The Price of Fentanyl

2023 Addicted.org Scholarship Award Winner

I hadn’t planned to write my little brother’s obituary over winter break, but following the first semester of my PhD program, that’s exactly what I found myself doing. His death hit us out of nowhere —one day we were planning our travels for Christmas, and the next our travel plans were for a funeral instead. I don’t know exactly how long my brother had been fighting this addiction, but I did know how hard he was trying to stay sober. Around a year earlier, his favorite tattoo artist had promised a free tattoo if he could stay clean for a year. He bought a safe and asked his friends to lock up his paraphernalia. He was determined to make it and motivated himself by planning vacations he knew he would want to be sober for. In preparation for Christmas and an upcoming trip, he decided to isolate himself – no money, no car, and staying with another sibling – to work through the withdrawals he had been experiencing. The fight with fentanyl ended up costing him everything. My brother died of a drug overdose from fentanyl on December 21, 2022.

The substances that are connected to the “epidemics” of the modern day have emerged from a variety of sources and for a variety of reasons—often with the intention to heal and help rather than cause harm (Oxford University Press, 2009). Fentanyl emerged as a synthetically-made opioid in the 1960s to be used as an anesthetic for patients undergoing significant open-heart surgeries (Stanley, 1992). In early studies of the drug, fentanyl proved to be significantly stronger than morphine and produced few side effects which made it highly valuable in the field of medicine (Stanley, 1992). For several decades, fentanyl was used throughout the field of medicine, often with cancer patients for managing pain (Drug Enforcement Administration, 2020; Millar, 2018). Illicit use of fentanyl reportedly began in the early 2000s, but was not widely recognized as other drugs, such as OxyContin, filled the spotlight at this time (Millar, 2018).

In the most recent decade, the prevalence of illicit fentanyl distribution and use has notably increased. The risk of overdose is exasperated as fentanyl is commonly combined with or sold under the guise of being another drug, such as heroin (Millar, 2018; Raffa et al., 2018). For youth and other young people who experiment with drugs, this creates a significant problem as they may be unknowingly introduced to fentanyl (Slavova et al., 2017). Experts have suggested that fentanyl may play a role in overdoses where the user believed they were taking another drug (e.g., heroin, cocaine), but which contained fentanyl in addition to or instead of the desired drug (Drug Enforcement Administration, 2020; Millar, 2018). As such, fentanyl overdoses are suspected to be underreported and often attributed to other drugs (Slavova et al., 2017). Raffa et al. (2018) explain that some users may be aware of the potential presence of fentanyl, but are unable to distinguish it from other drugs. As with many drugs, fentanyl comes in a variety of forms. Besides the ways in which it can resemble other drugs, fentanyl also comes in the form of lollipops, most often used for cancer patients, as well as in a colorful pill form that closely resembles candy (Drug Enforcement Administration, 2020). These forms are reported to make the drug more appealing to young people, which is reminiscent of early advertisements for candy cigarettes and other marketing strategies of drugs that have targeted children. Raffa et al. (2018) highlight the danger that this poses, as the form that drugs take plays a role in the occurrence of overdoses, with more appealing drug forms being connected to more drug use.

Reports of drug overdoses have continuously increased over the last several years, with fentanyl being a prominent piece of these overdoses (Centers for Disease Control and Prevention, 2021). Organizations and individuals alike work towards mitigating the threat of fentanyl, but go about this in different ways. For example, working emergency personnel are being more readily equipped with naloxone, which allows them to work on counteracting overdoses (Compton et al., 2019; Slavova et al., 2017). Overall, there is a need for prevention techniques to become more preventative and less reactive (Slavova et al., 2017). Efforts toward this include the development of non-addictive pain management medications that will reduce the dispersal of prescribed opioids (Compton et al., 2019). Additionally, by supporting mothers and their children during the initial years of a child’s life, community and healthcare organizations can help establish long-term positive resiliency factors for children (Compton et al., 2019). Hadland (2019) provides a number of recommendations directed toward doctors and medical providers, but that can be adopted by all. These include helping to inform others, specifically youth, of various harm reduction techniques, understanding what to do if someone is suspected of overdose, and minimizing stigmatizing language around drug use (Hadland, 2019). Schools are in a unique position to be able to employ these strategies and work beyond informative prevention programs that have existed in the past. School programs increase in effectivity and benefits for students when they are integrated with and supported by families and communities (Pechmann et al., 2020).

            In recent years, between an uptick of news stories, and my affiliated work with the juvenile justice system, I have been well informed of the prominence of the threat that fentanyl poses to young people. Despite my awareness of this significant problem, none of this prepared me for the day when the statistics and stories became personal. I have been left wondering and researching what could possibly be done to help prevent other families from having to go through the heartache that my family is experiencing. In considering what influence I might be able to have on my community—whether that community be professional, personal, virtual, or geographical—I am particularly struck by the recommendations put forth by Hadland (2019) that all center around becoming more personally educated and learning to communicate more effectively with youth about drug use. Becoming involved in the work of preventing fentanyl use necessitates an awareness of the resources that exist within communities including needle exchange programs or safe areas for those who use drugs (Hadland, 2019). Although this may seem counterintuitive, these resources help individuals using drugs to stay safe and do not lead to an increase in drug use (Potier et al., 2014). Additionally, working to reduce the stigma around drug use and rehabilitative treatments may allow individuals experiencing addictions to be more open to sharing their experiences or receiving help (Hadland, 2019). Further, becoming personally informed on how to care for and support someone experiencing adverse drug side effects or overdose symptoms is a critical first aid skill (Hadland, 2019). I hope that through becoming more aware of resources and skills related to fentanyl use, I can make a difference in my community and support others in increasing their own awareness of the real price of fentanyl – not money, but life.

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