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caption: Naloxone blocks the effects of opioid overdose
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Naloxone blocks the effects of opioid overdose
Credit: KUOW Photo/Gil Aegerter

Washington overdose deaths rise sharply. Fentanyl availability a main factor

In the waning days of 2020, the CDC put out a startling report. It found that over a year-long period ending in May, more than 81,000 people in the U.S. died from drug overdoses.

That's nearly a 20% increase from the previous year.

The main driver of that increase was Fentanyl, a synthetic opioid that is extremely dangerous, even in minuscule amounts. A similar trend is playing out here in Washington.

To learn more, we spoke with Caleb Banta-Green, a principal research scientist at the Alcohol & Drug Abuse Institute at the University of Washington.

This interview has been edited for clarity.

You have described the state's data as stunning. What's been happening here in Washington?

Caleb Banta-Green: We've seen a striking increase in drug overdoses in the first half of 2020, and even continuing on further into the year. Specifically, what we've seen is that in an average quarter for the last several years there have been about 300 overdose deaths in Washington state.

In the second quarter of 2020, we saw 400. That was up significantly from another significant increase we saw in the quarter before. So, we've seen a really striking increase in all drug overdose deaths. It's really clearly getting driven by these deaths that are involved in Fentanyl.

Why are overdose deaths from Fentanyl on the rise?

There are several reasons. Fentanyl is increasingly available. It is sold in what looks like pills, so people think it's safe. It's very inexpensive. It's very strong. So, you have a drug that is widely available, and very dangerous.

We also have people under tremendous personal stress. You have a lot of triggers, and reasons and motivations that people want to relieve that stress. Using medications or drugs are something that people often do to deal with stress. It's just that now, what many people are turning to is a very, very dangerous drug.

We know that deaths from Fentanyl began increasing pretty rapidly at the beginning of 2020, as you mentioned, and that coincides with the start of the pandemic. Is there a connection there?

We don't know for sure, but a couple of things do fit together. As I mentioned, people use drugs because they make them feel better in some way. The pandemic has caused a lot of stress and made people feel bad. So, there's motivation to use these drugs.

We also know that when an overdose occurs, it's much more likely to be fatal if a person is alone. That's because there's nobody there to see that a person is not doing well, is struggling, that they're breathing is slowing down, and in fact that their breathing has stopped. So, we have this increase in motivations to use, and yet we have a more dangerous situation where people may be more likely to use alone.

Where do you think this is headed?

I don't see any reason to think that Fentanyl numbers are going to go down. Fentanyl is a synthetic drug. It's made in a laboratory. The profit motive is very, very high for it. In terms of the drug being available, I see no reason to think that would go down.

It's just a very difficult thing to control the supply of a synthetic drug made with precursors and/or in laboratories all around the world, then assembled or processed in Mexico and pushed up through very effective, long standing drug trafficking organizations.

From the supply side, I don't see any reason that that would decline. The big issue is how do we really deal with the demand? Why are people using? Why are people overdosing? I think we have much better tools to address that side of the equation than we do the supply side.

We know we're dealing with a very deadly drug. What is motivating sellers and buyers, given its danger?

The interesting thing about a drug that is deadly is it also sends a signal to people who are using that it's a strong, good drug. That's a complication in this. For a person who is selling drugs, their goal is to make money, bottom line. The more profit they can make on a drug, the better. The more appealing the drug—for instance a pill versus black tar heroin-- the better. They've just made a bigger market.

For people who are looking to consume drugs, there's really two different things going on. You have people with opioid use disorder. They need to use opioids to not feel bad. It often is just a matter of which opioid is available, and which one is the cheapest. It may well be that it is these fake Oxycodone pills that look like Fentanyl.

Conversely, you have people who may be much more drug naïve, who haven't really used them much before. Either they're kind of seeking a high, or seeking an escape, or trying to relieve physical or emotional pain. In that instance, it's much more of a naïve perspective of, "Oh, this looks like a pill. It looks safe. It says 30 milligrams on it. That must be what it is. I can control this and I can manage it."

The issue is that because pills off the street are basically guaranteed to be Fentanyl, you can't control it. You don't know how strong it is. You don't know what effect it's going to have on you. The likelihood is that it's going to be really devastating.

What is the key to getting a handle on this and preventing addiction and overdoses?

In this emergency situation that we're in, number one is making sure that people don't die. So, that's good, accurate information about a tainted drug supply. We have an unsafe drug supply. People knowing that these pills are almost assuredly going to be Fentanyl if they're purchasing them anywhere other than a pharmacy. So, knowing how to identify and respond to an overdose. If they or their loved one is a regular user of opioids, knowing how to respond to an overdose, and having the overdose reversal medication Naloxone.

The next thing is for people who have opioid use disorder, for them and their family and friends and loved ones to understand opioid use disorder is a treatable medical condition. The frontline treatments are effective medications like Buprenorphine and Methadone. Also beneficial can be counseling and other types of supports, but the medications are the most effective component of opioid use disorder treatment. Those medications, really importantly, also reduce mortality. They reduce mortality long term, as long as a person takes the medications, by at least 50%. In addition to reducing mortality, they support recovery.

In terms of prevention, that's a much bigger issue that we all need to be talking about. That comes down to fundamentally, how do we manage our own stress and our own pain? Do we do that with internal strengths, and resiliency, and ways to deal with stress, and/or reaching out and connecting with other people and talking, or getting counseling, or exercising, or eating well? It sounds really simplistic, but it's really important because stress and pain are normal parts of life. They are even more normal right now, unfortunately, during this pandemic, and there are safer and less safe ways to deal with that stress.

Those are the things we really need to look at so that we aren't reaching outside of ourselves to think about a quick fix in terms of something in a pill.

You can learn more about preventing overdoses at stopoverdose.org and you can learn more about treatment options at learnabouttreatment.org. Both sites are run by the University of Washington.

Listen to the interview by clicking the play button above.