By Holly Broce, MHA, LCADC, President, Opioid Treatment Program (OTP) Division, Pinnacle Treatment Centers
Be Part of The Solution: Raise Awareness and Reduce Stigma
Every year on the last day of August, a non-profit health advocacy group based in Australia organizes International Overdose Awareness Day.
There has never been a more important time to raise awareness about drug overdose worldwide, and in the United States in particular. In fact, last year, the President of the United States proclaimed the last week in August as Overdose Awareness Week. Here’s the official announcement from the White House, published on August 27th, 2021:
“We call upon citizens, government agencies, organizations, healthcare providers, and research institutions to raise awareness of substance use disorders to combat stigma, to promote treatment and celebrate recovery, and to strengthen our collective efforts to prevent overdose deaths. August 31st also marks Overdose Awareness Day, on which our Nation mourns the lives lost to the drug overdose epidemic.”
Overdose Awareness Week and Overdose Awareness Day have real meaning in the lives of our citizens. We’re in the midst of a crisis of drug use and drug overdose – fueled by the opioid epidemic – that’s lasted over two decades already. Unfortunately, the situation is not improving. It’s getting worse. That’s why the goals established last year by the President and the White House are now a national and worldwide priority:
- Raise awareness around addiction and overdose
- Reduce stigma related to addiction and overdose
- Promote evidence-based addiction treatment
- Celebrate those in recovery
- Reduce overdose fatalities
In support of these overall goals, the organizer of International Overdose Awareness Day 2022 – share awareness online with #iOAD2022 – established a theme for this year:
“Time to Remember. Time to Act.”
It’s time to remember those who have died of drug overdose:
Every overdose death is a tragedy because overdose death is preventable.
It’s time to act because – as we mention above – the overdose crisis is getting worse:
We can mitigate the harm caused by the crisis with evidence-based treatment and support.
At Pinnacle Treatment Centers, we’re listening – and we’ve organized and/or are planning to participate in events in support of International Overdose Awareness Day.
What is Overdose?
According to the National Institute on Drug Abuse (NIDA), a coroner or medical examiner is the only person empowered to determine whether an overdose death is intentional – a suicide – or unintentional – an accidental overdose.
Unintentional, non-suicide overdose deaths are considered accidents or errors:
- Accidental overdose occurs when an individual ingests a substance on purpose, but takes a fatal dose by mistake
- Overdose by error occurs when a fatal dosing mistake is made during a medical procedure like a surgery.
This article is about the former category: fatal accidental overdose not related to a medical procedure. With that said, it’s also important to understand that not all overdose is fatal. International Overdose Awareness Day and Overdose Awareness Week focus on fatal overdose, but non-fatal overdose is a real phenomenon with serious consequences.
To learn more about nonfatal overdose, please read this article by our Chief Medical Officer, Dr. Chris Johnston, published last year in the online magazine Medium:
The Opioid Crisis: Consequences of Nonfatal Overdose
Nonfatal overdose can cause a wide range of physical, emotional, and psychological problems. Some people never fully recover from non-fatal overdose. One of the most dangerous things about nonfatal overdose is that a person who survives an overdose – in the absence of evidence-based treatment for substance use disorder (SUD) – is at increased risk of subsequent, fatal overdose.
Drug Overdose Fatalities in the U.S.: Facts and Figures
If you’re reading this article, you probably know that rates of fatal overdose in the U.S. have increased over the past twenty years. But you may not know how much the rates have increased. That means you may not know why, exactly, our local, state, and federal leaders label these increases a crisis, and have implemented programs around the country to meet the challenges created by the ongoing, annual increases in overdose fatality.
The latest, most reliable statistics on drug overdose in the U.S. explain the crisis in simple numbers.
The Centers for Disease Control (CDC) reports that in 2021:
- Over 107,000 people in the U.S. died of drug overdose
- Over 70,000 of those – around 66% – involved synthetic opioids
- Fentanyl is the most common synthetic opioid involved in overdose fatalities, and also the most dangerous
- Between 1999 and 2021:
- Over 1,000,000 people in the U.S. died from overdose.
- Yearly overdose rates increased by over 350%
- Opioid-related overdose rates increased by over 200%
- Overdose totals (number of deaths as opposed to rates) rose by 535%
- The World Health Organization (WHO) reports that an average of 150,000 people die each year from accidental drug overdose
- Over 70,000 of those – around 66% – involved synthetic opioids
Those numbers confirm, without a doubt, that we’re in crisis – and the crisis is getting worse.
How Did We Get Here?
Here’s a brief summary of the past two decades of the overdose/opioid crisis. Overdose deaths:
- Increased from 1999 to 2006
- Remained stable from 2006 to 2013
- Increased from 2013 through 2017
- Decreased from 2017-2018
- Increased from 2018-present
To learn more about the opioid crisis, please read the various articles – a total of 43 – we’ve published about the opioid crisis on our blog:
Pinnacle Treatment Blog: The Opioid Crisis
We’ll end our presentation of overdose facts and figures with a list of the drugs most often associated with fatal overdose. These drugs include:
- Opioids:
- Benzodiazepines:
- Alprazolam
- Clonazepam
- Diazepam
- Lorazepam
- Alcohol.
- Often called alcohol poisoning, alcohol overdose can be fatal
- Stimulants:
- Cocaine
- Methamphetamine
- MDMA
- Dextroamphetamine
- Methylphenidate
This list brings us to a topic we need to discuss: fentanyl.
More specifically, the role fentanyl plays in our current situation. Every public health and law enforcement organization in the country agree on one thing:
Fentanyl is now driving the overdose crisis in the United States.
The Centers for Disease Control (CDC), the Substance Abuse and Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), the Drug Enforcement Agency (DEA), and the Department of Justice (DOJ) have issued warnings about the presence of fentanyl and its contribution to the current crisis.
The Fentanyl Problem
In the summary bullet points we share above, you can see that overdose fatalities decreased from 2017 to 2018. Then, something happened, and rates increased from 2018 to 2019. Remember – this happened before COVID-19. The something that happened was fentanyl. There are three things about fentanyl that make it incredibly dangerous:
- It’s a synthetic opioid that’s 50 times stronger than heroin and 100 times stronger than morphine.
- It’s easy to make in illicit drug production facilities.
- Drug traffickers and dealers put fentanyl in both illicit opioid and non-opioid drugs.
These three facts are literally a recipe for disaster. We don’t casually throw around colloquialisms like that, either, but the phrase is one hundred percent accurate. Let’s talk about these three fentanyl facts one at a time, to explain what we mean.
Potency:
- Fentanyl is so strong one dose can kill you.
Ease of production:
- The fact that it’s easy to produce means the U.S. is “flooded” with fentanyl. We’re not exaggerating. That’s the word law enforcement uses to describe the ongoing influx of fentanyl in to the U.S.
Presence in other drugs:
- Fentanyl is dangerous as an additive to opioids, because it increases their potency, which increases risk of overdose death.
- When traffickers and dealers add fentanyl to non-opioid drugs and leads to overdose, people often miss the signs of fentanyl/opioid overdose because they have no idea they took a powerful opioid and therefore don’t know what to watch for.
To that last point, authorities report identifying fentanyl in the following non-opioid drugs:
- Methamphetamine
- Cocaine
- MDMA (ecstasy)
- Benzodiazepines (Xanax, Alprazolam, Klonopin, etc.)
- Amphetamines (Adderall, Ritalin, etc.)
That list, however, is incomplete: the DEA indicates that nearly half the counterfeit pills they confiscate contain a lethal dose of fentanyl. A lethal dose of fentanyl is 2 milligrams. For reference, a pinch of salt is about 355 milligrams. That’s what we mean – and what all the authorities and public health official mean – when they say one dose can kill: with regards to fentanyl, the equivalent of 0.55% of a pinch of salt can be fatal.
International Overdose Awareness Day and Week: Policies to Create Change
We spent time explaining the fentanyl problem because right now in the overdose crisis, fentanyl is the main problem. That’s not to downplay everything else that contributes to overdose in the U.S., including ongoing stigma, barriers to treatment and support for SUD, and the extreme social, emotional, and psychological stress associated with the extended denouement of the COVID-19 pandemic.
The non-profit advocacy group Shatterproof, founded by Gary Mendell, who lost his son to a drug overdose in 2011, partnered with experts in mental health, substance use treatment, and law enforcement to create a national strategy to implement policies to mitigate the harm caused by fentanyl.
Here are the policies they advocate:
- Expand real-time overdose monitoring by funding programs that collect and report overdose data
- Create fentanyl education programs that reach as many people as possible, through as many channels as available: in-person, online, in school, and in communities
- Expand access the overdose reversing, lifesaving drug naloxone
- Expand training programs for naloxone administration
- Increase the presence, visibility, and funding for programs that reduce stigma related to substance use disorder and treatment for substance use disorder
- Equip local, state, and federal law enforcement with the resources they need to stop fentanyl trafficking
- Implement and integrate evidence-based awareness and prevention programming for substance use with other community-based programming for children
- Provide ongoing funding for existing prevention programs.
- Test potential of fentanyl identification strips for overdose prevention, which may involve changing laws in some states to make ID strips available
Those are the big-picture, public policy oriented, structural changes that can help reverse the trend in overdose caused by fentanyl. These apply directly to almost all drug overdose prevention programs, too – which means they can have a disproportionately positive impact, if implemented.
What We Can Do
On a smaller scale – the one person at a time scale, as it were – we can all work to mitigate the harm caused by the overdose crisis. The primary way to do this is by educating ourselves about the facts around opioids, fentanyl, substance use disorder, and treatment for substance use disorder. We can start by reading articles like this one: we provide the latest information from reliable, peer-reviewed scientific sources that represent our current state of knowledge about these important public health topics.
When you learn, you can share what you know. Each person you share real knowledge with has the opportunity to share this knowledge with others, thereby expanding our collective understanding of where are and where we need to go with regards to the opioid/overdose crisis. Here’s a rule of thumb: when talking about substance use disorder and treatment for substance use disorder, lead with compassion, kindness, and empathy.
We want people who need help to feel welcome, feel supported, and yes – feel loved and appreciated. Not only by their families, but by society as a whole.
Why?
Addiction is treatable. Overdose is preventable.
We know that if we work together, we can meet this moment and overcome this challenge. We can improve lives through evidence-based treatment and support, and we can save lives through advocacy, awareness, and prevention.
Please join us in our efforts. This year, for International Overdose Awareness Day and Overdoses Awareness Week, we can all live by the theme of #iOAD22: