The danger of fentanyl was made very clear to my family just last week, and that was in a hospital context. My mother was having an outpatient procedure that required general anesthesia. She'd had severe reaction to fentanyl during a previous procedure, so she made sure a "no fentanyl" note was placed in her chart and on her bracelet, and she communicated that directly to the medical staff, including the anesthesiologist. And then during the procedure she started to wake up early, so the anesthesiologist made the decision to give her a "micro" dose of fentanyl. She stopped breathing and it took two doses of Narcan to save her life. When she regained consciousness, the nurse in her room was crying and told her they'd almost lost her. I can only imagine the risks involved when taking pill with an unknown amount of fentanyl in a non-hospital setting.
This is a case of malpractice. It should be reported and investigated. Such an error was extremely careless and life-threatening. There is no excuse for it.
I'm so glad your mother survived. I can't imagine why the anesthesiologist didn't just give her more of whatever had been given in the first place, but I've seen such medical mistakes before. I can't take albuterol and my chart, when there were paper charts, said that on a red label, but my doctor's partner gave it to me anyway without telling me. When I reacted badly, I checked the vial, and sure enough, albuterol. I made sure never to see him again, even if it was urgent.
Your perception of how deadly the drug problem is to our population, particularly our youth is right on. The underlying causes are many but certainly inequality, no national health care, a corrupt political system and a tendency to seek out autocratic leaders with simple but deadly answers are a few.
Why are the fake pills being laced with fentanyl? What is driving the illegal manufacturers to add it to the formula? Is the intention to increase addiction or to commit murder? It's a criminal conspiracy either way. Thanks for the article, Nick. Excellent as always.
This is an excellent question. After all, you'd think the business model of even the most odious firm would not include killing one's own clientele. I've heard a few answers, and the one I find most convincing is that these companies traditionally sold counterfeit pills with flour or inert ingredients, but then the consumer knows that it's fake; it does nothing. Fentanyl is only a little more expensive but has two benefits. First, it creates a high, so people feel an effect (and if they think they've taken a Percocet, it will indeed reduce pain). In other words, some people will not realize that it's counterfeit even after buying and taking the pills. Second, fentanyl creates an addiction that creates a future demand among those whom it does not kill. My sense is that many first-time users buying fake pills initially believe them to be the real thing, but that more experienced users often have an addiction to fentanyl and realize that the fake pills are in fact fentanyl and will keep them from getting sick. That creates an ongoing business demand. I believe that's the answer to your question, but others have thoughts?
You do know that they are ( Percocet/oxycodone and Fentanyl) are both opioids of different strengths? How about this explanation: fentanyl is synthesized and does not require the plant based natural raw material which is subject to attempts to rigidly control it. Probably much more expensive to source for illegal manufacturers
My professional area of expertise is addiction and mental illness. I suspect that the numbers that Mr. Kristof cites are the best he can find, but they are probably underestimated because a death certificate may cite another cause of death, especially in deaths related to alcoholism. Among those might be heart or liver disorders or even dementia, the proximate but not ultimate cause of many deaths. We need to modernize our approach to addiction disorders. In my area, there are few inpatient treatment beds, even though we are a tourist area where people "party." Some doctors provide treatment with suboxone or other drugs, but people with addictions need more than a drug. They need counseling and training in how to lead drug-free lives. We have too few psychiatrists with addiction training and we have too few psychiatrists with dual diagnosis training. Psychiatry is among the lowest paid of all medical fields, so many doctors choose more lucrative specialties. This is true almost everywhere. We need a national imperative that encourages more doctors to train in this field and to treat addicts and alcoholics. Perhaps using national medical service that forgives student loans is one possibility, but there must be many more choices if we want to fix this problem and save lives.
I can't say specifically, but psychiatrists are on the low end of the medical doctor pay scale. You'd have to check the labor department statistics to determine which is lower.
What's your estimation of the amount of financial resources we need in Oregon to address the issue as you have proposed, and if we do have them, what do we take them from?
On the first order response, we already have financial resources that are adequate, but they are misallocated. The last legislative session provided substantial funds that have been stuck in OHA, and then Measure 110 money is beginning to roll in. But Measure 110 money must be redesignated for treatment, for that's arguably the most cost-effective intervention in this space. It's appalling that Oregon ranks last among states in access to treatment. Other interventions, like drug education in schools, have a mixed record, and incarceration is both extremely expensive and utterly ineffective. We also have to tweak reimbursement rates so that treatment pays providers as well as, say, hip replacements. That will address the staffing shortages that have been a huge problem. In terms of financing the broader interventions such as early childhood programs and high school graduation rates, we can squeeze better outcomes out of existing funds. For example, Oregon ranks in the middle in terms of per capita taxation, yet third from bottom in h.s. graduation rates and in the bottom 10 in early literacy. But early childhood etc will require more funds overall, and options include a timber severance tax like Washington's and more sensible allocations. For example, the legislature handed out $240 million for individual legislators to hand out in their districts -- a waste. And the money that Oregon is now spending on tampon distribution in boys' restrooms in elementary schools could surely be more effectively spent on early reading programs in those same elementary schools. Note also that some evidence-based programs are extremely cost effective. Reach Out and Read is only $20 per kid per year. Lead testing and reduction is one of the best bargains in public health, but we substantially undertest in Oregon. And, Chuck, you will have better ideas than this!
Personal experience: A young man in his 30's, son of my wife's best friend, took a single pill that he thought was Percocet for pain from his gout. His mother found him and called the EMTs. They administered Narcan twice and revived him, but he was DOA at the hospital. That was a year ago, and his mother is still wracked by grief.
The police analysis of the remaining pills said that they included enough Fentanyl to kill most people. They also found the number of a known drug dealer on his cell phone.
I'm so sorry. Please pass on to your wife's friend that she might check out songforcharlie.org, founded by the parents of the young man I wrote about. There's a community of bereaved parents who support each other as they endure the unbearable.
Have you read “ How The South Won The Civil War” by Heather Cox Richardson? One of the reasons our society does not respond to this type of issue is a view of society where government does not worry about or help individuals. I would love your thoughts on that book.
I appreciate you and all the work you are doing. I agree with your sentiment about how we need to do more for people with childhood trauma and other aspects of life that cause people to self medicate. The current minimum wage is so very offensive.
So true, but many young adults lack fear. I recognize the photo of Charlie because he was a classmate of my daughters at Santa Clara University. A group of public health students (including daughter) did their capstone project on the dangers of fentanyl. In surveys, they found that students where unaware of the drug, the dangers of it and the worst outcome- death. The conference helped to educate and inform. Also, they were able to give attendees Narcan spray and training. It's not a solution to the drug problem, but it can help save a life.
Finally, someone intelligent, well-meaning, moral, and rightfully incensed, speaks up loudly, clearly and grammatically, and doesn't ask for money at the end. Nick, I have donated yearly to the charities you have singled out, and have thanked you for bringing them to my attention. I do wish you could and will run for public office again. I am truly frightened about the future of our country. Barbara Lipton
I'm sorry I'm not on the ballot in tomorrow's Oregon election, for this is one of the issues I wanted to lead on. But Secretary of State Shemia Fagan decided otherwise. I hope whoever is elected governor will tackle this issue aggressively, along with the housing crisis, education and public safety.
I think perhaps that an unaddressed part of this issue is pain itself. I am very fortunate that I did not become an opioid addict. I developed symptoms of trigeminal neuralgia ("the suicide disease") a few years ago, and it came at a time when I was already dealing with a lot. My mom had trigeminal neuralgia and suffered intensely from it for 15 years, so I was scared. But I found a pain app that teaches a mind/body approach to pain (it's called Curable - I've no other affiliation with them) and thankfully was able to stop the trigeminal pain through the exercises and through altering some things about my use of vitamin B12. The app is really good and Curable Health's podcast and Facebook videos are excellent. I think we need broader education about mind/body relationship and also about pain - what it is, what it isn't, how the brain plays its role in the experience of pain, what we can do about it if we encounter it. I wish emotional pain could be understood and worked with in a similar way, but haven't found that yet. If a person knows, though, to seek help other than a pain pill, then they're going to have that much more of a chance to avoid addiction. What Curable taught me is that when you take the time to get toknow yourself and to learn the terrain of your own experience more closely, and to cultivate skills to navigate it, it can substantially improve your experience of life. I had a bad (deep, but relatively small area) burn accident back in 2006 and was given one Fentanyl lollipop in emergency, followed some pain meds at home. I wish I'd had Curable's app then, and wish I had known about how to manage the trauma and pain of such a deep and painful body wound. It was sheer luck that I didn't end up getting addicted to pain pills after that accident.
If people were getting adequate pain relief from their doctors through pharmacies they wouldn't be so quick to turn to illicit sources for it. But we are not, so we do. Yes, we cause much of our own pain. We're sedentary and we overeat. We're stressed, anxious and we don't sleep. When medical providers look the other way, we try taking things in hand ourselves and get scammed, get sold poisonous pain pills of dubious origin. Why not expect doctors to do their jobs?
Fentanyl is the new way to have a war with America without a weapon. Clearly this kills more Americans than the cited wars. Where do the pills laced with fentanyl come from? We are at war with them and we are losing.
As the founder of the non-profit Conquer Addiction, I couldn't agree more -- the growth in the use of fentanyl in street drugs and counterfeit drugs is terrifying. The DEA reported in late 2021 that 40% of all the counterfeit pills they confiscated that year contained lethal amounts of fentanyl! This 20 second video shows the spread of fentanyl-related deaths across the country: https://www.conquer-addiction.org/When-One-Pill-Kills
The danger of fentanyl was made very clear to my family just last week, and that was in a hospital context. My mother was having an outpatient procedure that required general anesthesia. She'd had severe reaction to fentanyl during a previous procedure, so she made sure a "no fentanyl" note was placed in her chart and on her bracelet, and she communicated that directly to the medical staff, including the anesthesiologist. And then during the procedure she started to wake up early, so the anesthesiologist made the decision to give her a "micro" dose of fentanyl. She stopped breathing and it took two doses of Narcan to save her life. When she regained consciousness, the nurse in her room was crying and told her they'd almost lost her. I can only imagine the risks involved when taking pill with an unknown amount of fentanyl in a non-hospital setting.
This is a case of malpractice. It should be reported and investigated. Such an error was extremely careless and life-threatening. There is no excuse for it.
I'm so glad your mother survived. I can't imagine why the anesthesiologist didn't just give her more of whatever had been given in the first place, but I've seen such medical mistakes before. I can't take albuterol and my chart, when there were paper charts, said that on a red label, but my doctor's partner gave it to me anyway without telling me. When I reacted badly, I checked the vial, and sure enough, albuterol. I made sure never to see him again, even if it was urgent.
I am so pleased you continue to write your very special and poignant articles.They makes my day.Susan Uchitelle
Your perception of how deadly the drug problem is to our population, particularly our youth is right on. The underlying causes are many but certainly inequality, no national health care, a corrupt political system and a tendency to seek out autocratic leaders with simple but deadly answers are a few.
Why are the fake pills being laced with fentanyl? What is driving the illegal manufacturers to add it to the formula? Is the intention to increase addiction or to commit murder? It's a criminal conspiracy either way. Thanks for the article, Nick. Excellent as always.
This is an excellent question. After all, you'd think the business model of even the most odious firm would not include killing one's own clientele. I've heard a few answers, and the one I find most convincing is that these companies traditionally sold counterfeit pills with flour or inert ingredients, but then the consumer knows that it's fake; it does nothing. Fentanyl is only a little more expensive but has two benefits. First, it creates a high, so people feel an effect (and if they think they've taken a Percocet, it will indeed reduce pain). In other words, some people will not realize that it's counterfeit even after buying and taking the pills. Second, fentanyl creates an addiction that creates a future demand among those whom it does not kill. My sense is that many first-time users buying fake pills initially believe them to be the real thing, but that more experienced users often have an addiction to fentanyl and realize that the fake pills are in fact fentanyl and will keep them from getting sick. That creates an ongoing business demand. I believe that's the answer to your question, but others have thoughts?
You do know that they are ( Percocet/oxycodone and Fentanyl) are both opioids of different strengths? How about this explanation: fentanyl is synthesized and does not require the plant based natural raw material which is subject to attempts to rigidly control it. Probably much more expensive to source for illegal manufacturers
My professional area of expertise is addiction and mental illness. I suspect that the numbers that Mr. Kristof cites are the best he can find, but they are probably underestimated because a death certificate may cite another cause of death, especially in deaths related to alcoholism. Among those might be heart or liver disorders or even dementia, the proximate but not ultimate cause of many deaths. We need to modernize our approach to addiction disorders. In my area, there are few inpatient treatment beds, even though we are a tourist area where people "party." Some doctors provide treatment with suboxone or other drugs, but people with addictions need more than a drug. They need counseling and training in how to lead drug-free lives. We have too few psychiatrists with addiction training and we have too few psychiatrists with dual diagnosis training. Psychiatry is among the lowest paid of all medical fields, so many doctors choose more lucrative specialties. This is true almost everywhere. We need a national imperative that encourages more doctors to train in this field and to treat addicts and alcoholics. Perhaps using national medical service that forgives student loans is one possibility, but there must be many more choices if we want to fix this problem and save lives.
Um.. psychs make less than Pediatricians?
I can't say specifically, but psychiatrists are on the low end of the medical doctor pay scale. You'd have to check the labor department statistics to determine which is lower.
What's your estimation of the amount of financial resources we need in Oregon to address the issue as you have proposed, and if we do have them, what do we take them from?
On the first order response, we already have financial resources that are adequate, but they are misallocated. The last legislative session provided substantial funds that have been stuck in OHA, and then Measure 110 money is beginning to roll in. But Measure 110 money must be redesignated for treatment, for that's arguably the most cost-effective intervention in this space. It's appalling that Oregon ranks last among states in access to treatment. Other interventions, like drug education in schools, have a mixed record, and incarceration is both extremely expensive and utterly ineffective. We also have to tweak reimbursement rates so that treatment pays providers as well as, say, hip replacements. That will address the staffing shortages that have been a huge problem. In terms of financing the broader interventions such as early childhood programs and high school graduation rates, we can squeeze better outcomes out of existing funds. For example, Oregon ranks in the middle in terms of per capita taxation, yet third from bottom in h.s. graduation rates and in the bottom 10 in early literacy. But early childhood etc will require more funds overall, and options include a timber severance tax like Washington's and more sensible allocations. For example, the legislature handed out $240 million for individual legislators to hand out in their districts -- a waste. And the money that Oregon is now spending on tampon distribution in boys' restrooms in elementary schools could surely be more effectively spent on early reading programs in those same elementary schools. Note also that some evidence-based programs are extremely cost effective. Reach Out and Read is only $20 per kid per year. Lead testing and reduction is one of the best bargains in public health, but we substantially undertest in Oregon. And, Chuck, you will have better ideas than this!
Personal experience: A young man in his 30's, son of my wife's best friend, took a single pill that he thought was Percocet for pain from his gout. His mother found him and called the EMTs. They administered Narcan twice and revived him, but he was DOA at the hospital. That was a year ago, and his mother is still wracked by grief.
The police analysis of the remaining pills said that they included enough Fentanyl to kill most people. They also found the number of a known drug dealer on his cell phone.
I'm so sorry. Please pass on to your wife's friend that she might check out songforcharlie.org, founded by the parents of the young man I wrote about. There's a community of bereaved parents who support each other as they endure the unbearable.
Have you read “ How The South Won The Civil War” by Heather Cox Richardson? One of the reasons our society does not respond to this type of issue is a view of society where government does not worry about or help individuals. I would love your thoughts on that book.
I appreciate you and all the work you are doing. I agree with your sentiment about how we need to do more for people with childhood trauma and other aspects of life that cause people to self medicate. The current minimum wage is so very offensive.
So true, but many young adults lack fear. I recognize the photo of Charlie because he was a classmate of my daughters at Santa Clara University. A group of public health students (including daughter) did their capstone project on the dangers of fentanyl. In surveys, they found that students where unaware of the drug, the dangers of it and the worst outcome- death. The conference helped to educate and inform. Also, they were able to give attendees Narcan spray and training. It's not a solution to the drug problem, but it can help save a life.
Very scary stuff.
Finally, someone intelligent, well-meaning, moral, and rightfully incensed, speaks up loudly, clearly and grammatically, and doesn't ask for money at the end. Nick, I have donated yearly to the charities you have singled out, and have thanked you for bringing them to my attention. I do wish you could and will run for public office again. I am truly frightened about the future of our country. Barbara Lipton
I'm sorry I'm not on the ballot in tomorrow's Oregon election, for this is one of the issues I wanted to lead on. But Secretary of State Shemia Fagan decided otherwise. I hope whoever is elected governor will tackle this issue aggressively, along with the housing crisis, education and public safety.
I think perhaps that an unaddressed part of this issue is pain itself. I am very fortunate that I did not become an opioid addict. I developed symptoms of trigeminal neuralgia ("the suicide disease") a few years ago, and it came at a time when I was already dealing with a lot. My mom had trigeminal neuralgia and suffered intensely from it for 15 years, so I was scared. But I found a pain app that teaches a mind/body approach to pain (it's called Curable - I've no other affiliation with them) and thankfully was able to stop the trigeminal pain through the exercises and through altering some things about my use of vitamin B12. The app is really good and Curable Health's podcast and Facebook videos are excellent. I think we need broader education about mind/body relationship and also about pain - what it is, what it isn't, how the brain plays its role in the experience of pain, what we can do about it if we encounter it. I wish emotional pain could be understood and worked with in a similar way, but haven't found that yet. If a person knows, though, to seek help other than a pain pill, then they're going to have that much more of a chance to avoid addiction. What Curable taught me is that when you take the time to get toknow yourself and to learn the terrain of your own experience more closely, and to cultivate skills to navigate it, it can substantially improve your experience of life. I had a bad (deep, but relatively small area) burn accident back in 2006 and was given one Fentanyl lollipop in emergency, followed some pain meds at home. I wish I'd had Curable's app then, and wish I had known about how to manage the trauma and pain of such a deep and painful body wound. It was sheer luck that I didn't end up getting addicted to pain pills after that accident.
Thank you so much for sharing your story and this App. the witness of others is so powerful
If people were getting adequate pain relief from their doctors through pharmacies they wouldn't be so quick to turn to illicit sources for it. But we are not, so we do. Yes, we cause much of our own pain. We're sedentary and we overeat. We're stressed, anxious and we don't sleep. When medical providers look the other way, we try taking things in hand ourselves and get scammed, get sold poisonous pain pills of dubious origin. Why not expect doctors to do their jobs?
Fentanyl is the new way to have a war with America without a weapon. Clearly this kills more Americans than the cited wars. Where do the pills laced with fentanyl come from? We are at war with them and we are losing.
As the founder of the non-profit Conquer Addiction, I couldn't agree more -- the growth in the use of fentanyl in street drugs and counterfeit drugs is terrifying. The DEA reported in late 2021 that 40% of all the counterfeit pills they confiscated that year contained lethal amounts of fentanyl! This 20 second video shows the spread of fentanyl-related deaths across the country: https://www.conquer-addiction.org/When-One-Pill-Kills