International Overdose Awareness Day: Why are so many people dying?

In this interview, Michael Brown, Global Director of Counter Narcotics Technology for Rigaku Analytical Devices, retired DEA Special Agent and The Opioid Matrix podcast host, identifies what’s behind the US opioid epidemic and what we can do to help prevent more untimely deaths.

Why are tens of thousands of people dying each year from opioid overdoses in the US?

It’s become an illicitly manufactured synthetic fentanyl epidemic. You can’t make a pill capable of killing 6 in 10 people safe. 

When people were taking drugs like heroin or methamphetamine, the risk of an immediate fatal overdose was significantly lower compared to fentanyl. The DEA has just found that 6 in every 10 illicitly manufactured pills now have a potentially lethal dose of fentanyl inside them. That’s an increase from 4 in 10 only a year before¹. We’re talking about synthetic pills here, the ones made by drug cartels, not legitimate medical fentanyl used in hospitals. These deadly pills are being made by the Sinaloa and Jalisco Cartels, among others, in Mexico, and they’re coming into the US over the border. They look just like real prescription pills, for example Oxycontin®, Percocet® and Xanax®, so it’s impossible for people to tell them apart². 

Synthetic fentanyl is incredibly addictive, and it gives people a better high than they’d get with heroin or methamphetamine alone, but it’s also deadly. You only need 2 milligrams for a potentially lethal dose, which is an amount small enough to fit on a pencil tip³. Around two thirds of the people who died from opioid overdoses in 2021 had synthetic fentanyl in their system, and sometimes this was mixed with other drugs such as heroin and cocaine. And now they’re mixing xylazine, an animal tranquilizer, with fentanyl, which is causing people to get terrible wounds on their skin⁴.

What impact is this having on people’s lives?

I went to Kensington, Philadelphia, four months ago. While I was with the volunteers who were helping to clean people’s wounds, a school bus pulled up. Parents came rushing down to pick up their kids and I asked them what it was like living in that neighborhood. They said they felt like prisoners in their own community because they’re so worried about their children getting hurt by one of the needles just lying on the ground. These people are victims of this opioid epidemic even though they’re not actually taking drugs themselves. 

When I talk to substance users and ask them how they feel about the risks, they tell me all they’re thinking about is getting high. They don’t care about their life because they’re in a state of complete hopelessness and are no longer capable of making decisions about their own well-being. The worsening social and economic situation in some communities is also contributing to the epidemic. People are struggling in the aftermath of the Covid-19 pandemic and there are added challenges in areas where drug misuse is leading to higher levels of crime and disenfranchisement. There’s no easy fix, but we have to do what we can to help people through targeted support and better access to quality treatment programs.

How can we help people?

Overdose Prevention Centers are spaces for people to take drugs more safely, with trained staff ready to help if someone has an overdose. They also give people clean needles and an opportunity to access help. Safe facilities like this help to reduce open drug use but they’re not addressing the root of the problem, which is drug trafficking. Society has a responsibility to protect people so that we can live safely and progress. We have to look at the struggle that’s happening in our communities and do what we can to reduce the drugs that are coming into the US. 

The drug paradigm has shifted. We have more and more young people overdosing from opioids who are taking them for the first time. Kids who think they’re taking something safe, and they’re not even getting them from dealers on the streets, because these drugs are online now as well. At the other end of spectrum, we have long term substance users who are moving onto fentanyl because it gives them a better high. We need to address these challenges differently, to stop that first time use and help people who are already addicted to access treatment. We also have to build up our communities to address some of the social problems that surround substance use, such as a lack of education, high unemployment, deprivation, and criminality. 

The most important message to people, some of whom are school kids, contemplating taking drugs for the first time is simply, don’t. It only takes once to wind up dead.

What’s your advice for someone suffering from an opioid addiction?

References: 

¹ https://www.dea.gov/alert/dea-laboratory-testing-reveals-6-out-10-fentanyl-laced-fake-prescription-pills-now-contain 

² https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf

³ https://www.dea.gov/press-releases/2022/12/20/drug-enforcement-administration-announces-seizure-over-379-million-deadly

⁴ https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a4.htm