2-29-2024 4:24am

THE NEW EPIDEMIC

Jeff Barto Editor

The Fentanyl Epidemic: What You Need to Know to Save Lives

Like the rest of the country, Los Angeles County has experienced a dramatic upswing in overdoses from fentanyl, an opiate that is 100 times stronger than heroin.

According to the L.A. County Department of Health, accidental fentanyl deaths increased 1,652% between 2016 and 2022.

The numbers are shocking, and so is the patient population. No longer is the epidemic of overdoses limited to regular drug users. Today, emergency medicine experts say it’s common to treat overdosing patients who had no idea they had ingested fentanyl.

At Huntington Health, an affiliate of Cedars-Sinai, healthcare workers are trying to change that. A team of doctors, pharmacists and nurses is traveling to schools, libraries and community centers to educate people about the opioid crisis and the importance of knowing what to do when witnessing an overdose.

Cedars-Sinai’s Newsroom spoke with Huntington Health Emergency Department Pharmacist Evan Adintori, PharmD, and Emergency Physician Sam Beckerman, MD, PhD, about their work to curb the fentanyl epidemic.

Why is fentanyl so dangerous?

Sam Beckerman, MD, PhD: Fentanyl is an extremely powerful and very effective drug that we use every day in the hospital, but it has made its way into the illicit drug supply in our country. It is an extremely powerful and potent drug, an opiate like heroin, but you need like 1/100th the amount of fentanyl compared to heroin to make you overdose and stop breathing.

Evan Adintori, PharmD: People are buying medication that they don’t have a prescription for, such as anxiety medications, and they are buying it online or in the street, and in many cases, these pills are laced with fentanyl, which can lead to potentially fatal overdoses by unsuspecting customers.

Who is at risk for a fentanyl overdose?

Beckerman: It's not just people who use drugs regularly. It's anybody who experiments with drugs, anybody who takes pills, anybody who might have gotten a pill from a friend for a headache, or being told that this is like a study drug. We're seeing it creep into our high schools and middle schools. What we're seeing—and the language that I like to use is that we're basically seeing fentanyl poisonings. These are people who oftentimes had no intention of taking fentanyl, or no intention of taking an opiate, but they end up ingesting a potentially lethal dose, without knowing it, and can die as a result of it.

What does a fentanyl overdose look like?

Adintori: There are several major signs to look for. If their pupils are what we call pinpoint pupils, they become very, very small, like the size of a point of a pin. In addition, they might be breathing very slowly or very irregularly. If you try to wake them up, they may not respond very well. They might seem very drowsy, and no matter how hard you shake them, they're not waking up. Those are some of the major signs of a fentanyl overdose.

What action should you take if you suspect someone has overdosed on fentanyl?

Beckerman: If somebody has a fentanyl overdose or a suspected fentanyl overdose, there's now an over-the-counter medication called Narcan or naloxone that can be given to people who are suffering from an opiate overdose. It can help them start breathing again and give people enough time to call 911 and get paramedics and have patients be brought to the emergency room while they're still breathing, as opposed to having the paramedics bring us somebody who's already died because they stopped breathing.

How do you use naloxone?

Adintori: Naloxone is very easy to use. It's designed so that anybody can use it while waiting for help to arrive. There is one dose per device and there are usually two devices in every box. If you believe someone is experiencing an overdose, you want to lay them down on their right side in case they have any adverse effects, or if they vomit, it won't go in their airway. You insert the device into the patient's nose, and you push the button. You only have to push it once. It will administer a single dose. And then if the person does not respond, you can administer another dose using the second device. It does not matter which nostril it goes in. You do not have to divide it between nostrils. The most important thing is that you just insert the device, push the button, and the dose is administered. This medication reverses the effects on someone's breathing. It only works for opioid medications; it will not work for other types of overdoses. However, if someone is experiencing an overdose from an opioid, it'll help them to start breathing again, and it will give you time for help to arrive.

What do you want the public to know about naloxone?

Beckerman: It's something we feel really strongly about. It's a very safe medication. It has a long shelf life. It doesn't require special handling. It's very similar to the nasal sprays that people use for their everyday allergy medications. And we recommend that people keep this medicine next to their fire extinguisher in their house, and that they have it available. We try to provide it to people in a judgment-free way, especially in light of the fact that the people who are at risk of having a fentanyl overdose these days are any human beings who might encounter a pill. One of our goals is to remove the stigma for having this in your first-aid kit in your house, just like you would a fire extinguisher or gauze or Band-Aids, because you just don't know these days.

What are you and your team doing to educate the public on the dangers of fentanyl and the benefits of naloxone?

Adintori: We've gone to a fair number of schools within the area as well as libraries and community centers, and we've been able to educate as many people as we can on the opioid crisis and using naloxone. We've had extremely positive feedback. We've had schools invite us for the next years, so we can continue to educate some of their students and parents, especially some of the freshman classes at the high schools.

Beckerman: One of our main messages is that we know that people will likely still continue to experiment with potentially dangerous drugs, so our goal is to inform them of what those risks are if they choose to do so. Our main goal is to save as many lives as possible because it's now the case where if someone—maybe they decided to try something new just this once—we don't want that to be the last mistake someone makes. We want to empower them and the people around them to know what to do in that situation and potentially save a life.

Read more on the Cedars-Sinai Blog: Talking to Your Kids About Drugs