Amy Palmer discusses the strength of fentanyl compared to other opiates during a naloxone training event on July 8 at The Dandy Lion Cafe in Ashland, Missouri. The next training event is scheduled for Sept. 12, but Palmer said the goal is to host events monthly
fentanyl epidemic
Fentanyl 101: What You Need to Know
The fentanyl epidemic is getting worse in Missouri, with record numbers of overdoses in the last four years and 2023 on course to be another record year.
Data points to a nearly 75% increase in overdoses in Missouri since 2019, and last year was the second consecutive year that fentanyl accounted for over two-thirds of overdoses in Missouri.
Trends in Missouri match what the U.S. Drug Enforcement Administration describes as a “nationwide overdose epidemic” fueled by the spread of fentanyl.
The drug has a place in reducing suffering when its use is deliberate and controlled. Diluted to thousandths of a milligram and administered by medical professionals, fentanyl can relieve pain in half the time it takes morphine and without its unpleasant side effects.
However, it takes merely one grain of salt’s worth of fentanyl to cross into a fatal dose.
The drug is up to 50 times more powerful than heroin and far cheaper to produce. It can also be spliced into various drugs to make counterfeit pills that can be fatal.
Counterfeit pills are often disguised as legitimate prescription drugs such as Oxycontin, Xanax, Vicodin, Adderall and Percocet and are increasingly culprits in fentanyl overdoses.
Overdoses can occur when victims believe they are using cocaine or pill-based drugs that don’t usually prove fatal, according to the DEA.
For every 10 fentanyl-laced counterfeit pills created, six contain a dose that can kill, the agency said in a public notice. Earlier in June, nearly 1,000 counterfeit Percocet pills laced with fentanyl were recovered in one traffic stop in Miller County.
Nationwide, DEA seizures of counterfeit pills containing fentanyl have risen by 430% since 2019. The DEA released a letter in 2021 warning federal, state and local law enforcement about so-called “mass-overdose” events — three or more overdoses at the same time and place.
“Fentanyl is killing Americans at an unprecedented rate,” according to DEA Administrator Anne Milgram. “Drug traffickers are driving addiction, and increasing their profits, by mixing fentanyl with other illicit drugs. Tragically, many overdose victims have no idea they are ingesting deadly fentanyl until it’s too late.”
Amy Palmer discusses the strength of fentanyl compared to other opiates during a naloxone training event on July 8 at The Dandy Lion Cafe in Ashland, Missouri. The next training event is scheduled for Sept. 12, but Palmer said the goal is to host events monthly.
Citizens make a difference
Amy Palmer, an emergency responder who works at Columbia/Boone County Public Health and Human Services, said she’s seen overdoses across all ages, races and socioeconomic classes. Emergency services will typically know a “bad batch” has hit town because of a sudden burst of overdose calls, she said.
Palmer also works as an educator with the University of Missouri-St. Louis Addiction Science team and recently led a 45-minute class to teach participants how to administer naloxone, a synthetic drug that inhibits opiate receptors in the nervous system while reversing adverse effects.
Throughout the course of this Save-a-Life class, attendees receive step-by-step instructions about naloxone to keep a person alive while waiting for first responders.
Students are given 4mg doses, typically enough to save a life. If a first dose isn’t effective, emergency responders can administer additional doses until the patient is revived. Eighty-five percent of revivals recorded by UMSL are achieved within two doses.
In the last two years, records from Palmer’s EMS station show that her team has administered naloxone 189 times. The procedure has reversed a number of potential deaths in Boone County. Missouri Institute of Mental Health data shows that no more than four people given naloxone in Columbia perished each year from 2018 to 2022.
Save-a-Life training is often attended by people with no background in emergency medical aid, or “good Samaritans,” said Heather Harlan, who has also been an instructor. She said family members and friends of those with substance use disorder seek out the class.
“We don’t ask questions — they get training and they get naloxone,” she said.
Good Samaritans
Brian Adermann, who works in grounds and maintenance at Rock Bridge Memorial State Park, attended a recent class. Three weeks before the training, Aldermann said he noticed a half-conscious stranger with a needle in their arm in a parked car.
Adermann’s first thought was fentanyl overdose. He knocked on the window, and the stranger slowly sobered up and drove away. If it had been an overdose, Adermann said he wouldn’t have known what to do. So, he decided to attend the training.
A recent UMSL report suggests that fire police, EMS and clinicians account for only slightly more naloxone administration than friends, significant others, parents and strangers like Aldermann.
As of April 2023, citizens made up 47% of reported naloxone administrations, with emergency personnel taking responsibility for nearly 50%, approaching an even split, according to UMSL data.
The UMSL Addiction Science Team responsible for the data set qualifies its findings, saying that results are “limited to those who (have) been trained and (feel) comfortable completing it,” and that its figures are likely a “large underestimate” of non-fatal overdoses in Missouri.
Harlan said residents can no longer expect to avoid witnessing an overdose event — a person slumped in a public space and unresponsive — and as the first person on scene they’re best equipped to give the victim the best shot of survival.
Camaron Nielsen, a volunteer for Heart of Missouri CASA, court-appointed special advocates for children in foster care, came to the training as part of her continuing education.
As an advocate for children in foster care, Nielsen said she knows fentanyl might reach those communities too, so she wants to be prepared.
“It (drug use) is something that is an unfortunate reality so we try to be knowledgeable about it,” she said.
Since October 2021, Boone County has received 908 boxes of naloxone, and nearly all have been distributed.
For those who haven’t seen an overdose in their circle of friends or acquaintances, it’s difficult to understand fentanyl overdoses, Harlan said. But stories she’s heard make the impact on the community clear.
“We too casually say that ‘this is a choice,’” and dismiss the problem as a moral failing, Harlan said. “When people ask me, ‘well why do people use drugs?’ Pain is why.”
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