substance Use and Overdose Prevention Taskforce, comprised of members of various entities including the San Diego County District Attorney’s Office, San Diego County Office of Education, California National Guard Counterdrug Task Force, Drug Enforcement Administration, and Center for Community Research.

With the goals in mind of preventing juvenile substance use and overdoses, the working group behind the report outlined five prevention programs identified for elementary, middle and high school populations: Positive Action, Project Towards No Drug Abuse, LifeSkills Training, DARE’s Keepin’ It Real, and Project Alert.

The programs touch on various topics, including drug use and decision-making skills that could help youths avoid behaviors that put them at risk for substance use.

Three other programs the report states may be instrumental to prevention efforts include:

  • Operation Prevention San Diego, a free DEA program with resources for educators that the report states “integrate seamlessly into classroom instruction.” The program addresses the impacts of drugs to the brain and body. The program is available to schools upon request or at operationprevention.com
  • I Choose My Future, a program offered by the San Diego County Office of Education that highlights substance abuse dangers and impacts at the individual, family, school, city, nation and global levels
  • A recommendation that all schools serving grades 6-12 have adequate supplies of naloxone, which the report states “has demonstrated effectiveness in reversing opioid overdoses and is recommended by the Centers for Disease Control and Prevention as a successful strategy for preventing an opioid overdose”

The task force says the recommendations have already been adopted by around two dozen San Diego County schools.

“It’s critical that we educate our youth through compelling and effective curriculum, giving them the tools they need to stay healthy and make decisions that can literally save their lives,” San Diego County District Attorney Summer Stephan said in a statement.

Source: https://www.nbcsandiego.com/news/local/san-diego-county-task-force-drug-prevention-programs-schools/3654778/

This week, beginning today, Sunday, August 25 through Saturday, August 31, is being recognized as Overdose Awareness Week. This year’s international theme is “Together we can.”

The substance use crisis in America has had a devastating impact on our tribal communities, families, and individuals. In Indian Country, overdoses from fentanyl, opioids, and other deadly drugs such as “tranq” are leading to loss of life as well as a steep decline in the health and well-being of tribal communities. In addition, the epidemic is contributing to the spread of infectious diseases, such as HIV and hepatitis C.

On Friday, the White House released a presidential proclamation for Overdose Awareness Week, 2024. In the proclamation President Joe Biden says: “even one death is one too many, and far too many Americans continue to lose loved ones to fentanyl.”

Overdose Awareness Week Proclamation, 2024

During Overdose Awareness Week, we mourn those who have lost their lives to overdose deaths. We acknowledge the devastating toll the opioid epidemic has taken on individuals, families, and communities across America. We reflect on the progress we have made so far in reducing the number of annual overdose deaths and protecting American lives — and how much more there is to do. And we reaffirm our commitment to doing more to disrupt the supply of fentanyl and other synthetic opioids and support those who suffer with substance use disorder and their families in all of our communities.

My Administration made beating the opioid epidemic a key priority in my Unity Agenda for the Nation, calling for Republicans and Democrats to work together to stop fentanyl from flowing into our communities, hold those who brought it here accountable, and deliver life-saving medication and care across America.

We are working to tackle this crisis through a comprehensive approach, including by expanding access to evidence-based prevention, treatment, harm reduction, and recovery support services as well as reducing the supply of illicit drugs. We have expanded access to life-saving treatments, like medications to treat opioid use disorder, and have increased the number of health care providers who can prescribe these medications by 15 times.  In February 2024, the Department of Health and Human Services issued a rule to comprehensively update the regulations governing Opioid Treatment Programs for the first time in 20 years — removing barriers to the treatment of substance use disorder and expanding access to care. My Administration has made historic investments in the State Opioid Response and Tribal Opioid Response programs to improve prevention; expand treatment; and deliver free, life-saving medications across America. Already, this program has delivered nearly 10 million kits of opioid overdose reversal medications, such as naloxone.

We also continue to fight the stigmatization that surrounds substance use and accidental overdose so that people feel comfortable reaching out for help when they need it.  Naloxone is now available over-the-counter for people to purchase at their local grocery stores and pharmacies.  We also launched the White House Challenge to Save Lives from Overdose and several awareness campaigns, raising awareness and securing commitments from local governments and cross-sector organizations to increase training on and access to opioid overdose reversal medications in schools, worksites, transit systems, and other places where overdose may occur in our communities. My Fiscal Year 2025 Budget requests $22 billion to expand substance use treatment and help more Americans achieve and stay in recovery.

Under my Administration, Federal law enforcement agents are keeping more deadly drugs out of our communities than ever before. We are seizing deadly drugs at our borders so that illicit drugs never reach our neighborhoods. Officials have stopped more illicit fentanyl at ports of entry over the last 2 fiscal years than in the previous 5 fiscal years combined. The Department of Justice has prosecuted leaders of the world’s largest and most powerful drug cartel along with thousands of drug traffickers. The Department of the Treasury has sanctioned more than 300 people and organizations involved in the global illicit drug trade. I have also deployed cutting-edge drug detection technology across our southwest border, and I continue to call on the Congress to strengthen border security, increase penalties on those who bring deadly drugs into our communities, and close loopholes that drug traffickers exploit. And in July 2024, I issued a National Security Memorandum that calls on all relevant Federal departments and agencies to work collaboratively to do even more than they are already doing to stop the supply of illicit fentanyl and other synthetic opioids into our country.

I am also committed to working with partners across the globe to address this crisis. Last year, I negotiated the re-launch of counternarcotics cooperation between the United States and the People’s Republic of China — which has led to increased law enforcement coordination, increased efforts to tackle illicit financing of drug cartels, and increased regulation of certain precursor chemicals. I have increased counternarcotics cooperation with other key foreign governments; launched the Global Coalition to Address Synthetic Drug Threats, which brings together more than 150 countries in the fight against drug trafficking cartels; put in place new initiatives between the United States, Mexico, and Canada targeting the supply of illicit drugs; and made countering fentanyl and other synthetic opioids a key priority of the G7.

Now for the first time in 5 years, the number of overdose deaths in the United States has started to decline. But even one death is one too many, and far too many Americans continue to lose loved ones to fentanyl.

Today I grieve with all the families and friends who have lost someone to an overdose. This is a time to act.  And this is a time to stand together — for all those we have lost and all the lives we can still save.

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim August 25 through August 31, 2024, as Overdose Awareness Week. I call upon citizens, government agencies, civil society organizations, health care providers, and research institutions to raise awareness of substance use disorder so that our Nation can combat stigmatization, promote treatment, celebrate recovery, and strengthen our collective efforts to prevent overdose deaths. August 31 also marks Overdose Awareness Day, on which we honor and remember those who have lost their lives to the overdose epidemic.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-third day of August, in the year of our Lord two thousand twenty-four, and of the Independence of the United States of America the two hundred and forty-ninth.

​​​​​​JOSEPH R. BIDEN JR.

Source: https://nativenewsonline.net/health/president-biden-s-overdose-awareness-week-proclamation-2

(Spectrum News/Vania Patino)

By Los Angeles

LOS ANGELES — Facing peer pressure can be hard, but teens at the Boys and Girls Club in Monterey Park are learning to say no to drugs and alcohol together.

 


What You Need To Know

    • The Boys and Girls Club in Monterey Park offers a drug and alcohol prevention program for youth called Brent’s Club
    • Participants are drug tested at random every week and rewarded through activities, trips and scholarships for saying no to drugs
    • Earlier this year, a group of students traveled to Washington D.C to participate at the Boys & Girls Clubs of America’s Summit for America’s Youth
    • The students were able to speak with elected officials about the need for continued funding toward drug prevention resources

 

Victoria Perez is one of the high school students who chooses to spend her afternoons at the Brent’s Club chapter offered at the Boys and Girls Club.

“I thought maybe it would just be lessons of drug and alcohol awareness, but it just it’s so much bigger than that,” Perez said.

Perez and the other participants soon realized they were not just gaining knowledge about the dangers of drugs, but were also being rewarded for actively taking those lessons into their daily decision making.

The program takes their commitment to staying drug free serious, and it’s why every week participants are drug tested at random.

So far, director of the Brent’s Club, Angel Silva, says they have not had any test results come back positive.

The deal is that those who remain drug free are rewarded through field trips, activities and also become eligible for a full four-year scholarship or partial renewable scholarships.

“Like our Maui trip that we do every summer, where we go, and we do a service project on the island of Maui,” Silva said.

The approach was designed by the Brent Shapiro Foundation, which was created by Brent’s parents after losing their son to addiction. The hope was to prevent this from happening to any other families and help reduce the risks of falling into substance abuse among youth.

This year, some participants created the TLC or Think, Lead, Create Change mental health project to advocate for continued funding toward drug use prevention, treatment and recovery resources.

Perez was one of the participants and, along with her team, was able to attend the Boys & Girls Clubs of America’s Summit for America’s Youth in Washington, D.C.

This was the first time flying for many of the participants and the first time at D.C. for all the students.

It’s experiences like those that Silva says these students would otherwise not have access to without the program.

Perez says it took a lot of preparing and researching to create the project, but was all worth it when they were able to present it to elected officials and share why this cause means so much to them.

“It was such an amazing opportunity, especially for advocating for not just alcohol and drug abuse, but for mental health and how those things merge together,” Perez said.

The advocacy and awareness the students are helping create comes as a time when fentanyl continues to be the most common cause of accidental drug overdose deaths in Los Angeles County.

“We were learning and teaching at the same time very much, because we thought we knew everything about fentanyl, but it decided to change the whole game,” Silva said.

Although, it can be tough to keep up, he says the ever-changing substance landscape makes their efforts that much more important.

Something Perez’s mother, Monica Vargas, agrees with and why she says the program has given her a peace of mind although the idea was jarring at first.

“It was a little shocking because where I come from, I’m a first generation, so we tend to come sometimes from very close or conservative families. So we think out of sight, out of mind. We don’t talk about it,” Vargas said.

However, she knew it was important for parents to communicate with their children, and this program was the perfect way to do it.

“If those additional incentives help, especially with so much pressure out there for these teens, by all means, I’m all for it. I’m 100% for it,” Vargas said.

Along with the incentives, Silva says the students have also become each other’s support system, which itself is a way to reduce the risk of substance abuse among youth.

“That’s the great part. You know, it’s not just within the clubhouse, they all go to the same school, and they hold each other accountable,” Silva said.

Source: https://spectrumnews1.com/ca/southern-california/health/2024/09/02/teens–drug-and-alcohol-prevention-

By  Charlotte Caldwell

LIMA — The Lima Police Department recently posted on its Facebook page about an increase in overdoses in Lima over the past few weeks.

With September being National Recovery Month, where organizations try to increase public awareness about mental health and addiction recovery, local organizations and law enforcement agencies shared their experiences with addiction and overdoses and the help that is available.

The problem

Lima Fire Chief Andy Heffner said his department responded to 85 overdoses so far this year. He said the overdose numbers have risen and fallen throughout the year, with about one-week breaks in between. He believed the numbers were based on the drugs available in the area.

Project Auglaize County Addiction Response Team Project Coordinator/Peer Support Specialist Brittany Boneta spoke on the reason for the overdose spikes.

“When it comes to overdoses, one is too many,” Boneta said. “I think the number of overdoses comes in waves. There could be a really bad batch of heroin or fentanyl that gets distributed throughout the county that could lead to a spike in overdoses.”

Heffner cited the Drug Enforcement Administration’s website, which said seven out of every 10 pills seized by the DEA contain a lethal dose of fentanyl. The website also said 2 milligrams of fentanyl can be enough to kill someone.

“It only takes one time when Narcan is not available that you could lose your life. If you get clean, you will never have to worry about an overdose, and neither will the people that love you,” Heffner said.

Bath Township Fire Chief Joe Kitchen said his department used Narcan 21 times on patients from August 2023 to August 2024. The department also distributes Narcan to families just in case an overdose occurs.

“Although we have only left behind a few kits so far, I think it gives the family of a known addict some peace of mind that they could assist them in the event of an OD prior to EMS arrival,” Kitchen said.

Another problem is a tranquilizer called Xylazine is being mixed with fentanyl, which does not respond to the usual methods of reversal.

“There are always new drugs/drug combinations being introduced on the streets that make it difficult for those in the treatment world to keep up with and know how to effectively treat,” said Jamie Declercq, the vice president of clinical operations for Lighthouse Behavioral Health Solutions. “Right now, we are seeing an increase in substances (such as Xylazine) across the county which does not respond to Narcan, so that is likely one reason for the increase in overdose deaths.”

Their stories

Boneta was addicted to opiates and crack cocaine over a seven-year period, and her addiction journey started when she was prescribed Percocet by a cardiologist for a heart condition when she was 18.

“There wasn’t a drug I wouldn’t use,” Boneta said. “I was an honor roll student in high school with more trauma than almost anyone I know, and when I went off to college I wasn’t educated on the true dangers of drugs, the thirst to fit in, and all of my trauma stuffed down.”

When her doctor stopped prescribing Percocet, she bought them from drug dealers, not knowing they were laced with heroin.

“When the drug supply of the fake Percocet ran out, I was just buying actual heroin. The heroin was starting to have fentanyl added to it, and before long that was all I was consuming,” Boneta said.

Boneta was eventually sent to prison for drugs, and during that time her 6-year-old son was involved in a house fire and suffered serious injuries.

“I was transported from the prison, in my orange jumpsuit and shackles on my wrists and ankles, to say my goodbyes to my son. I think seeing him lying there in a coma covered in bandages was something so soul-shaking that I knew this was my rock bottom,” Boneta said.

“My son had countless surgeries and was getting better and stronger as the months went by, so I decided I was going to completely reset my life and work my butt off just as hard,” Boneta continued. “I completed as many recovery groups and classes as possible and started learning coping skills and tools to use when I was released from prison. I knew that I wanted to help other people like me and show them that people can understand what they are going through and not have judgment towards them.”

Diane Urban, of Delphos, the founder/president of the Association of People Against Lethal Drugs, started APALD because her youngest son died from a fentanyl overdose. Her older son is also a former addict, and her niece is in active addiction.

“He was clean for the last nine months of his life, he came to live with me, and he relapsed due to an ingrown wisdom tooth that was coming in, his face was swelling up, and because he had Medicaid, we couldn’t find him any help anywhere except for a place in Van Wert, and it was a two-week out appointment. Unfortunately, unbeknownst to me, he relapsed, and I found him dead in his bedroom from a fentanyl overdose,” Urban said.

Challenges to get help

Transportation, not enough of a variety of local recovery options available and financial barriers were all cited as issues addicts face when they decide to get help.

“For peers that are needing inpatient treatment or sober living, we have to send them to other counties for help,” Boneta said. “There is definitely a need for more substance abuse treatment in our county.”

Declercq said Allen County also has a need for inpatient or residential treatment, and people who need that care have to go to one of the major cities nearby.

Urban dealt with having to go outside the area when her son got help.

“Seven years ago when I had to get help for my son, we had to go to Columbus. There was no help to get in right away because (Coleman Health Services) was so backed up,” Urban said. “There can never be enough resources because what happens is all these resource centers and rehabilitation centers, they keep you for a period of time then they release you, and a lot of people when they get released like that, they don’t have adequate support for more of a long-term stay, more of them tend to relapse.”

Urban said her son got treatment for free with Medicaid, but in her experience, organizations prioritize people who have insurance.

Auglaize County Sheriff Mike Vorhees also mentioned a challenge with people not having a way to get to treatment.

“We don’t provide transportation yet, but that’s something that we’re working on,” Vorhees said in regard to the services Project ACART provides. “It depends on who it is. If it’s an elderly person, we can work with the Council on Aging; if it’s a veteran we go through Veterans Services.”

Financially, Declercq said Lighthouse Behavioral Health Solutions’ case managers help people apply for Medicaid, or the local mental health board has options for those who don’t qualify for Medicaid.

“One of the most frustrating barriers for seeking treatment is those with commercial insurance or Medicare, as those companies only pay for very limited services,” Declercq said. “Commercial plans typically pay for a short detox stay and limited individual/group counseling sessions, but do not pay for the intensive level of treatment that a program like Lighthouse offers.”

“Thirty days of treatment and/or 10 individual counseling sessions are not enough to truly treat a person who has been in active addiction for years,” Declercq continued. “Oftentimes even one year of intense treatment only touches the surface of the issues that someone in addiction needs to address.”

Available help

Project ACART has only been around about a year, and Boneta is working part-time and is the only employee. She has reached out to 19 people so far, and only two have denied treatment. She put together a resource guide in 2023 including mental health and substance abuse centers; residential detox treatment centers; 24/7 support services; substance use support groups; where to find Narcan; food pantries, hot meals and clothing; housing assistance and shelters; and low income and subsidized housing.

Boneta received help from peer support specialists through Coleman Health Services during her addiction. Now, as a peer support specialist, she uses a combination of her own experiences and formal training. She equated her role to being like a cheerleader. She is available to clients day and night to connect them to agencies to get help or just talk about their struggles.

“I meet people where they’re at and treat every situation differently. Some of the things I do are assessing needs and struggles, setting goals, advocating for my peers, giving resources, facilitating engagement with my peers and their families or service providers, and encouraging and uplifting them,” Boneta said.

Project ACART’s services are also free because of an Ohio grant.

“Many people in active addiction do not have housing, food, clothing, money or insurance, but they should still have the opportunity to get the help they need,” Boneta said.

Declercq said Lighthouse Behavioral Health Solutions also recently opened a peer support center in Lima for clients to have a place to go for sober activities.

“Downtime/boredom is often a trigger for people who are early in recovery, so this gives them a place to fill that time in a positive way,” Declercq said. “Our peer supporters offer a unique support system to our clients because they are people with past lived experience in addiction who are able to show them that life beyond addiction is achievable and fulfilling.”

Coleman’s seemed to be the go-to choice for law enforcement referrals, and Urban also directs people to the organization.

“My oldest son was a success story, he went to Coleman’s, got treatment, got on the MAT (medication-assisted treatment) program, Suboxone, and he’s thriving today. Owns his own house, owns his own business, married, doing absolutely wonderful. He’s like eight years clean,” Urban said.

Ohio Department of Commerce Division of Securities Recovery Within Reach program also provides a list of recovery resources and offers ways to pay for treatment.

 

Source: https://www.limaohio.com/top-stories/2024/09/06/local-organizations-share-addiction-experiences-challenges-resources/

Tuesday, August 13, 2024
Dan Krauth has the details on a new and potentially lethal narcotic that is creeping into the NYC area from Latin America.

NEW YORK (WABC) — There’s a new mystery drug that’s hitting the club scene in New York City and the ease of how it’s pouring into the area may surprise you.

It’s called pink cocaine.

While its bright color from food coloring stays the same, what’s inside can change from day to day and from dealer to dealer.

“You have no idea what you’re taking,” said NYC Special Narcotics Prosecutor Bridget Brennan. “I’ve never seen the drug supply as lethal as the one we’re in today.”

In cases the Special Narcotics Prosecutor and DEA have seen, when its lab tested, it actually has very little to no cocaine in it at all. Instead they’re finding cheaper manmade drugs from ketamine to ecstasy. It can be a dangerous and even deadly mixture of uppers and downers.

“When you see that mixture of your body being pulled in two directions, being amped up with a methamphetamine or cocaine and being sedated with something like ketamine, that’s a recipe for a terrible, terrible effect on the body,” said Brennan.

The Special Agent in Charge of the DEA in New York said in some cases the deadliest of drugs, fentanyl, is also getting mixed in, where even a tiny amount can be lethal.

“They’re mixing fentanyl in because they want to increase addiction, they want to increase their customer base they want more people to come back and buy their drug and it’s something every parent should be concerned about,” said Frank Tarentino, Special Agent in Charge of the Drug Enforcement Administration’s New York Division.

The drugs aren’t being sold in shady places or dark street corners as you might imagine. Prosecutors busted a New York City woman this summer for allegedly selling pink cocaine, and other drugs, over a messaging app on her cell phone. She’s accused of then shipping the drugs through the mail to customers. She has pleaded not guilty to the charges.

“You have this criminal underworld that has weaponized social media to push their poison to the far corners of the United States and across the world,” said Tarentino.

According to law enforcement sources, with the use of technology and social media, the mystery mixtures are easier to get than ever before and there are more drug overdose deaths reported than ever before. They say there’s no longer any such thing as safe experimentation, no matter how colorful the drug might be.

Pink cocaine also goes by the name Tusi.

Prosecutors say it’s a drug that’s difficult to track but was first spotted in the New York City area in January of 2023.

Source: https://abc7ny.com/post/pink-cocaine-nyc-new-mystery-drug-hitting-club-scene-new-york/15176935/

Tricia Otto’s son, Calvin, will forever be 29 years old. That’s because he lost his life to fentanyl poisoning at age 29 in April of last year.

“He was funny. He had an amazing sense of humor. He was thoughtful. He was kind. He always worried about how other people were feeling. Um, he struggled with addiction for about 14 years, but he fought really hard against that,” Tricia Otto explains. “He always talked about wanting to be a fireman … And instead of fighting fires, my son spent his time fighting demons.”

In 2023 alone, there were over 1, 200 drug overdose deaths from fentanyl in Colorado.

That’s according to the Common Sense Institute. That equates to roughly three deaths per day on average. This upcoming Wednesday, August 21st, is National Fentanyl Prevention and Awareness Day. It was started by the nonprofit Facing Fentanyl. They’re organizing a takeover of Times Square in New York City this week.

Here in Colorado, there will be a Candlelight Vigil at the Denver City and County Building this Wednesday at 7 p. m. (flyer posted below).

Tricia Otto, in addition to being Calvin’s mom, is the Drug-Induced Homicide Foundation Colorado Chapter State Representative. She joined KGNU’s Jackie Sedley to discuss how important it is to talk about fentanyl poisoning, to use language that takes blame off of those with substance use disorder, and to hold those who sell illicit substances accountable.

“Referring fentanyl poisoning as an accidental overdose diminishes the calculated greed and disregard for human life that led to this tragic, tragic passing,” Otto says. “Those struggling with substance abuse disorder are targeted and exploited by drug dealers and others who stand to profit from their vulnerability. Calling it an accident ignores the deliberate actions of those that prey on the addicted, pushing dangerous substances for their own gain. This is not an unfortunate mishap. It’s a calculated act of malice that leads to the death and devastates families.”

Source: https://kgnu.org/fentanyl-overdose-prevention-awareness-triciaotto-calvinotto/

 

Mothers of children who died via fentanyl poisoning champion NC’s new death-by-distribution law and continue to advocate for awareness

BY GALE MELCHER   The CityBeat 

JULY 20TH, 2024

On a billboard off of Battleground Avenue in Greensboro, 20 smiling faces flash grins through the screen — smiles that will forever be contained in pictures and their families’ memories. All 20 people pictured on the billboard passed away after taking drugs they didn’t know were laced with fentanyl, a synthetic opioid drug that is being mass-produced and added to other illicit drugs to increase their potency. This often results in death — in North Carolina, 183 deaths occurred this March.

Next to the faces a message reads: “Hidden in so-called ‘recreational’ drugs, fentanyl steals families.”

On July 6 around noon, families gathered around Elizabeth’s Pizza facing the billboard to remember their loved ones and raise awareness about the dangers of illicit drugs.

Deborah Peeden lost her granddaughter Ashley in October 2021 and shared her story with TCB last year.

In 2023, the Drug Enforcement Administration seized more than 80 million fentanyl-laced fake pills. This year, that number has reached more than 28.1 million and is still climbing. Additionally, seven out of 10 pills seized by the DEA contain lethal doses of fentanyl.

 

Deborah Peeden stands next to an image of her granddaughter, Ashley, who thought

she was doing cocaine with friends when she died from fentanyl poisoning at age 23.

(Photo by Gale Melcher)

In an interview, Peeden said that she felt it was important to put the billboard up to highlight the memory of locals lost to fentanyl. For the past two years, Peeden has paid for a billboard in memory of Ashley. Peeden is now an ambassador for Facing Fentanyl, a campaign that provides prevention education and opioid-reversal kits to schools.

“Some days I’m good, and other days it just hits out of the blue,” Peeden said. “She’s on my mind 24/7 every single minute of every single day. She’s got her birthday coming up on August 1.”

Peeden explained that when dates like birthdays come around, she “can feel that tsunami wave coming.”

“You feel like you’re drowning,” she said.

On July 6, TCB spoke with other mothers who have lost their children to fentanyl poisoning;  TCB is not publishing their names as their childrens’ cases are still active. Many of the families have connected via support groups and bonded over their losses. One mother tugged at the layers of colorful bracelets on her wrist before finding the name of Thomas Lamb etched into a plastic bracelet. Thomas died from fentanyl poisoning in September 2022. She’s friends with Thomas’s mother, Amy Lamb, who still celebrates his birthday every year with his friends and family.

 

A bracelet etched with the name of Thomas Lamb. In September 2022, Thomas, age 18,

purchased a pill to help him sleep; he thought it was Xanax. It was fentanyl.

(Photo by Gale Melcher)

A small child bobbed through the crowd, stopping to point at their loved one’s face on the billboard and shout out their name. Some of the families are hopeful that they will be able to see some form of justice through North Carolina’s death-by-distribution law, passed in 2019 and recently updated on Dec. 1.

The older version of the law stated that a person is guilty of death by distribution if all of the following requirements are met: the person unlawfully sold at least one controlled substance such as an opioid, cocaine or methamphetamine, that the substance they sold caused the death of the user and that the person who sold the drug did not act with malice. The crime was a Class C felony, which usually results in a 5-12 year prison sentence with a maximum sentence of 19 years.

The updated version of the law removes the malice requirement or proof that the drug was sold. Under the new law, perpetrators can be charged with a Class C felony if they simply distribute a drug such as methamphetamine, fentanyl or cocaine that leads to a victim’s death. If the perpetrator did act with malice, they could be charged with a Class B2 felony.

In an email to TCB, the Greensboro Police Department’s Public Information Coordinator Patrick DeSota explained that in response to the updated law, the police department “instituted internal procedural changes in [their] response to suspected overdose deaths” in an effort to further these types of investigations. DeSota added that they have implemented screening questions specific to suspected overdose investigations.

Peeden was a vocal critic of GPD and the way they handled Ashley’s case, and said she’s “glad” the law has been updated.

“I’m hoping that that will make a big difference,” Peeden said. “With Ashley’s case, they just never did anything with hers. Nothing more than a police report.”

 

Posters warn of the dangers of fentanyl.

(Photo by Gale Melcher)

Still, communications specialist for Guilford County Sheriff’s Office Bria Evans wrote that the change in law “does not directly affect [their] investigative procedures” but that it does “make it easier for [them] to criminally charge individuals” because they no longer have to “prove the actual ‘sell’ of the substance.”

Another anonymous mother TCB spoke to said that she hopes the updated law will send “shockwaves” to drug dealers, reverberating the message that selling drugs could have serious consequences.

One silver lining is that NC deaths from fentanyl appear to be declining according to data collected by the state Department of Health and Human Services. Since December, which totaled 264 deaths, monthly deaths have dropped to 220 in January, 207 in February and 183 in March. And awareness of the drug is key, Peeden explained.

“It can happen to anybody’s child, and if you don’t think it can happen to you, think again,” Peeden said.

And while Peeden and the other families have been advocating for their loved ones for years, the pain “doesn’t get easier,” she said.

“I’ve had someone tell me ‘Debbie, you’ve done enough, just stop, you’ve done enough, you need to quit.’ I’m like no, I can’t quit,” Peeden said. “We’ve got too many kids out there who don’t know, we have too many parents out there that don’t know, and we want to try to save the lives of other kids so that these parents go through the nightmare that we’re going through.”

 

Thomas Lamb, who died in September 2022 from fentanyl poisoning,

will forever be 18 to his family and friends.

(Photo by Gale Melcher)

 

Source: Gale Melcher, Citybeat Reporter (She/They) gale@triad-city-beat.com

The number of drug overdoses in this country went down in 2023. But not enough.

Key points

  • While overdoses from fentanyl went down in 2023, overdoses from cocaine and methamphetamine went up.
  • Increased availability of Narcan, harm-reduction practices, and drug seizures likely decreased deaths.
  • The best way to save lives and end the opioid epidemic is to prevent addiction in the first place.

With this tragic news just in, there are several important things to say about the drug overdose situation in this country.

The first is this: It is important that we don’t talk about the more than 107,000 overdose deaths in the United States last year like it’s just a statistic.

These are people’s lives that ended, people like you and me. People with friends and loved ones who cared about them, and who wanted them to succeed.

Evidence of an ongoing tragedy

This is where we are with the continuing drug epidemic, according to the recently released Centers for Disease Control and Prevention (CDC) data from 2023:

  • 107,543 people died from drug overdose deaths compared to 111,029 in 2022. That is a 3 percent decline.
  • 2023 witnessed the first annual decrease in five years (since 2018).
  • Indiana, Kansas, Maine, and Nebraska each saw overdose deaths decrease by at least 15 percent. Note: We need to determine what’s working in those states, and replicate it elsewhere.
  • Alaska, Oregon, and Washington each saw overdose deaths increase by at least 27 percent. Note: We need to determine what’s not working in those states, and figure out solutions including by sharing best practices from states with lower overdose rates.)
  • While overdoses from fentanyl (the main driver of drug deaths) went down in 2023, overdoses from cocaine and methamphetamine went up.

Three developments that are helping to reduce deaths

1. Greater availability of Narcan: I’m a huge advocate for this overdose reversal drug, which is naloxone in nasal spray form. I have argued often that it should be as ubiquitous as the red-boxed automated external defibrillators (AEDs) you now see in malls, hotel lobbies, schools, airports, and workplaces.

The U.S. Food and Drug Administration (FDA) took a big and meaningful step in that direction when it approved Narcan for over-the-counter use in March 2023. I have no doubt the increased availability of Narcan has helped bring the overdose numbers down, since Narcan targets opioids like fentanyl and heroin.

2. The stepping up of harm-reduction efforts: Harm reduction means reducing the health and safety dangers around drug use. The goal is to save lives and protect the health of people who use drugs through such measures as fentanyl test strips, overdose prevention sites, and sterilized injection equipment and services.

Harm reduction was a key plank of the White House’s 2022 National Drug Control Strategy aimed directly at the overdose epidemic. Countless harm-reduction efforts have gained traction at the local and state level as well. Again, this continued push may have helped bring down the overdose numbers last year.

3. Increased efforts around law enforcement drug seizures: Of the 107,543 people who overdosed in 2023, 74,702 (70 percent) of them did so after using the synthetic opioid fentanyl, which is many times more potent than heroin. For the first time in years, that number of deaths was lower than the year before.

Why? No doubt in part because 115 million pills containing fentanyl were seized by law enforcement in 2023. That compared to 71 million fentanyl-laced pills seized in 2022. These seizure efforts seem to be working, and they need to be stepped up even more.

Drug use prevention efforts must increase also

Ultimately, the best way to save lives, end the opioid epidemic, and halt the spread of substance use disorder is to stop people from becoming addicted in the first place.

The big news: Statistics show that drug use may be trending down among young people. Even delaying the onset of addiction can change the trajectory of the problem, says Nora Volkow, MD, director of the National Institute on Drug Abuse.

When asked recently about the lower number of overdose deaths last year, Volkow said: “Research has shown that delaying the start of substance use among young people, even by one year, can decrease substance use for the rest of their lives. We may be seeing this play out in real time [in 2023]. The trend is reassuring.”

Final thoughts on turning the tide of addiction

As the antismoking campaign that began in the 1960s showed us, massive and well-coordinated public health efforts can work.

Surgeon General warning labels, hard-hitting public service announcements, school-based programs—all of those had a cumulative effect on smoking habits in this country, especially among young people. Those efforts all targeted one thing: prevention.

We need to do much more of that in 2024 around opioids, methamphetamines, cocaine, and other lethal drugs. Lives depend on it.

Source: https://www.psychologytoday.com/us/blog/use-your-brain/202407/a-closer-look-at-107543-lives-lost-to-drug-overdoses

July 29, 2024

This blog was also published in the American Society of Addiction Medicine (ASAM) Weekly on July 24, 2024.

Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl.

Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence.

Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid.

It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5.

Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP.

SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention.

Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centres found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths.

Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict.

The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions.

Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines.

Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients.

Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioural treatment. Data suggest that counselling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counselling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation.

Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.

Source: https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed

It’s become one of the most startling signs of the fentanyl crisis happening across California: Seemingly zombified drug users slumped over in awkward positions. 

Alternately called “the fentanyl fold” or “the fentanyl bend over,” videos and photos of people reportedly using the drug have spread through social media.

What is the ‘fentanyl fold’?

If you have ever witnessed what looks like seemingly intoxicated people bent over or frozen in place on sidewalks or in parks, you might be seeing someone in the throes of opioid use.

But why do the people look hunched over or moving like zombies?

“It’s a degree of loss of consciousness and a degree of lost muscular control,” Dr. Daniel Ciccarone, a UCSF professor of addiction medicine, told ABC7 San Francisco.

The “fentanyl fold” effect can reportedly kick in within two or three minutes after taking the drug, Ciccarone said.

And how long will the awkward body position last?

“Fentanyl can be a short-action drug and a long-acting drug. So some people they’re back upright in 45 minutes to an hour. Some people could be longer than that,” Ciccarone said.

Fentanyl abuse isn’t the only opioid that can cause the awkward body reaction, Ciccarone said. Any opioid can have the same effect on users.

How many people have died of fentanyl poisoning in California and the United States?

Deaths related to fentanyl began to rise around 2019, according to the California Department of Health. In the last detailed study in 2022, the CDPH estimated nearly 6,000 opioid-related overdose deaths in California.

Nationwide, the Center for Disease Control and Prevention numbers show 84,181 opioid overdose deaths in 2022 to 81,083 and 81,083 in 2023. 

What are the signs of a fentanyl overdose?

The CDPH advises people who suspect a friend or family of opioid abuse should look at for:

  • Falling asleep or losing consciousness 
  • Not responding to stimuli like shouting, a pinch or sternum rub
  • Slow, weak or no breathing 
  • Choking or gurgling sounds 
  • Limp body 
  • Cold and/or clammy skin 
  • Discolored skin (especially in lips and nails)  
  • ​​​​Small, constricted “pinpoint pupils” ​

The CDPH and doctors advise people who use opioids or suspect family or friends are abusing opioids to carry Naloxone, a nasal spray medication that can reverse an opioid overdose.

Naloxone is safe and easy to use and works almost immediately, the CDPH says. It is available over the counter, without a prescription at pharmacies and other stores.

Source: https://eu.desertsun.com/story/news/nation/california/2024/07/19/what-is-the-fentanyl-fold-how-to-treat-opioid-overdoses/74471357007/ July 2024

Overdose deaths are a widespread problem North Carolinians have been struggling to combat in recent years.

According to the state health department, American Indian/Indigenous and Black communities are the most at risk. From 2019 to 2021, both populations saw reports of overdoses more than double. The number of overdoses is up 117% for the Indigenous population and 139% for Black people. Overdoses increased 53% among white people during the same timeframe.

The problem has only been exacerbated by a rise in illegally manufactured fentanyl.

Estimates from the North Carolina Office of the Chief Medical Examiner show roughly 11.4 people died each day from overdoses in 2023.

In Wake County in 2023:

  • Wake County EMS responded to 1,268 suspected overdoses
  • Wake County EMS administered 1,578 doses of Narcan
  • Wake County EMS left behind 132 Narcan overdose reversal kits

The danger of fentanyl not only lies in its widespread availability state-wide, but in the drug’s potency itself.

According to the U.S. Drug Enforcement Administration, fentanyl is considered 100 times more potent than morphine.
How quickly the drug can lead to an overdose largely depends on how fentanyl gets into someone’s body. Your body may take more time to absorb the drug than if
fentanyl is inhaled or injected.
The National Institute on Drug Abuse reports synthetic fentanyl is illegally sold in several ways including as a powder, eye drops, nasal spray, pills or dropped onto blotted paper.
Once fentanyl gets into your system, the drug binds to opioid receptors in the brain. These receptors control things like emotions and pain.
Fentanyl can then keep your brain from telling your vital organs how to function properly by depressing the central nervous system and respiratory function, according to the Centers for Disease Control and Prevention.

When someone’s lungs aren’t told to expand and contract properly, their body starts to lack sufficient oxygen supply.

Without enough oxygen, someone can lose consciousness in a matter of seconds. Studies of patients who have needed help breathing after a traumatic brain injury or stroke found the brain uses about 20% of the body’s oxygen.

Without enough oxygen supply, the brain can shut down within minutes. This can then lead to permanent brain damage or death once other organs stop functioning properly due to a lack of blood flow.

The medication naloxone has emerged as a powerful antidote for opioid overdoses.

The CDC reports that naloxone can reduce the effects of several opioids including, fentanyl, morphine, heroin, oxycodone, methadone, hydrocodone, codeine and hydromorphone.

When the overdose-reversal medication was first approved, it was sold under the brand name Narcan.
Naloxone works by binding to opioid receptors in the brain and essentially blocks and reverses the effects of other opioids.

The medication allows for the body’s response system to switch back ‘on’ and restore normal breathing.

The medication comes in two FDA-approved forms: a nasal spray or an injection. Naloxone is available for over-the-counter purchase.
North Carolina has 50 Syringe Service Programs across 58 counties. The state health department reports the programs collectively distributed over 109,000 naloxone kits from 2022-2023.

During the same timeframe, the state tells WRAL News there were nearly 17,000 overdose reversal reports.

Naloxone will not harm someone who hasn’t taken an opioid, so it is recommended even when it is unclear what kind of drug a person has taken.

More than one dose may be needed because some opioids, like fentanyl, can take a stronger hold on the opioid receptors.

Narcan may only work for 30-90 minutes, but some opioids remain in the body for a longer time. Those administering naloxone are highly encouraged to call 911, because someone may once experience the effects of an overdose again after the medication wears off.
North Carolina became the first state in the country to begin an EMS Naloxone Leave-Behind Program in 2018. The initiative allows first responders to leave a naloxone kit with an individual who refuses the option to go to a hospital after an overdose.
Other states, including Arizona, and cities like San Franscico, have since molded similar programs on North Carolina’s success.

Other states, including Arizona and San Franscico, have since molded similar programs on North Carolina’s success.

Source: https://www.wral.com/amp/21525957/ July 2024

Illicit use of the veterinary tranquilizer xylazine continues to spread across the United States. The drug, which is increasingly mixed with fentanyl, often fails to respond to the opioid overdose reversal medication naloxone and can cause severe necrotic lesions.

A report released by Millennium Health, a specialty lab that provides medication monitoring for pain management, drug treatment, and behavioral and substance use disorder treatment centers across the country, showed the number of urine specimens collected and tested at the US drug treatment centers were positive for xylazine in the most recent 6 months.

As previously reported by Medscape Medical News, in late 2022, the US Food and Drug Administration (FDA) issued a communication alerting clinicians about the special management required for opioid overdoses tainted with xylazine, which is also known as “tranq” or “tranq dope.”

Subsequently, in early 2023, The White House Office of National Drug Control Policy designated xylazine combined with fentanyl as an emerging threat to the United States.

Both the FDA and the Drug Enforcement Administration have taken steps to try to stop trafficking of the combination. However, despite these efforts, xylazine use has continued to spread.

The Millennium Health Signals report showed that the greatest increase in xylazine use was largely in the western United States. In the first 6 months of 2023, 3% of urine drug tests (UDTs) in Washington, Oregon, and California were positive for xylazine. From November 2023 to April 2024, this rose to 8%, a 147% increase. In the Mountain West, xylazine-positive UDTs increased from 2% in 2023 to 4% in 2024, an increase of 94%. In addition to growth in the West, the report showed that xylazine use increased by more than 100% in New England — from 14% in 2023 to 28% in 2024.

Nationally, 16% of all urine specimens were positive for xylazine from late 2023 to April 2024, up slightly from 14% from April to October 2023.

Xylazine use was highest in the East and in the mid-Atlantic United States. Still, positivity rates in the mid-Atlantic dropped from 44% to 33%. The states included in that group were New York, Pennsylvania, Delaware, and New Jersey. East North Central states (Ohio, Michigan, Wisconsin, Indiana, and Illinois) also experienced a decline in positive tests from 32% to 30%.

The South Atlantic states, which include Maryland, Virginia, West Virginia, North and South Carolina, Georgia, and Florida, had a 17% increase in positivity — from 22% to 26%.

From April 2023 to April 2024 state-level UDT positivity rates were 40% in Pennsylvania, 37% in New York, and 35% in Ohio. But rates vary by locality. In Clermont and Hamilton counties in Ohio — both in the Cincinnati area — about 70% of specimens were positive for xylazine.

About one third of specimens in Maryland and South Carolina contained xylazine.

“Because xylazine exposure remains a significant challenge in the East and is a growing concern in the West, clinicians across the US need to be prepared to recognize and address the consequences of xylazine use — like diminished responses to naloxone and severe skin wounds that may lead to amputation — among people who use fentanyl,” said Millennium Health Chief Clinical Officer Angela Huskey, PharmD, in a press release.

The Health Signals Alert analyzed more than 50,000 fentanyl-positive UDT specimens collected between April 12, 2023, and April 11, 2024. Millennium Health researchers analyzed xylazine positivity rates in fentanyl-positive UDT specimens by the US Census Division and state.

Source: https://www.medscape.com/viewarticle/emerging-threat-xylazine-use-continues-spread-across-united-2024a1000d1h July 2024

Filed under: Fentanyl,Health :

The city is gripped in an opioid crisis worse than America’s. Locals say overly liberal drug laws have sparked a catastrophe

“Yes, I feel fine,” she replies.

“Okay, hold still.”

Eyes wide and hands trembling, Larry, 32, flicks the syringe’s needle before crouching over his friend and injecting a mixture of fentanyl and benzodiazepines into a prominent vein in her neck.

Hailey, 38, is lying on a grimy pavement, surrounded by graffiti, filth, and other drug users. She inhales deeply, curls into a foetal position, and sucks on her thumb to hold her breath.

As the discoloured liquid enters her bloodstream, her body relaxes and her eyes lose focus.

“June 7th,” she murmurs. “I’m counting down the days until I can finally go to detox.”

Hailey and Larry are two of approximately 5,000 active drug users who reside in Vancouver’s Downtown Eastside, a 10-block corridor that runs through the heart of the city along Hastings Street.

Walking the half-mile stretch is profoundly shocking. Bodies lie scattered on the tree-lined streets, some scarcely breathing. Discarded needles are everywhere, and the detritus from makeshift encampments – tents, cardboard, sleeping bags – clutter alleys and verges. The scream of sirens is unrelenting.

The crisis is being fuelled by fentanyl, a synthetic opioid that is 50 times stronger than heroin. Manufactured in numerous illicit labs in Canada’s wilderness, fentanyl is now so common in Vancouver’s Downtown Eastside that you can literally pick it up off the street.

Vancouver once topped the charts of the world’s “most desirable places to live”. Its reputation is that of a city which provides the perfect balance – a metropolis “perched on the edge of nature” combining “outdoor recreation and a great cultural diversity”, as one local website puts it.

But a landmark experiment to decriminalise the possession of certain drugs in public – including fentanyl, heroin, cocaine, methamphetamines, and ecstasy – has allowed an opioid crisis to take hold that surpasses even the epidemic in the United States.

In April, David Eby, British Columbia’s premier announced that halfway into the three-year trial, the province would recriminalise drug use in public spaces.

With a severe backlash from police, politicians, and the public showing no sign of abating, Mr Eby is now under pressure to scrap the pilot scheme altogether.

Since last month, police once again have the power to approach and arrest drug users in hospitals, restaurants, parks, and beaches. But people are still able to legally consume 2.5 grams of hard drugs in their homes and in designated public shelters. It also remains unclear how the revised rules will be meaningfully enforced by the police.

Despite the province’s best efforts, opioid overdoses have become the leading cause of death for people aged 10-59 in British Columbia, and now account for more deaths than homicides, suicides, accidents, and natural diseases combined.

Last year, the province recorded 2,511 drug-related overdoses, 87 per cent of them down to fentanyl. The death rate in Vancouver itself now stands at 56 per 100,000 people – nearly three times the national average. And in the Downtown Eastside, the rate is nearly 30 times higher than the rest of the country.

For comparison, England and Wales have a drug-related mortality rate of 8.4 per 100,000 people. In Scotland – the worst in Europe – it stands at 19.8. The only G7 country with anything close to a comparable rate is the United States, at 32.6 per 100,000 people.

With the city gripped in an opioid epidemic nearly twice as fatal as America’s, the Downtown Eastside is becoming a key battleground for the province’s decriminalisation debate. As overdose numbers continue to rise, many view the liberal rollout as fuel to the fire. Yet others argue there are wider societal issues at play that are far more insidious than fentanyl.

Now entrenched in a public health emergency, Canadians of nearly all political stripes are asking, “How did we get here?”

Decriminalisation ‘not about drugs anymore’

In the first year of British Columbia’s decriminalisation rollout, public drug use exploded – with reports of people injecting heroin on family beaches and smoking crack in maternity wards.

Fiona Wilson, the deputy chief constable of the Vancouver Police Department, says the experiment has tied the hands of police across the city, leaving the wider community at risk. Despite having seized over 1,000 kilos of fentanyl from dealers in 2023 alone, officers are powerless to intervene when they see it used on the streets.

“Decriminalisation has been a massive challenge for the police because it’s taken away our ability to arrest someone. We don’t have any grounds to approach a person who is publicly using illicit drugs in the absence of any other criminality,” she says.

“If someone is sitting at a coffee shop and wants to snort a line of cocaine, we don’t have any authority to intervene in that situation. This presents a real problem because families don’t necessarily want to sit next to somebody in a restaurant who’s shooting up fentanyl.”

On the other side of the debate, left-wing advocates for liberalisation have sought to frame the debate around privilege and class.

Brittany Graham, the executive director of the Vancouver Area Network of Drug Users (VANDU), says bigger societal issues – namely, a lack of housing and inadequate welfare services – are to blame.

“Decriminalisation will always exist for the upper class. When someone has enough money to snort cocaine in the privacy of their own home, the police are never going to get them. What we are witnessing right now is a homelessness crisis on top of a toxic and unregulated drug supply.

“The right-wing is blaming everything on decriminalisation, but the reality is Vancouver has seen a 32 per cent increase in homelessness since the beginning of Covid. But the government continues to label poor drug users as the scapegoats for everything wrong in our province.

“Decriminalisation is not about drugs anymore, it’s about power and control. Drugs have been killing people for decades, now it’s toxic politics.”

Elenore Sturko, the shadow minister for mental health and addictions, says decriminalisation has been a “dangerous and disastrous” policy failure.

“The entire policy was politically motivated. Clearly, the government didn’t do the work on decriminalisation. In fact, they ignored the advice of the police. Now, we end up where we are today – not only failing to reduce death and overdoses, but actually causing increased harm.”

‘I never wanted to use fentanyl’

Beyond the issue of decriminalisation, British Columbia has introduced a raft of “harm reduction” measures in a bid to solve the public health emergency – but these too have proved controversial.

The backbone of the province’s harm reduction project revolves around “safe injection sites” where users can access clean needles and a regulated supply of drugs. In these government-run locations, drug users are able to consume their illicit substance of choice – predominantly fentanyl – while being monitored by healthcare workers with an opioid antidote on hand.

Tiffany, 37, says VANDU’s safe injection site has saved her life many times over. Shortly after moving to Vancouver at 15, she got hooked on heroin. Now, almost two decades later, fentanyl is her drug of choice.

“I never wanted to switch over to fentanyl, but it’s everywhere,” says Tiffany, preparing her needle at VANDU’s site. She’s already crushed and melted down her mixture of benzodiazepines and fentanyl.

“I use drugs as a way of coping with my emotions, and being separated from my son. But I do love myself – that’s why I can’t do this anymore. I refuse to become another statistic,” she says.

Vancouver has long been a pioneer in harm reduction. Over 30 years ago, during the heroin and HIV epidemic, the city opened its first safe injection facility in the Downtown Eastside – the only one of its kind in North America.

But what once helped stem the tide of HIV does not appear to be working now.

Some policymakers claim that harm reduction initiatives have become politicised and are perpetuating the problems of addiction, homelessness, and public disorder – specifically in the Downtown Eastside, which they argue has become a death trap for drug users.

Ms Graham from VANDU accepts that harm reduction can be hard to quantify, but continues to believe Vancouver’s clinics do some good.

“In principle, harm reduction is meeting a person where they’re at, no matter what substance they’re using or harm they’re causing. Inherently, we know that drugs are harmful, so it’s crucial to help them mitigate that harm – for example, providing clean needles and a sanitary space,” she says.

Tiffany shoots up twice in the VANDU facility before slumping over. As the mix of fentanyl and benzodiazepines takes control of her senses, she whispers, “The high feels like a warm hug.”

‘No question’ of drug diversion

While many users like Tiffany in the Downtown Eastside source their drugs from the street, the government has launched a “safer supply” program which allows users to receive pharmaceutical-grade opioids free of charge from a physician.

The initiative is “preventing overdoses, saving lives, and connecting drug users to health and social services”, the province says.

But according to those on the ground, safer supply has created many unexpected consequences. The Vancouver Police Department says a significant portion of the opioids being freely prescribed by doctors are not actually being consumed by their intended recipients.

Instead, the drugs are being resold on the black market at rock-bottom prices – in a process called “diversion” – typically to fund the ongoing purchase of fentanyl.

Deputy Wilson says “there is no question” that these drugs are being diverted to the streets, specifically the Downtown Eastside. In fact, she says that 50 per cent of hydromorphone seizures in British Columbia have originated from the government.

Not only are safer supply drugs being diverted to active users, there are also reports of these powerful opioids falling into the hands of children. Ms Sturko explains that highly addictive drugs are freely going out into every corner of the community, allowing new users to develop opioid use disorders.

“Parents in Vancouver are telling me stories of their children using high quantities of dillies [hydromorphone] because they thought the opioid was ‘safe’ under the government’s label of ‘safer supply’,” she says.

“It’s horrifying. It makes me angry because we’re talking about the lives of our children who may start experimenting with an opioid that won’t kill them, but it eventually leads them to use fentanyl which will kill them.

“It’s a potential pathway of serious addiction. These safer supply drugs are subsidising the fentanyl market.”

But Ms Graham from VANDU claims that banning safer supply drugs is not the answer. She says removing government-regulated opioids from the system would taint the drug supply to an even greater degree.

“It’s clear that stamping out the [regulated] drug supply doesn’t stop people from using the substances. It just makes the quality of the substances they can access less reliable.”

Ms Graham goes as far as to claim that the police are against a regulated drugs market and because it threatens their jobs.

“We need to solve the toxic drugs crisis by providing the substances,” she insists.

Stuck in a ‘detox limbo’

Andrew, a paramedic in the Downtown Eastside, has responded to hundreds – if not thousands – of overdose calls during his time as a first responder. In his view, the government is “subsidising and enabling” the fentanyl crisis by throwing money at it instead of solving it.

He says he can only speak anonymously, as the local health authority has cracked down on interviews in the lead up to the provincial election later this year.

“This is all our fault. We’ve created a system where people can wake up and get high everyday – why would they want to leave the Downtown Eastside? It’s a free ride in life that’s funded by taxpayers.

“You would never see anything like this in a poor country. The government is giving people enough slack so they don’t have to change – this perpetuates the problem that will never be solved.

“The Downtown Eastside is like a warzone. It’s unbelievable the depravity people will endure to simply exist.”

But getting clean is certainly not easy.

Mark Ng Shun from Vancouver Detox explains that “walk-ins” are not permitted in government-funded locations. Instead, drug users are told to join a waiting list that can average anywhere from three to six weeks.

To secure a spot, it’s mandatory to call every day, and users must start detoxing before being admitted.

“Vancouver’s detox system is not working for those who need it the most,” says Mr Ng Shun.

“Many Downtown Eastside residents are stuck in the ‘detox limbo’ – they have a desire to seek a different kind of life, but they’re told they have to wait six weeks. Many people can give up during that time.

“Plus, there is still a stigma attached to Downtown Eastside residents who are seeking help. The services themselves are tailored towards upper- and middle-class white people.

“Only certain lives are supported in detox. The system is oppressive. People who are the least advantaged have the least access to it.”

Lisa Weih lost her 29-year-old daughter, Renée, to an opioid overdose in 2020. She says the city’s detox and recovery systems are inadequate.

“Renée never stopped trying to get better. She put herself through the tortures of detox several times, but there was nothing there for her afterwards… our leaders want to get away with murder.”

On the frontlines of Vancouver’s fentanyl crisis, there is not much sign of change.

Ms Graham, who witnesses the carnage of the Downtown Eastside on a daily basis, says hope is the one thing she can’t afford to lose sight of.

“I’ve lost a school bus full of people to opioids. But there is a way forward, and it’s increased harm reduction,” she insists.

“This isn’t a political debate, it’s a human rights debate.”

Source:  https://www.telegraph.co.uk/global-health/climate-and-people/vancouver-opioid-crisis-drug-addiction-british-columbia-canada/

PHOENIX – The fentanyl and opioid crisis cost Arizona an estimated $58 billion for 2023, according to a Common Sense Institute Arizona report published Monday. The nonpartisan think tank’s report included the costs of fatalities, opioid use disorder, hospitalizations and border security.The report analyzed data from the Centers for Disease Control and Prevention, Arizona Department of Health Services and the National Institute on Drug Abuse, among others.

It showed a decline across the U.S. in opioid prescriptions over the past decade. In Arizona, drug-related seizures have decreased since 2020.

“Naively, you should be able to assume that there are fewer drugs, but that isn’t the case,” said Glenn Farley, lead author of the report, at a Monday news briefing.

The report cited the southern border migrant crisis as an underlying cause for more drugs making their way across the border, noting that Customs and Border Protection has been strained due to the increased number of individuals and fewer checkpoints. “As a result of these resource shifts, the ability of CBP to prevent the smuggling of drugs like fentanyl into the United States is likely compromised,” the report said.

Farley said the amount of fentanyl in the United States is unknown, but deaths from the highly addictive synthetic opioid continue to rise.

Fentanyl-related overdose deaths have increased drastically in the U.S. since 2014. The National Institute on Drug Abuse reported almost 74,000 deaths in 2022. Opioid deaths have hovered around 2,000 per year since 2020 in Arizona, according to ADHS.

Source: https://cronkitenews.azpbs.org/2024/06/24/report-estimates-fentanyl-crisis-costs-arizona-2023/

Filed under: Fentanyl,Prevalence,USA :

By Killian Meara

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

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.

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.

Source:  https://www.drugtopics.com/view/fentanyl-education-prevention-key-to-ending-crisis-in-us

The web-based and social media campaigns aim to educate youth, families and adults about the dangers of fentanyl and risk of overdose deaths and addiction

BY:  – MAY 7, 2024 4:02 PM
A national nonprofit organization released a new program on Tuesday to help families navigate the hazards of fentanyl and prevent deaths of young people as Oregon continues to battle the lethal drug epidemic.

Song for Charlie, a nonprofit focused on raising awareness about fake fentanyl pills, launched The New Drug Talk Oregon, an educational web-based platform with free information about the risks of fentanyl and the dangers of self-medication and experimentation. The program also gives families guidance on how to discuss the drug, which is highly lethal and commonly found in counterfeit prescription drugs and sold illegally.

The campaign was one of several in Oregon to start on Tuesday and coincides with National Fentanyl Awareness Day. The Oregon Health Authority launched a five-week campaign to educate Oregonians about fentanyl risks, harm reduction strategies like fentanyl test strips and how to respond to an overdose. The state’s campaign will unfold on the health authority’s English and Spanish-language Facebook accounts.

Multnomah County also launched a fentanyl awareness campaign, called Expect Fentanyl, targeting Portland-area youth.

More information

For more information about the educational program for families, visit thenewdrugtalk.org/oregon.

Visit the Oregon Health Authority site for a list of syringe and needle exchange services available in Oregon.

More than 300 young Oregonians 15 to 24 years old have died of drug overdoses in the last five years, many of them from fentanyl, according to Centers for Disease Control and Prevention data. The rate of teen drug-related deaths has increased in the state nearly sixfold, and Oregon now has the fifth-worst per capita rate of drug deaths among teenagers, according to CDC data compiled by Song for Charlie.

Meanwhile, a survey of Oregon parents and youth commissioned by Song for Charlie found persistent gaps in how families are responding to the crisis. Nearly three-quarters of Oregon parents said they talked to their children about the dangers of prescription pills laced with fentanyl. But only about 40% of young people said they remember having this conversation.

And just three in five Oregon youth – teenagers and young adults – consider the misuse of prescription pills a serious issue. The survey, completed in the spring, is based on interviews of more than 1,300 teenagers, young adults and parents in Oregon, and has a margin of error of 4 to 5.65 percentage points.

‘Ongoing conversations’

The New Drug Talk Oregon program was backed by a $1 million grant from Trillium Community Health Plan, a Medicaid insurer for about 90,000 people on the Oregon Health Plan in the Portland area and Lane County. That funding means the Song for Charlie’s program is available to Oregonians at no cost.

A Washington County resident, Jennifer Epstein, director of strategic programs for Song for Charlie, is involved with the program. She became an advocate to increase awareness and education about fentanyl after her 18-year-old son Cal died in 2020 after he ingested a counterfeit pill with fentanyl.

“What we want to do is encourage parents to have ongoing conversations with young people,” Epstein said in an interview.

The program’s site has articles and videos that guide parents through talking to their children about fentanyl, staying safe on social media or the death of someone from an overdose.

Epstein said if the resource had been available before her son died, it could have saved his life.

“I certainly think that this could have changed what happened to our family if we had been able to have conversations about fentanyl and the risks it poses and the danger of self-medicating,” Epstein said.

Source:  https://oregoncapitalchronicle.com/2024/05/07/fentanyl-awareness-campaigns-kick-off-in-oregon-amid-an-overdose-epidemic/

Research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. Fentanyl continues to devastate American lives. Now, new research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. (Scripps News)
Posted at 5:47 PM, Jul 05, 2024

A new study by NYU Langone, funded by the National Institutes of Health and the National Institute on Drug Abuse, shows how fentanyl has taken over America’s illegal drug supply. It has happened fast.

Law enforcement seizure data shows that illicit fentanyl seizures grew more than 1700% in the 6 year span from 2017 to 2023.

Fentanyl pills specifically made up nearly half of fentanyl seizures in 2023, at 49%. Compare that to 10% in 2017.

As much as 85% of these seizures are happening in the western part of the United States.

A lead researcher on the study, Dr. Joseph Palamar, said that though the numbers are staggering, they’re not surprising given recent trends.

“A couple of years ago, most fentanyl was in powder form. The way it began was fentanyl started creeping up into the heroin supply …then pills started coming around — particularly in the West, and pills introduced fentanyl in a whole different manner to people,” he said.

Related stories:

Palamar says fentanyl in pill-form changes the game, so to speak, in terms of who is now able to obtain it.
Pills are easier to take or to smoke, so there’s no need to figure out how to use a needle. Also, because many fentanyl pills are meant to look like legitimate pills, it’s easier for people who don’t necessarily know they’re taking fentanyl to find it, ingest it and overdose.

“My fear in particular is that there are young people who are trying to get their hands on pills like Adderall or Oxy or Xanax and if they buy them illegally, they don’t know that they could have fentanyl in them — just a few milligrams is enough to kill a teenager,” Palamar said.

Rob Sullivan oversees multiple drug detox programs in northwestern Washington state, and has been in the industry for 20 years.

He says he and his colleagues have noticed that it takes longer for someone to detox from fentanyl — prompting requests to insurance companies to extend detox stays. He also says people have a harder time completing detox, and many times people detox without even realizing they’ve taken fentanyl.

“We see right now, we’re about 66% complete. And 44% don’t complete. Whereas we used to be higher when it was just regular opioids, because people knew what to expect, meaning clients, and also professionals knew what to expect,” Sullivan said.

“Whereas with fentanyl — so different, and so powerful — that it’s really, it’s a different ballgame than what it was,” he said.

Palamar hopes that these findings spark a stronger emphasis on drug use prevention

“We need people to be educated about fentanyl and the associated risks, particularly the people who have not used fentanyl. I worry about people starting fentanyl, and I also worry about people being unintentionally exposed to fentanyl — especially young people.”

Source: https://www.ktvq.com/us-news/new-study-shows-the-rising-prevalence-of-fentanyl-pills

The following detailed report to members of DrugWatch International was produced by John Coleman, President of the Board of Directors.

Dear friends,

Yesterday, April 16, 2024, the Select Committee on the Strategic Competition Between the United States and the Chinese Communist Party, a committee comprised of members of the House of Representatives that describes itself as “committed to working on a bipartisan basis to build consensus on the threat posed by the Chinese Communist Party and develop a plan of action to defend the American people, our economy, and our values,” issued a 64-page report titled, “The CCP’s Role in the Fentanyl Crisis.”

I’ve attached a copy of the report.

Among the Committee’s findings are the following:

The PRC government, under the control of the CCP:

  1. Directly subsidizes the manufacturing and export of illicit fentanyl materials and other synthetic narcotics through tax rebates.
  2. Gave monetary grants and awards to companies openly trafficking illicit fentanyl materials and other synthetic narcotics.
  3. Holds ownership interest in several PRC companies tied to drug trafficking.
  4. Fails to prosecute fentanyl and precursor manufacturers.
  5. Allows the open sale of fentanyl precursors and other illicit materials on the extensively monitored and controlled PRC internet.
  6. Censors content about domestic drug sales but leaves export-focused narcotics content untouched.
  7. Strategically and economically benefits from the fentanyl crisis.

No one reading this email should be surprised about any of these findings as they have been known and written about in books and scholarly papers for years. That said, having the imprimatur of a congressional committee is important and may help to move the ball closer to the goalpost.

Regrettably, Mike Gallagher, the Committee’s chairman and a four-term Representative of Wisconsin’s 8th Congressional District, has surprisingly and suddenly decided to resign from Congress. In two days, on April 19, 2024, Gallagher will leave his job in Congress to join Palantir Technologies Inc., a global software company serving the analytic needs of the intelligence community. It was founded by billionaire and conservative activist Peter Thiel, co-founder of PayPal and several other highly successful companies.

The Committee’s report provides the reasoning and grounds to support the findings mentioned above. None of it should be surprising because all of it has been known for decades. The Committee is to be commended for putting this material together in one comprehensive and relatively brief document.

Ironically, the Committee’s report may be more important not for what it says or suggests but, instead, for what it ignores and fails to address.

At the conclusion of the report’s Executive Summary is a list of recommendations:

  1. Establish a Joint Task Force – Counter Opioids (JTF-CO) that concentrates all non-military elements of state power and executes a coordinated strategy to target the weak points in the global illicit fentanyl supply chain.
  2. Provide law enforcement and intelligence officials with the statutory authorities, tools, and resources they need to execute their responsibilities, including through enhancing international law enforcement cooperation, appropriately prioritizing fentanyl and antimony laundering in intelligence and enforcement efforts; and recruiting and retaining top talent to combat the fentanyl threat.
  3. Strengthen U.S. sanctions authorities and use those authorities in an aggressive and coordinated manner against entities involved in the fentanyl trade.
  4. Enact and use trade and customs enforcement measures to restrict fentanyl trafficking.
  5. Close regulatory and enforcement gaps exploited by PRC money launderers and fentanyl traffickers.

These recommendations are what we used to call “blue sky” proposals, ideas that one would like to see implemented, assuming ceteris paribus – if all other relevant things remain unaltered. The “real” world, however, is a dynamic cesspool of interests that makes folly of most, if not all, of these recommendations.

I’m reminded of the late Janet Reno who, when she was Attorney General, would give very nice speeches about what the government needed to do to reduce crime. For some reason, it never dawned on Reno that she was the government and could indeed do or attempt to do what she was demanding to be done by the government.

It’s the same here. The Committee could have proposed and even presented legislation to accomplish some of its recommendations but decided not to do so. In addition, the conditions described in the Committee’s report did not occur spontaneously but were allowed to develop incrementally over time. Why?

When recommendations like these are simply reported-out without assignment, they go unnoticed by the organs of government empowered to act on them. Indeed, a closer reading of these recommendations might suggest that some have already been tried – as described, or with modest modifications.

Let’s look at the scoreboard. The 2016 National Drug Control Strategy presented to Congress by President Barack Obama said this about China’s role in the drug trade:

China remains the source of many raw chemical compounds used to manufacture NPS. The United States and China have intensified cooperation between law enforcement agencies through enhanced intelligence exchanges, increased cooperation on investigations, and a series of technical exchanges on precursor chemicals, NPS, and related topics. On October 1, 2015, China placed 116 chemicals – primarily NPS – under national control. This action is expected to have a significant impact on the export of NPS products to the United States.

[…]

Fentanyl used for illicit purposes comes from several sources including pharmaceutical fentanyl diverted from legal medical use, which accounts for a small percentage of the fentanyl in the illicit market, and clandestine fentanyl that is manufactured in Mexico or China and smuggled into the United States through a variety of means. Fentanyl is extremely dangerous and deadly. Between 2013 and 2014, at least 700 deaths in the United States were attributed to fentanyl and its analogues, although the actual number is likely higher. [internal references omitted]

The number of fentanyl deaths – noted here as 700 between 2013 and 2014 – has risen more than tenfold to 73,000, according to yesterday’s congressional report. Despite this, our National Drug Control Strategies, regardless of which administration is in power, call for little more than assessing the problem and its impact on our nation, pointing the finger at China, but doing little else.

Our latest 2022 National Drug Control Strategy updates this insouciance with the following stated principle that could have been copied and pasted from just about any earlier strategy in the last 20 years:

  1. Work with the PRC to strengthen control of the production, diversion, and transshipment of illicit synthetic drugs and their precursors. (Agencies Involved: DHS; DOD; DOJ; DOS; HHS; IC/NSC; Treasury; USAID; USPIS)

A significant volume of non-fentanyl opioids and precursor chemicals used to produce fentanyl, fentanyl analogues, and other synthetic drugs originate in the People’s Republic of China (PRC). This assessment is supported by seizure evidence, law enforcement investigations, internet sales information, and judicial actions in the United States, PRC, and Mexico. Increased collaboration with the PRC on shared drug priorities can disrupt drug trafficking networks, along with the corrupt or compromised systems that support them, and reduce the availability of dangerous synthetic drugs in the United States. The United States will continue engagement with the PRC to reduce diversion of uncontrolled precursor chemicals to the illicit production and trafficking of synthetic drugs destined for markets in the United States, while also working with impacted third countries

Yesterday’s congressional report, like all the ONDCP National Drug Control Strategy reports for the past quarter century, does little but describe the problem and provide hand-wringing solutions tied to increased cooperation and international square-dancing. Do you think that Mike Gallagher is leaving Congress because he knows this? Gallagher’s exit remains a mystery. A former combat Marine who served in Iraq, and a graduate of Princeton University with three graduate degrees, including a doctorate in government and international relations from Georgetown University, Gallagher may have realized that the geopolitical and economic significance of China in today’s world makes doing anything about the fentanyl traffic impossible.

We are in a different world and a different time today. There is no Richard Nixon dispatching an “eyes only” telegram to Ambassador Bill Handley in Ankara on July 9, 1970, ordering him to return to Washington “at the request of the President for consultations, and stating that the President places the highest priority on the drug problem notwithstanding the defense and political components.”  [Ref: Declassified White House papers of Henry Kissinger, July 10, 1970]

This order to Handley followed an earlier entreaty by Under-Secretary Elliot Richardson in a Secret “eyes only” telegram on May 6, 1970, in which Richardson explained that his job and Handley’s job were at risk if they didn’t succeed in getting Turkey out of the opium business: “It is now perfectly clear, as a result, that the Department, the Embassy, the Foreign Service and you and I are definitely on the spot to produce results.” [Ref: Declassified DOS Telegram State 068968, Amembassy Ankara, 6 May 70]

This unpublished de facto drug control strategy worked and within two years, Turkey was out of the opium business, the French Connection was history, and we as a nation were ready to tackle the next drug problem. Or were we?

Realistically, it would be foolhardy to think that President Biden or even President Trump would or could replicate the doings of Nixon and Kissinger and how they handled America’s heroin problem more than a half-century ago. It’s often said and dubiously attributed to Winston Churchill that “Generals are always prepared to fight the last war.” But what worked in the last war may not work in the next one and that seems to be the situation in which we find ourselves when it comes to dealing with China and the fentanyl crisis.

So, the mission becomes thus: can we do more than simply describe the problem and offer recommendations that have little likelihood of being adopted and even less likelihood of working should they be adopted? The agencies designed to protect public health against such dangers have been compromised by succumbing to something surprisingly and shockingly like the Stockholm Syndrome. After combatting the Harm Reduction forces for many years, our Department of Health and Human Services (HHS) and the Office of National Drug Control Policy are squarely nowadays in the Harm Reduction camp.

Our most recent National Drug Control Strategy issued by President Biden in 2022 mentions China three times but the phrase “harm reduction” appears 198 times. In December 2021, HHS announced its Harm Reduction Grant Program and would begin accepting grant applications for a program funded to the tune of $29.250 million.

Maybe Gallagher knows something we don’t!

John Coleman

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Ernesto CabralUpdated 
At least 1,089 people died from fentanyl poisoning in 2023, up 18.4% from the year before, preliminary data shows
As many as 7 in 10 counterfeit pills tested in 2023 contained a potentially lethal dose of fentanyl, or roughly the amount that fits on the tips of a pencil, national DEA laboratory testing showed. (Photo courtesy of Rocky Mountain Field Division of the Drug Enforcement Administration)

Fentanyl-related overdose deaths hit a new high in 2023 as law enforcement seized record amounts of the synthetic opioid, official data shows.

At least 1,089 people died from fentanyl poisoning last year, up 18.4% from 920 the year before, according to preliminary data released by the Colorado Department of Public Health and Environment.

A surge that started five years ago has continued, with the number of fentanyl-related deaths increasing more than 900% from the 102 recorded in 2018, data from the health department’s Center for Health and Environmental Data shows.

Denver recorded more deaths in 2023 than any other county with 321, compared with Adams (136), Arapahoe (133), Jefferson (124) and El Paso (116).

The health department anticipates releasing final data in June.

So far this year, 141 fatalities have been reported to the CDPHE, however the data is typically lagging by at least three months. Denver again leads with 37 deaths from fentanyl.

The Centers for Disease Control and Prevention’s records tell a similar story about Colorado. In 2023, 1,187 fatalities were registered provisionally in the “other synthetic narcotics” category, which mainly comprises fentanyl. Unlike the state agency, the CDC said it does not have an exact number of fentanyl deaths.

The numbers for 2023 mark a 22.2% rise from the previous year and a 785% surge since 2018, according to the CDC database.

“We are facing more than just an opioid crisis in the U.S”, said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health. “Stimulants like methamphetamine, which is more prevalent in use in the Western U.S., are now increasingly being contaminated or used together with fentanyl.”

News of the rising death toll comes days after the DEA announced a new strategy to combat fentanyl in the Rocky Mountain region. Earlier this month around 200 money service businesses and financial institutions that aid in sending money to people in other countries were asked to cooperate in an investigation into the cash flowing to support the illicit opioid market.

The probe, called Operation “Cash Out,” was launched in Colorado, Utah, Wyoming and Montana by the DEA, IRS and the Rocky Mountain High Intensity Drug Trafficking Area, the DEA said in a news release.

U.S. authorities say fentanyl constitutes a multi-billion-dollar enterprise for Mexican cartels such as Sinaloa and Jalisco, which operate near the U.S. border.

“The only thing they care about is their money. This interagency operation intends to target the networks and seize their assets through building stronger relationships with the private sector financial community,” said David Olesky, acting special agent in charge for DEA’s Rocky Mountain Field Division, in the release.

In recent years, new legislationofficial investigations and initiatives from families and schools have emerged to prevent and combat the rising number of fentanyl-related deaths in Colorado, a bill signed into law on April 22 making it legal for students and staff at public and charter schools to carry and administer opioid overdose reversal drugs such as naloxone.

“The Colorado Department of Public Health and Environment is committed to doing all we can to prevent drug overdoses, and one of our current strategies is to increase access to naloxone,” said the state agency in a statement.

Associate Professor | Department Chair | Director, Forensic Science Research Center

Department of Criminal Justice, California State University

The opioid epidemic is a public health and safety emergency that is killing thousands and destroying the quality of life for hundreds of thousands of Americans and those who care about them. Fentanyl and other opioids affect all age ranges, ethnicities, and communities, including our most vulnerable population, children. Producing fentanyl is increasingly cheap, costing pennies for a fatal dose, with the opioid intentionally or unintentionally mixed with common illicit street drugs and pressed into counterfeit pills. Fentanyl is odorless and tasteless, making it nearly untraceable when mixed with other drugs. Extremely small doses of fentanyl, roughly equivalent to a few grains of salt, can be fatal, while carfentanil, a large animal tranquilizer, is 100 times more potent than fentanyl and fatal at an even smaller amount.

The Biden-Harris Administration should do even more to fund opioid-related prevention, treatment, eradication, and interdiction efforts to save lives in the United States. The 2022 Executive Order to Address the Opioid Epidemic and Support Recovery awarded $1.5 billion to states and territories to expand treatment access, enhance services in rural communities, and fund law enforcement efforts. In his 2023 State of the Union address, President Biden highlighted reducing opioid overdoses as part of his bipartisan Unity Agenda, pledging to disrupt trafficking and sales of fentanyl and focus on prevention and harm reduction. Despite extensive funding, opioid-related overdoses have not significantly decreased, showing that a different strategy is needed to save lives.

Opioid-related deaths have been estimated cost the U.S. nearly $4 trillion over the past seven years—not including the human aspect of the deaths. The cost of fatal overdoses was determined to be $550 billion in 2017. The cost of the opioid epidemic in 2020 alone was an estimated $1.5 trillion, up 37% from 2017. About two-thirds of the cost was due to the value of lives lost and opioid use disorder, with $35 billion spent on healthcare and opioid-related treatments and about $15 billion spent on criminal justice involvement. In 2017, per capita costs of opioid use disorder and opioid toxicity-related deaths were as high as $7247, with the cost per case of opioid use disorder over $221,000. With inflation in November 2023 at $1.26 compared to $1 in 2017, not including increases in healthcare costs and the significant increase in drug toxicity-related deaths, the total rate of $693 billion is likely significantly understated for fatal overdoses in 2023. Even with extensive funding, opioid-related deaths continue to rise.

With fatal opioid-related deaths being underreported, the Centers for Disease Control and Prevention (CDC) must take a primary role in real-time surveillance of opioid-related fatal and non-fatal overdoses by funding expanded toxicology testing, training first responder and medicolegal professionals, and ensuring compliance with data submission. The Department of Justice (DOJ) should support enforcement efforts to reduce drug toxicity-related morbidity and mortality, with the Department of Homeland Security (DHS) and the Department of the Treasury (TREAS) assisting with enforcement and sanctions, to prevent future overdoses. Key recommendations for reducing opioid-related morbidity and mortality include:

  • Funding research to determine the efficacy of current efforts in opioid misuse reduction and prevention.
  • Modernizing data systems and surveillance to provide real-time information.
  • Increasing overdose awareness, prevention education, and availability of naloxone.
  • Improve training of first responders and medicolegal death investigators.
  • Funding rapid and thorough toxicology testing in emergency departments and coroner/medical examiner agencies.
  • Enhancing prevention and enforcement efforts.

Challenge And Opportunity

Opioids are a class of drugs, including pain relievers that can be illegally prescribed and the illicit drug heroin. There are three defined waves of the opioid crisis, starting in the early 1990s as physicians increasingly prescribed opioids for pain control. The uptick in prescriptions stemmed from pharmaceutical companies promising physicians that these medications had low addiction rates and medical professionals adding pain levels being added to objective vital signs for treatment. From 1999 to 2010, prescription opioid sales quadrupled—and opioid-related deaths doubled. During this time frame when the relationship between drug abuse and misuse was linked to opioids, a significant push was made to limit physicians from prescribing opioids. This contributed to the second wave of the epidemic, when heroin abuse increased as former opioid patients sought relief. Heroin-related deaths increased 286% from 2002 to 2013, with about 80% of heroin users acknowledging that they misused prescription opioids before using heroin.  The third wave of the opioid crisis came in 2013 with an increase in illegally manufactured fentanyl, a synthetic opioid used to treat severe pain that is up to 100 times stronger than morphine, and carfentanil, which is 100 times more potent than fentanyl.

In 2022, nearly 110,000 people in the United States died from drug toxicity, with about 75% of the deaths involving opioids. In 2021, six times as many people died from drug overdoses as in 1999, with a 16% increase from 2020 to 2021 alone. While heroin-related deaths decreased by over 30% from 2020 to 2021, opioid-related deaths increased by 15%, with synthetic opioid-involved deaths like fentanyl increasing by over 22%. Over 700,000 people have died of opioid-related drug toxicity since 1999, and since 2021 45 people have died every day from a prescription opioid overdose. Opioid-related deaths have increased tenfold since 1999, with no signs of slowing down. The District of Columbia declared a public emergency in November 2023 to draw more attention to the opioid crisis.

In 2023, we are at the precipice of the fourth wave of the crisis, as synthetic opioids like fentanyl are combined with a stimulant, commonly methamphetamine. Speedballs have been common for decades, using stimulants to counterbalance the fatigue that occurs with opiates. The fatal combination of fentanyl and a stimulant was responsible for just 0.6% of overdose deaths in 2010 but 32.3% of opioid deaths in 2021, an over fifty-fold increase in 12 years. Fentanyl, originally used in end-of-life and cancer care, is commonly manufactured in Mexico with precursor chemicals from China. Fentanyl is also commonly added to pressed pills made to look like legitimate prescription medications. In the first nine months of 2023, the Drug Enforcement Agency (DEA) seized over 62 million counterfeit pills and nearly five tons of powdered fentanyl, which equates to over 287 million fatal doses. These staggering seizure numbers do not include local law enforcement efforts, with the New York City Police Department recovering 13 kilos of fentanyl in the Bronx, enough powder to kill 6.5 million people. 

The ease of creating and trafficking fentanyl and similar opioids has led to an epidemic in the United States. Currently, fentanyl can be made for pennies and sold for as little as 40 cents in Washington State. The ease of availability has led to deaths in our most vulnerable population—children. Between June and September 2023, there were three fatal overdoses of children five years and younger in Portland, OR. In a high-profile case in New York City, investigators found a kilogram of fentanyl powder in a day care facility after a 1-year-old died and three others became critically ill.

The Biden Administration has responding to the crisis in part by placing sanctions against and indicting executives in Chinese companies for manufacturing and distributing precursor chemicals, which are commonly sold to Mexican drug cartels to create fentanyl. The drug is then trafficked into the United States for sale and use. There are also concerns about fentanyl being used as a weapon of mass destruction, similar to the anthrax concerns in the early 2000s.

The daily concerns of opioid overdoses have plagued public health and law enforcement professionals for years. In Seattle, WA, alone, there are 15 non-fatal overdoses daily, straining the emergency medical systems. There were nearly 5,000 non-fatal overdoses in the first seven months of 2023 in King County, WA, an increase of 70% compared to 2022. In a landmark decision, in March 2023 the Food and Drug Administration (FDA) approved naloxone, a drug to reverse the effects of opioid overdoses, as an over-the-counter nasal spray in an attempt to reduce overdose deaths. Naloxone nasal spray was initially approved for prescription use only in 2015 , significantly limiting access to first responders and available to high-risk patients when prescribed opioids. In New York, physicians have been required to prescribe naloxone to patients at risk of overdose since 2022. Although naloxone is now available without a prescription, access is still limited by price, with one dose costing as much as $65, and some people requiring more than one dose to reverse the overdose. Citing budget concerns, Governor Newsom vetoed California’s proposed AB 1060, which would have limited the cost of naloxone to $10 per dose. Fentanyl testing strips that can be used to test substances for the presence of fentanyl before use show promise in preventing unwanted fentanyl-adulterated overdoses. The Expanding Nationwide Access to Test Strips Act, which was introduced to the Senate in July 2023, would decriminalize the testing strips as an inexpensive way to reduce overdose while following evidence-based harm-reduction theories.

Illicit drugs are also one of the top threats to national security. Law enforcement agencies are dealing with a triple epidemic of gun violence, the opioid crisis, and critical staffing levels. Crime prevention is tied directly to increased police staffing, with lower staffing limiting crime control tactics, such as using interagency task forces, to focus on a specific crime problem. Police are at the forefront of the opioid crisis, expected to provide an emergency response to potential overdoses and ensure public safety while disrupting and investigating drug-related crimes. Phoenix Police Department seized over 500,000 fentanyl pills in June 2023 as part of Operation Summer Shield, showing law enforcement’s central role in fighting the opioid crisis. DHS created a comprehensive interdiction plan to reduce the national and international supply of opioids, working with the private sector to decrease drugs brought into the United States and increasing task forces to focus on drug traffickers.

Prosecutors are starting to charge drug dealers and parents of children exposed to fentanyl in their residences in fatal overdose cases. In an unprecedented action, Attorney General Merrick Garland recently charged Mexican cartel members with trafficking fentanyl and indicting Chinese companies and their executives for creating and selling precursor chemicals. In November 2023, sanctions were placed against the Sinaloa cartel and four firms from Mexico suspected of drug trafficking to the United States, removing their ability to legally access the American banking system. Despite this work, criminal justice-related efforts alone are not reducing overdoses and deaths, showing a need for a multifaceted approach to save lives.

While these numbers of opioid overdoses are appalling, they are likely underreported. Accurate reporting of fatal overdoses varies dramatically across the country, with the lack of training of medicolegal death investigators to recognize potential drug toxicity-related deaths, coupled with the shortage of forensic pathologists and the high costs of toxicology testing, leading to inaccurate cause of death information. The data ecosystem is changing, with agencies and their valuable data remaining disjointed and unable to communicate across systems. A new model could be found in the CDC’s Data Modernization Initiative, which tracked millions of COVID-19 cases across all states and districts, including data from emergency departments and medicolegal offices. This robust initiative to modernize data transfer and accessibility could be transformative for public health. The electronic case reporting system and strong surveillance systems that are now in place can be used for other public health outbreaks, although they have not been institutionalized for the opioid epidemic.

Toxicology testing can take upwards of 8–10 weeks to receive, then weeks more for interpretation and final reporting of the cause of death. The CDC’s State Unintentional Drug Overdose Reporting System receives data from 47 states from death certificates and coroner/medical examiner reports. Even with the CDC’s extensive efforts, the data-sharing is voluntary, and submission is rarely timely enough for tracking real-time outbreaks of overdoses and newly emerging drugs. The increase of novel psychoactive substances, including the addition of the animal tranquilizer xylazineto other drugs, is commonly not included in toxicology panels, leaving early fatal drug interactions undetected and slowing notification of emerging drugs regionally. The data from medicolegal reports is extremely valuable for interdisciplinary overdose fatality review teams at the regional level that bring together healthcare, social services, criminal justice, and medicolegal personnel to review deaths and determine potential intervention points. Overdose fatality review teams can use the data to inform prevention efforts, as has been successful with infant sleeping position recommendations formed through infant mortality review teams.

Plan Of Action

Reducing opioid misuse and saving lives requires a multi-stage, multi-agency approach. This includes expanding real-time opioid surveillance efforts; funding for overdose awareness, prevention, and education; and improved training of first responders and medicolegal personnel on recognizing, responding to, and reporting overdoses. Nationwide, improved toxicology testing and reporting is essential for accurate reporting of overdose-involved drugs and determining the efficacy of efforts to combat the opioid epidemic.

Agency Role
Department of Education (ED) ED creates policies for educational institutions, administers educational programs, promotes equity, and improves the quality of education.

ED should increase resources for creating and implementing evidence-based preventative education for youth and provide resources for drug misuse with access to naloxone.

Department of Justice (DOJ) DOJ is responsible for keeping our country safe by upholding the law and protecting civil rights. The DOJ houses the Office of Justice Programs and the Drug Enforcement Agency (DEA), which are instrumental in the opioid crisis.

DOJ should be the principal enforcement agency, with the DEA leading drug-related enforcement actions. The Attorney General should continue to initiate new sanctions and a wider range of indictments to assist with interdiction and eradication efforts.

Department of Health and Human Services (HHS) HHS houses the Centers for Disease Control and Prevention (CDC), the nation’s health protection and preventative agency, and collects and analyzes vital data to save lives and protect people from health threats.

The CDC should be the primary agency to focus on robust real-time opioid-related overdose surveillance and fund local public health departments to collect and submit data. HHS should fund grants to enhance community efforts to reduce opioid-related overdoses and provide resources and outreach to increase awareness.

Department of Homeland Security (DHS) DHS focuses on crime prevention and safety at our borders, including interdiction and eradication efforts, while monitoring security threats and strengthening preparedness.

DHS should continue leading international investigations of fentanyl production and trafficking. Additional funding should be provided to allow DHS and its investigative agencies to focus more on producers of opioids, sales of precursors, and trafficking to assist with lessening the supply available in the United States.

Department of the Treasury (TREAS) TREAS is responsible for maintaining financial infrastructure systems, collecting revenue and dispersing payments, and creating international economic policies.

TREAS should continue efforts to sanction countries producing precursors to create opioids and trafficking drugs into the U.S. while prohibiting business ties with companies participating in drug trades. Additional funding should be available to support E.O. 14059 to counter transnational organized crime’s relation to illicit drugs.

Bureau of Prisons (BOP) The BOP provides protection for public safety by providing a safe and humane facility for federal offenders to serve their prescribed time while providing appropriate programming for reentry to ease a transition back to communities.

The BOP should provide treatment for opioid use disorders, including the option for medication-assisted treatment, to assist in reducing relapse and overdoses, coupled with intensive case management.

State Department (DOS) The DOS spearheads foreign policy by creating agreements, negotiating treaties, and advocating for the United States internationally.

The DOS should receive additional funding to continue to work with the United Nations to disrupt the trafficking of drugs and limit precursors used to make illicit opioids. The DOS also assists Mexico and other countries fight drug trafficking and production.

Recommendation 1. Fund research to determine the efficacy of current efforts in opioid misuse reduction and prevention.

DOJ should provide grant funding for researchers to outline all known current efforts of opioid misuse reduction and prevention by law enforcement, public health, community programs, and other agencies. The efforts, including the use of suboxone and methadone, should be evaluated to determine if they follow evidence-based practices, how the programs are funded, and their known effect on the community. The findings should be shared widely and without paywalls with practitioners, researchers, and government agencies to hone their future work to known successful efforts and to be used as a foundation for future evidence-based, innovative program implementation.

Recommendation 2. Modernize data systems and surveillance to provide real-time information.

City, county, regional, and state first responder agencies work across different platforms, as do social service agencies, hospitals, private physicians, clinics, and medicolegal offices. A single fatal drug toxicity-related death has associated reports from a law enforcement officer, fire department personnel, emergency medical services, an emergency department, and a medicolegal agency. Additional reports and information are sought from hospitals and clinics, prior treating clinicians, and social service agencies. Even if all of these reports can be obtained, data received and reviewed is not real-time and not accessible across all of the systems.

Medicolegal agencies are arguably the most underprepared for data and surveillance modernization. Only 43% of medicolegal agencies had a computerized case management system in 2018, which was an increase from 31% in 2004. Outside of county or state property, only 75% of medicolegal personnel had internet access from personal devices. The lack of computerized case management systems and limited access to the internet can greatly hinder case reporting and providing timely information to public health and other reporting agencies.

With the availability and use of naloxone by private persons, the Public Naloxone Administration Dashboard from the National EMS Information System (NEMSIS) should be supported and expanded to include community member administration of naloxone. The emergency medical services data can be aligned with the anonymous upload of when, where, and basic demographics for the recipient of naloxone, which can also be made accessible to emergency departments and medicolegal death investigation agencies. While the database likely will not be used for all naloxone administrations, it can provide hot spot information and notify social services of potential areas for intervention and assistance. The database should be tied to the first responder/hospital/medicolegal database to assist in robust surveillance of the opioid epidemic.

Recommendation 3. Increase overdose awareness, prevention education, and availability of naloxone.

Awareness of the likelihood of poisoning and potential death from the use of fentanyl or counterfeit pills is key in prevention. The DEA declared August 21 National Fentanyl Prevention and Awareness Day to increase knowledge of the dangers of fentanyl, with the Senate adopting a resolution to formally recognize the day in 2023. Many states have opioid and fentanyl prevention tactics on their public health websites, and the CDC has educational campaigns designed to reach young adults, though the education needs to be specifically sought out. Funding should be made available to community organizations and city/county governments to create public awareness campaigns about fentanyl and opioid usage, including billboards, television and streaming ads, and highly visible spaces like buses and grocery carts.

ED allows evidence-based prevention programs in school settings to assist in reducing risk factors associated with drug use and misuse. The San Diego Board of Supervisors approved a proposal to add education focused on fentanyl awareness after 12 juveniles died of fentanyl toxicity in 2021. The district attorney supported the education and sought funding to sponsor drug and alcohol training on school campuses. Schools in Arlington, VA, note the rise in overdoses but recognize that preventative education, when present, is insufficient. ED should create prevention programs at grade-appropriate levels that can be adapted for use in classrooms nationwide.

With the legalization of over-the-counter naloxone, funding is needed to provide subsidized or free access to this life-saving medication. Powerful fentanyl analogs require higher doses of naloxone to reverse the toxicity, commonly requiring multiple naloxone administrations, which may not be available to an intervening community member. The State of Washington’s Department of Public Health offers free naloxone kits by mail and at certain pharmacies and community organizations, while Santa Clara University in California has a vending machine that distributes naloxone for free. While naloxone reverses the effects of opioids for a short period, once it wears off, there is a risk of a secondary overdose from the initial ingestion of the opioid, which is why seeking medical attention after an overdose is paramount to survival. Increasing access to naloxone in highly accessible locations—and via mail for more rural locations—can save lives. Naloxone access and basic training on signs of an opioid overdose may increase recognition of opioid misuse and empower the community to provide immediate, lifesaving action.

However, there are concerns that naloxone may end up in a shortage. With its over-the-counter access, naloxone may still be unavailable for those who need it most due to cost (approximately $20 per dose) or access to pharmacies. There is a national push for increasing naloxone distribution, though there are concerns of precursor shortages that will limit or halt production of naloxone. Governmental support of naloxone manufacturing and distribution can assist with meeting demand and ensuring sustainability in the supply chain.

Recommendation 4. Improve training of first responders and medicolegal death investigators.

Most first responders receive training on recognizing signs and symptoms of a potential overdose, and emergency medical and firefighting personnel generally receive additional training for providing medical treatment for those who are under the influence. To avoid exposure to fentanyl, potentially causing a deadly situation for the first responder, additional training is needed about what to do during exposure and how to safely provide naloxone or other medical care. DEA’s safety guide for fentanyl specifically outlines a history of inconsistent and misinformation about fentanyl exposure and treatment. Creating an evidence-based training program that can be distributed virtually and allow first responders to earn continuing education credit can decrease exposure incidents and increase care and responsiveness for those who have overdosed.

While the focus is rightfully placed on first responders as the frontline of the opioid epidemic, medicolegal death investigators also serve a vital function at the intersection of public health and criminal justice. As the professionals who respond to scenes to investigate the circumstances (including cause and manner) surrounding death, medicolegal death investigators must be able to recognize signs of drug toxicity. Training is needed to provide foundational knowledge on deciphering evidence of potential overdose-related deaths, photographing scenes and evidence to share with forensic pathologists, and memorializing the findings to provide an accurate manner of death. Causes of death, as determined by forensic pathologists, need appropriate postmortem examinations and toxicology testing for accuracy, incorporated with standardized wording for death certificates to reflect the drugs contributing to the death. Statistics on drug-related deaths collected by the CDC and public health departments nationwide rely on accurate death certificates to determine trends.

The CDC created the Collaborating Office for Medical Examiners and Coroners (COMEC) in 2022 to provide public health support for medicolegal death investigation professionals. COMEC coordinates health surveillance efforts in the medicolegal community and champions quality investigations and accurate certification of death. The CDC offers free virtual, asynchronous training for investigating and certifying drug toxicity deaths, though the program is not well known or advertised, and there is no ability to ask questions of professionals to aid in understanding the content. Funding is needed to provide no-cost, live instruction, preferably in person, to medicolegal offices, as well as continuing education hours and thorough training on investigating potential drug toxicity-related deaths and accurately certifying death certificates.

Cumulatively, the roughly 2,000 medicolegal death investigation agencies nationwide investigated more than 600,000 deaths in 2018, running on an average budget of $470,000 per agency. Of these agencies, less than 45% had a computerized case management system, which can significantly delay data sharing with public health and allied agencies and reduce reporting accuracy, and only 75% had access to the internet outside of their personally owned devices. Funding is needed to modernize and extend the infrastructure for medicolegal agencies to allow basic functions such as computerized case management systems and internet access, similar to grant funding from the National Network of Public Health Institutes.

Recommendation 5. Fund rapid and thorough toxicology testing in emergency departments and coroner/medical examiner agencies.

Rapid, accurate toxicology testing in an emergency department setting can be the difference between life and death treatment for a patient. Urine toxicology testing is fast, economical, and can be done at the bedside, though it cannot quantify the amount of drug and is not inclusive for emerging drugs. Funding for enhanced accurate toxicology testing in hospitals with emergency departments, including for novel psychoactive substances and opioid analogs, is necessary to provide critical information to attending physicians in a timely manner to allow reversal agents or other vital medical care to be performed.

With the limited resources medicolegal death investigation agencies have nationally and the average cost of $3000 per autopsy performed, administrators need to triage which deaths receive toxicology testing and how in-depth the testing will be. Advanced panels, including ever-changing novel psychoactive substances, are costly and can result in inaccurate cause of death reporting if not performed routinely. Funding should be provided to medicolegal death investigating agencies to subsidize toxicology testing costs to provide the most accurate drugs involved in the death. Accurate cause of death reporting will allow for timely public health surveillance to determine trends and surges of specific drugs. Precise cause of death information and detailed death investigations can significantly contribute to regional multidisciplinary overdose fatality review task forces that can identify potential intervention points to strengthen services and create evidence to build future life-saving action plans.

Recommendation 6. Enhance prevention and enforcement efforts.

DOJ should fund municipal and state law enforcement grants to use evidence-based practices to prevent and enforce drug-related crimes. Grant applications should include a review of the National Institute of Justice’s CrimeSolutions.gov practices in determining potential effectiveness or using foundational knowledge to build innovative, region-specific efforts. The funding should be through competitive grants, requiring an analysis of local trends and efforts and a detailed evaluation and research dissemination plan. Competitive grant funding should also be available for community groups and programs focusing on prevention and access to naloxone.

An often overlooked area of prevention is for justice-involved individuals who enter jail or prison with substance use disorders. Approximately 65% of prisoners in the United States have a substance abuse order, and an additional 20% of prisoners were under the influence of drugs or alcohol when they committed their crime. About 15% of the incarcerated population was formally diagnosed with an opioid use disorder. Medications are available to assist with opioid use disorder treatments that can reduce relapses and post-incarceration toxicity-related deaths, though less than 15% of correctional systems offer medication-assisted opioid use treatments. Extensive case management coupled with trained professionals to prescribe medication-assisted treatment can help reduce opioid-related relapses and overdoses when justice-involved individuals are released to their communities, with the potential to reduce recidivism if treatment is maintained.

DEA should lead local and state law enforcement training on recognizing drug trends, creating regional taskforces for data-sharing and enforcement focus, and organizing drug takeback days. Removing unused prescription medications from homes can reduce overdoses and remove access to unauthorized users, including children and adolescents. Funding to increase collection sites, assist in the expensive process of properly destroying drugs, and advertising takeback days and locations can reduce the amount of available prescription medications that can result in an overdose.

DHS, TREAS, and DOS should expand their current efforts in international trafficking investigations, create additional sanctions against businesses and individuals illegally selling precursor chemicals, and collaborate with countries to universally reduce drug production.

Budget Proposal

A budget of $800 million is proposed to evaluate the current efficacy of drug prevention and enforcement efforts, fund prevention and enforcement efforts, improve training for first responders and medicolegal death investigators, increase rapid and accurate toxicology testing in emergency and medicolegal settings, and enhance collaboration between law enforcement agencies. The foundational research on the efficacy of current enforcement, preventative efforts, and surveillance should receive $25 million, with findings transparently available and shared with practitioners, lawmakers, and community members to hone current practices.

DOJ should receive $375 million to fund grants; collaborative enforcement efforts between local, state, and federal agencies; preventative strategies and programs; training for first responders; and safe drug disposal programs.

CDC should receive $250 million to fund the training of medicolegal death investigators to recognize and appropriately document potential drug toxicity-related deaths, modernize data and reporting systems to assist with accurate surveillance, and provide improved toxicology testing options to emergency departments and medicolegal offices to assist with appropriate diagnoses. Funding should also be used to enhance current data collection efforts with the Overdose to Action program34 by encouraging timely submissions, simplifying the submission process, and helping create or support overdose fatality review teams to determine potential intervention points.

ED should receive $75 million to develop curricula for K-12 and colleges to raise awareness of the dangers of opioids and prevent usage. The curriculum should be made publicly available for access by parents, community groups, and other organizations to increase its usage and reach as many people as possible.

BOP should receive $25 million to provide opioid use disorder medication-assisted treatments by trained clinicians and extensive case management to assist in reducing post-incarceration relapse and drug toxicity-related deaths. The policies, procedures, and steps to create medication-assisted programming should be shared with state corrections departments and county jails to build into their programming to expand use in carceral settings and assist in reducing drug toxicity-related deaths at all incarceration levels.

DOS, DHS, and TREAS should jointly receive $50 million to strengthen their current international investigations and collaborations to stop drug trafficking, the manufacture and sales of precursors, and combating organized crime’s association with the illegal drug markets.

Conclusion

Opioid-related overdoses and deaths continue to needlessly and negatively affect society, with parents burying children, sometimes infants, in an unnatural order. With the low cost of fentanyl production and the high return on investment, fentanyl is commonly added to illicit drugs and counterfeit, real-looking prescription pills. Opioid addiction and fatal overdoses affect all genders, races, ethnicities, and socioeconomic statuses, with no end to this deadly path in sight. Combining public health surveillance with enforcement actions, preventative education, and innovative programming is the most promising framework for saving lives nationally.

 

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