‘... it takes a very small amount to actually kill you’
Increasingly popular drug is about 50 times more potent than heroin, highly addictive
Editor’s Note: Fentanyl has been making headlines both locally and around the country amid a spike in overdoses and arrests. This story is the final one in a series examining the fentanyl issue and its impact in Yuma County.
Families often don’t realize fentanyl is a problem in their loved one’s life until it’s too late.
The synthetic opioid is generally not sought out by drug users as a distinct substance, and its highly addictive nature isn’t why it’s making headlines, said Dr. Kristina Diaz, chief academic officer for Yuma Regional Medical Center.
“Saying that fentanyl is addictive isn’t the true problem. The true problem is that it takes a very small amount to actually kill you,” she said.
She said it only takes about a grain of sand’s worth of fentanyl to lead to a fatal overdose, and those who try to insert a safer amount into other drugs in a backyard or garage lab don’t have the training or equipment to consistently dilute it to a safer level.
“I don’t think their intent is to kill people, but unfortunately without having monitoring of the concentration of fentanyl in the illicit drugs, it’s almost an accidental death.
“If you think of a drug dealer, they want to get you hooked, so you’ll come back. So if they kill you, that’s not a very good business model,” she said.
Alfonso Zavala, spokesman for the Yuma County Sheriff’s Office, said the county medical examiner’s office did not begin tracking deaths where fentanyl was a contributing factor until 2018.
That year there were 33 deaths with drug involvement reported in the county, eight more than the previous year. Six of those were found to have fentanyl as a contributing factor.
For 2019 to date, there have been 21 deaths reported with drug involvement, six with fentanyl contributing.
Fentanyl is about 50 times more potent than heroin, which means a dose of fentanyl iequivalent to 1/50th of a dose of heroin will have the same effect. It can bond with opioid receptors in the brain much more quickly, creating an intense, euphoric high.
According to law enforcement and emergency response personnel, using fentanyl is like playing Russian roulette with your life.
So it is combined with other illicit drugs in pill or powder form to create a cheaper, more intense high for the user. It can be short-lived, and create cravings for more almost instantly.
Fentanyl has been prescribed as a powerful painkiller for patients suffering from chronic pain since 1959, according to the U.S. Drug Enforcement Administration. It is available in this form as transdermal patches, lozenges or a shot.
Prescriptions can be filled at a pharmacy, and the patches in particular can be dangerous or deadly to the people around the patients if not disposed of correctly. They are designed to deliver small dosages over the course of 72 hours.
The powder containing the fentanyl can be ingested, on purpose or not, or absorbed through the skin. Even in this form it can be deadly, especially to children, or cause major medical issues.
“There’s a lot of ways we can get that into our systems without us putting it there,” Diaz said. And it’s especially deadly to those who have not built up a tolerance to other opioids, whether they’re prescribed or illicit.
Diaz said when a fentanyl overdose turns fatal, it’s usually because the victim’s breathing slows down and then stops.
“Respiratory depression, you know, it just slows you down. And then you stop breathing, you go into respiratory arrest.” she said.
The symptoms of fentanyl abuse include confusion, depression, difficulty walking, muscle stiffness, slow/altered heart rate, weakness, dizziness, fainting, shaking, sleepiness, slurred speech, weight loss, visual hallucinations, nausea, vomiting, pinpoint pupils, and itching and scratching, DrugAbuse. com reports.
Symptoms of fentanyl overdose are similar to other types of opioids, so victims get the kind of treatment as those who have OD’d on heroin, Vicodin, morphine or other substances in the emergency room, Diaz said. Doctors generally don’t know if fentanyl was a factor until test results come back later.
Horizon Health and Wellness of Yuma similarly treats those who are addicted to fentanyl, though its inclusion in other drugs with the same type of prescription intervention for those trying to kick other opioid drugs.
Counselor Shawn Backs said this approach is the “industry standard” for treating those hooked on opioids. Yuma has one methadone clinic and another just opened, while in the future Horizon plans to open a clinic with suboxone, another drug commonly prescribed to addicted persons.
Alonda Brown, director of Yuma operations at Horizon, said the company’s Casa Grande location has launched a program which offers a primary care provider to clients, along with a clinician and a caseworker.
Brown said this program will be brought to Yuma once a primary care provider can be brought onboard, which has been difficult since only a limited number of physicians are authorized by the Drug Enforcement Administration to prescribe such drugs.
From the front lines of treating the crisis which can result from people encountering or overdosing on fentanyl, Diaz, Brown and Backs all believe public education and outreach, especially to middle- and high-school students, is the most important tool which can be used to combat its spread.
“Yes, this is a huge problem and yes, Border Patrol has seen a significant increase in fentanyl coming across the border,” Diaz said. “But what I would like for you to focus on is there is one key thing people can do, and that’s just talking about it.”
She particularly recommends a website, operationprevention.com, which has scripts and videos for parents on exactly how to talk to their children about drugs and drug use, along with the signs their kid might be dabbling in drugs.
“There’s a lot of good information on symptoms that your youth might be experimenting with simple drugs, which may lead them to using more illicit drugs that will be more unsafe for them, especially right now,” she said
Brown said Horizon Health and Wellness recently signed an agreement with Yuma Elementary School District One to begin outreach into its middle schools, particularly with students who are already facing some kind of intervention for using drugs.
Group meetings held at school are a key way to reach youths who might be resisting any kind of treatment in other settings, to the point where their families won’t force the issue.
“When they’re at school, and we’re at school, and it’s their peer group and others are dealing with the same challenge, it’s easier for them to engage in it because it’s not just them at that moment.
“So we just try to be there when they need us, and we support them,” she said.
Educating teens about the danger of pills containing fentanyl is also critical.
Brown said, “It’s a fad, right? And pills don’t seem as bad as shooting up heroin, so they would rather take a pill than use a drug like heroin.”
Backs said, “Because doctors prescribe it, it doesn’t seem as dangerous.”
“But it absolutely is,” they concluded in unison.
Diaz suggests those who feel they are already running into trouble with fentanyl or any other opioid talk to their primary care provider.
“It’s a very complicated answer, and the one thing I can tell you is if you think you have a problem, if you feel this has affected your life, please call your primary care provider and let them know. They will absolutely be able to help you,” she said.