Overdose fatalities on the rise

Aug. 29—Editor's Note: This is the first of a two part series about National Overdose Awareness Day Aug. 31.

In 2021, the Center for Disease Control (CDC) reported an estimated 107,000 drug overdose deaths — up 15% from 2020′s 93,000 deaths. Data from the first six months of 2022 shows that number has already been surpassed with overdose fatalities at more than 112,000.

"Drugs are getting stronger not weaker," said Crossroads Certified Prevention Specialist (CPS) Jessica Petter. "About 70% of heroin has fentanyl in it."

Aug. 31 marks International Overdose Awareness Day, a day that started in 2001. "Overdose Awareness Day is a day that was created to allow families and loved ones to grieve without stigma — to experience that loss openly, but also to work on preventing overdoses as well," Patten said. "It's a day to remember, and a day to remember we need to prevent these from continuing to happen."

North America continues to experience the highest drug-related mortality rate in the world, accounting for 1 in 4 drug-related deaths globally, the United Nations Office on Drugs and Crime reports.

Fentanyl-laced drugs

Counterfeit pills laced with fentanyl are increasingly being found in Iowa communities. In 2021, the Iowa Division of Criminal Investigation's Criminalistics Laboratory analyzed 17,163 fentanyl pills disguised as prescription drugs. In the first six months of 2022, that number has quadrupled to 70,556 fentanyl pills disguised as prescription drugs.

Fentanyl is a powerful synthetic opioid similar to morphine but is 50 to 100 times more potent. Like morphine, it is a medicine typically used to treat patients with severe pain, especially after surgery.

"Using counterfeit pills ups your risk of overdose," Petter said. "It's a rising and, unfortunately, continuing to rise problem."

Counterfeit pills are fake medications that have different ingredients than the actual medication. The Drug Enforcement Administration (DEA) says these pills may contain no active ingredient, the wrong active ingredient or have the right ingredient but in an incorrect quantity. Part of the lethal quality of these pills is the appearance of being a legitimate prescription drug.

A 2018 study showed a significant number of high school and college students purchase Adderall and Xanax from dark web drug markets or through social media referrals, which market deadly versions of these drugs tainted with fentanyl and/or methamphetamine.

Counterfeit pills often contain lethal amounts of illicit drugs. The DEA reports drug cartels as the primary way fentanyl gets into America from Mexico. It's common for dealers to be given fentanyl and told to get rid of it along with the drugs they were coming to purchase.

A lethal dose of fentanyl is about two milligrams, equivalent in size to a few grains of salt. According to the DEA, synthetic opioids, such as illicit fentanyl, remain the primary driver of the increase in overdose deaths, accounting for 80% of all deaths involving an opioid.

Petter said when manufacturing these pills, they are often encouraged to use blenders to mix ingredients. This creates pills with varying amounts of the active ingredient. When a user gets a pill with a small dose, they may take more next time thinking the pills will be the same.

"It's not safe to experiment with drugs anymore," Petter said.

Harm Reduction

According to the National Center for Drug Abuse Statistics (NCDAS), almost 32 million people, 11.7% of the population, were actively using drugs as of 2021. Marijuana, prescription stimulants and methamphetamines were the most common drugs of choice.

With opioid fatalities continuing to rise at unprecedented rates, the federal government has provided grant money to the states to bring the number of deaths down. Nearly $1.5 billion has been allocated for the State Opioid Response Grant in which each state can receive money to help with the problem.

"It is specifically to curb these overdose deaths," Petter said. "People dying in the community leaves some pretty big ripples. They are trying to stop the hemorrhage of deaths."

Part of this funding allows for anyone to be able to get naloxone, also known as Narcan, free of charge from a pharmacy. Naloxone is a medicine that rapidly reverses an opioid overdose in an emergency situation.

"Naloxone is really safe to have," Petter said. "It doesn't do anything fun. They made it as easy as possible." She said typically another drug user will catch the overdose. Good samaritan laws prevent the other user from being charged with possession if they call 911 in the case of an overdose.

"It is the gold standard for how someone can assist in an opioid overdose," Petter said. "The naloxone can reverse the overdose and prevent brain damage." She said if help is not being called for, it's important to know the medicine only lasts three hours. After the time is up, the overdose could kick back in. The medicine is good for up to three years if stored in a temperature-stable environment.

Crossroads will have a booth at Southwest Iowa Hot Air Balloon Days with harm reduction supplies. "We have them at all our offices," Petter said. "We have wound kits. We don't want people to hurt themselves worse."

Petter said drug users not planning to quit should avoid injecting drugs. If they do inject, they should use clean or bleached needles to prevent disease.

"We're looking to help the people who have already started on their addiction and hopefully stop people who have not started down that path yet," Petter said. "The best way to do that is to provide funding to curtail people's addictions, helping people with substance use disorders from overdosing."

Quitting

The path to stopping drug use generally starts with contacting a substance abuse facility like Crossroads. Petter said the person would sign up for an evaluation and meet with a substance abuse counselor who would see what's going on and what the user would like to change.

One of the primary treatments for substance abuse is medically-assisted treatment (MAT). This treatment combines medication and therapy to allow patients the capacity to participate in their treatment without the distraction of extreme withdrawal symptoms.

"Just because you take away their opioid doesn't take away their need and desire for said opioid," Petter said. MAT stabilizes patients so they can more meaningfully participate and potentially get a job.

"The more treatment people get, the better the outcomes seem to be. The less likely they seem to overdose," Petter said. "It's the best outcome for the largest number of people."