On August 6th, 2020, the Drug Enforcement Agency (DEA) issued a press release about a dangerous development in the San Diego area: a dramatic increase in overdose deaths connected to the synthetic opioid, fentanyl.
Law enforcement and public health officials released the following statistics:
- In the year 2019, there were 152 fentanyl-related overdose deaths in San Diego County. That’s about three (3) fentanyl-related overdose deaths per week.
- In the first six months of 2020, there were 203 fentanyl-related overdose deaths in San Diego County. That’s about eight (8) fentanyl-related overdose deaths per week.
This data shows a projected increase of 167% percent in fentanyl-related overdose deaths for the year 2020. That increase is of particular concern in light of our current circumstances:
- The ongoing opioid epidemic, which has been exacerbated by the increasing presence of illicit fentanyl in the U.S.
- The coronavirus pandemic, which evidence shows has an adverse impact on social and emotional health, which, in turn, increases risk of alcohol and substance use escalating to alcohol and substance use disorder (AUD/SUD).
- The practice of cutting a wide variety of illicit prescription drugs – including opioids like Oxycontin and sedatives like Xanax – with small doses of fentanyl.
These facts alarm us because in the past several months, we’ve received a number of calls from families that report their young adult/college-age children – those age 18-24 – have experienced near-fatal overdose encounters involving illicit prescription drugs. The parents of many of these young adults think these near overdoses involve combining drugs like illicit sedatives (i.e. Xanax) and opioids (i.e. Oxycontin) with alcohol.
That’s a deadly combination.
And although this sounds like a scare tactic straight from the 1950s, the fact is that just one dose of illicit fentanyl is enough to kill an otherwise healthy, non-drug using, non-heavy drinking adult.
What is Fentanyl?
Fentanyl is a synthetic opioid that’s similar to morphine and heroin but 50 to 100 times more potent. It was initially created as an analgesic to treat patients with severe post-operative pain or patients with chronic pain who develop a tolerance to standard opioid medication. However, over the past decade, illicit drug traffickers began producing fentanyl in illegal labs and selling it in various forms, from powder to counterfeit pills that look almost identical to their prescription analogs.
Public health and law enforcement officials report that in addition to using illegally produced fentanyl to mimic common prescription opioids such as Oxycontin, Norco, and Percocet, drug dealers also use illegal fentanyl to “cut” several types of illegal and prescription drugs. For those who may not be familiar with the term “cut” or “cutting,” in this context it means increasing the apparent volume or amount of a substance by mixing it with another, less expensive substance (fentanyl) in order to maximize profits and reduce cost.
Drugs that may contain illicit fentanyl include:
- Illicit prescription opioids (i.e. Oxycontin)
- Illicit prescription sedatives (i.e. Xanax)
All these drugs carry risk of addiction or overdose on their own. With the addition of fentanyl, the risk of overdose increases. According to Dr. Glenn Wagner, San Diego County Medical Examiner:
“Today almost all of the fentanyl deaths that we see result from people that have taken counterfeit pills sold illegally as oxycodone or alprazolam (but containing fentanyl instead of the other drugs). These pills are deadly and even just part of one pill kills.”
The absence of dosage control when fentanyl is mixed with either an illicit prescription drug or an illicit street drug makes the current situation very dangerous for young adults living at home under shelter-in-place and social distancing guidelines.
Drug and Alcohol Use Among Young Adults
During the coronavirus pandemic, people may seek to mitigate the stress of lockdown – and associated mental health challenges – by combining alcohol and drugs for temporary relief. This includes young adults who now live at home under much different circumstances than they expected at this time last year. Some are students who, in the absence of the pandemic, would be away at college. Others are recent college graduates who finished school in the spring and found themselves entering the workforce during a historic economic downturn. Still others are job-seeking high school graduates entering an economy with record unemployment numbers.
Most of these young adults do not want to live at home. They prefer to be in school, have a job, and live independently – yet circumstances mean that for millions of young adults across the country, that’s just not possible.
The latest data from the National Institutes of Health (NIH) Monitoring the Future Survey (2019 MTF) show that young adults 18-24 years old engage in alcohol and drug use at levels that make the recent warning from the DEA ominous:
Drug and Alcohol Use: Young Adults Age 18-24
- Over 30% reported drinking at least 5 or more alcoholic beverages in the two weeks before taking the survey
- 63% reported using illicit drugs during their lifetime
- 31.2% reported using illicit drugs other than marijuana during their lifetime
- 44.3% reported using an illicit drug in the year before taking the survey
- 17.6% reported using illicit drugs other than marijuana in the year before taking the survey
- 29.4% reported using illicit drugs in the month before the survey
- 7.6% reported using illicit drugs other than marijuana in the year before taking the survey
When we look at the first bullet point about alcohol use, then read the subsequent data about illicit drug use, then combine these facts with the DEA press report on the presence of fentanyl in several types of legal and illegal drugs, and finally integrate that knowledge with the increase in overdose fatalities and the calls we’ve received about near-overdose experiences among college-age adults living at home under the stress of the pandemic, we know we have a problem.
A serious problem.
Fentanyl Overdose: What to Look For
The problem is that right now, in California, conditions are conducive to accidental overdose for young adults age 18-24.
This problem is not exclusive to hard-partiers, extreme drinkers, frequent drug users, or people who regularly combine alcohol with recreational drugs.
Because fentanyl is so strong, it can kill an adult with one dose. Those chances increase when that dose is combined with alcohol. It’s not a stretch to imagine a healthy 21-year-old who drinks moderately might have a beer and take a pill offered by an acquaintance. Both people may think the pill is a low-dose Xanax, when in fact it could contain a lethal dose of fentanyl.
Yes, hard-partiers and regular drug users are at increased risk. But because of the confluence of circumstances we describe – the pandemic, the job market, the presence of illicit fentanyl in California, and the stats on alcohol and drug use among young adults – so are young adults who would typically be at far lower risk of overdose.
That’s why everyone needs to know the following signs of fentanyl overdose:
- Loss of consciousness
- Unresponsive to external stimuli
- Bluish lips and/or fingertips
- Cold, clammy, pale skin
- Abnormally loud snoring or gurgling/choking sounds
- Slow or erratic breathing
- No breathing
- Irregular or slow heartbeat
- Limp limbs
If a friend or loved one displays any of the signs, call 911 immediately. Click here to read an emergency overdose response pdf. Here are the steps:
- Call 911
- Administer Naloxone, if available
- Try to keep them awake and breathing
- To prevent choking, lay the person on their side
- Stay with the person until medical help arrives
After an overdose or suspected overdose, there’s another thing you can do. You can help the overdose victim seek professional support for a potential alcohol, substance, or mental health disorder.
Professional Assessment and Treatment for Addiction
It’s important to get the overdose victim a clinical evaluation to determine whether they have an alcohol or substance use disorder (AUD/SUD). A mental health professional can determine the presence of an AUD or SUD. They can also diagnose additional co-occurring mental health disorders that may contribute to or cause the alcohol or drug addiction.
After an assessment and diagnosis, your friend or loved one may receive a recommendation for treatment. Evidence shows that the most successful treatment approach for AUD, SUD, and AUD/SUD with co-occurring mental health disorder is an integrated model that includes:
- Individual therapy and counseling
- Group therapy and counseling
- Family therapy and counseling
- Experiential therapies/lifestyle changes
- Community support such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)
Recommendations may include intensive outpatient programs (IOP), partial hospitalization programs (PHP), or a residential treatment center (RTC). Parents of young adults with diagnosed alcohol, substance, or mental health disorders should know that treatment can work. People seek treatment and start their recovery journey every day. Millions of people with mental health disorders have learned to manage their symptoms and live a productive life on their terms. Millions of people with AUD or SUD have learned the skills they need to live a full, complete life without alcohol and drugs. It takes work and commitment – and the sooner a person in need of professional support gets that support and commits to doing the work, the greater their chances of sustained, lifelong recovery.