Why Is Fentanyl So Dangerous? (video/podcast)

Emergency room physician explains illicit fentanyl

Emergency room physician explains illicit fentanyl

“One pill can kill.” This simple phrase summarizes the danger of fentanyl, a synthetic opioid linked to more than 150 overdose deaths every day in the United States.

Fentanyl is extremely potent — 50 to 100 times stronger than morphine — and this potency is what makes it so deadly. In fact, fentanyl overdose is now considered an epidemic: In San Diego County alone, fentanyl overdose deaths increased by 2,366% from 2016 to 2021.

In this video, San Diego Health host Susan Taylor talks with Roneet Lev, MD, an emergency medicine physician and director of emergency department operations at Scripps Mercy Hospital, San Diego, about how to protect yourself and your loved ones from a fentanyl overdose.

What is fentanyl?

Fentanyl is a synthetic opioid. Opioids are a class of pain medications that include oxycodone, hydrocodone, morphine and heroin. While morphine and heroin are examples of natural opioids that are extracted from plants, synthetic opioids are manufactured in a laboratory.

There are two types of fentanyl. Pharmaceutical-grade fentanyl is used in health care to treat severe pain. Illicit fentanyl is produced in foreign labs and brought into the country illegally.

Unlike pharmaceutical-grade fentanyl, illicit fentanyl is typically contaminated with other chemicals, so its actual ingredients are unknown. The powder form can be mixed into other drugs, such as methamphetamine or cocaine, without the user knowing. Illicit fentanyl tablets can be made to look like other drugs, such as anti-anxiety medication or less-potent painkillers. As a result, people who believe they are taking other drugs can easily overdose on fentanyl.

“There’s fake everything, and even experts sometimes cannot tell a real tablet from a fake one. A college student who is studying for finals and thinks they’re getting an Adderall tablet may get something that just has fentanyl and various contaminants,” says Dr. Lev. “That’s not what they meant to buy. It’s a mistake they made and often a deadly one.”

Treating a fentanyl overdose

Fentanyl paralyzes your ability to breathe, so a person overdosing on the drug will be unresponsive despite efforts to wake them. Without treatment, they will turn blue and likely die. If you see somebody showing fentanyl overdose symptoms, call 911 immediately.

Additionally, Naloxone should be given as soon as possible. An opioid reversal agent that attaches to opioid receptors and blocks their effects, Naloxone can quickly restore normal breathing to a person whose breathing has slowed or stopped because of an opioid overdose.

“Anybody who’s using drugs should have naloxone ready to use,” says Dr. Lev. “If it’s given fast enough, the person feels like they’ve been asleep and they wake up right away as if nothing happened. If you wait too long, you could have lung damage, brain damage, or die.”

Naloxone is available by prescription, but anyone can walk into a pharmacy and ask for it without a prescription. Narcan is a brand of naloxone available over the counter.

In addition, the non-profit group End Overdose is supplying free Narcan to anyone who takes a 10-minute video course on how to recognize the signs and symptoms of pre-overdose and active overdose, a demo on the use of Narcan, and instructions for aftercare. While brief, the video course is worth the price of admission, and two doses of Narcan (or a similar brand name) will arrive at your door in only a week or so for a small cost of shipping. To get your free naloxone and basic training certification, go to EndOverdose.net. The non-profit provided more than 111,000 training sessions just last year.

Locally, Narcan is also available through the San Diego County Health & Human Services Agency’s Naloxone Distribution Program. You can order it for delivery to your home, pick it up at one of several San Diego locations, or even get it from one of 12 county vending machines. The San Diego program also makes Narcan available to high-risk patients through each of Scripps’ four emergency departments.

Preventing fentanyl overdose

One way to reduce the risk of fentanyl overdose is using only medications prescribed to you by a physician.

“There’s no safe drug supply, none, unless you get it from a pharmacy with your name on it. Only take drugs that are prescribed to you by your doctor and purchased from a reputable U.S. pharmacy,” says Dr. Lev. “Don’t get them from a friend and don’t get them illegally, because you could die.”

Treating and preventing addiction

In addition to people who mistakenly take fentanyl, Dr. Lev often treats patients in the emergency department who have an opioid use disorder and want treatment.

“Nobody should suffer from opioid withdrawal. We’re there 24/7 to meet people where they are, when they’re ready to get treatment, and start them on opioid addiction treatment medications,” she says. “We even have navigators that follow up with patients and make sure they’re connected with outpatient treatment.”

For parents who are concerned about their kids using drugs, Dr. Lev recommends having age-appropriate conversations about the dangers of drugs even before middle school, which is when drug use often begins.

“The brain is still growing and developing until 25 to 27 years old, and the chance of addiction during that time is seven times higher than for an adult,” she says. “So if there is a suspected problem, it’s good to catch it early. Addiction is a chronic disease of the brain, but there is treatment and there is hope.”

Listen to the podcast on the dangers of fentanyl

Listen to the podcast on the dangers of fentanyl

Follow San Diego Health on iTunes for the latest episodes on new medical technologies and wellness tips. We’re also on SoundCloud and Spotify. You can also listen to Dr. Lev’s podcast High Truths on Drugs and Addiction on Apple Podcasts.

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