How fentanyl has transformed the opioid crisis

In the 1990s, growing use of painkillers such as Percocet and Oxycodone helped seed the opioid epidemic. Afterward, demand for heroin increased, exacerbating the problem.

More recently, a surge in  synthetic opioid fentanyl use has worsened the crisis. According to the CDC, more than 100,000 Americans now die from drug overdoses yearly. Of those, approximately 75,000 involve opioids, 64,000 of which involve synthetic opioids such as fentanyl.

We spoke with Sarah O’Brien, a business development representative at Ark Behavioral Health, to learn more about the opioid crisis and the role fentanyl is playing in it. 

In the following interview, O’Brien touches on how fentanyl has transformed the opioid epidemic and highlights the importance of accountability in addressing the crisis. 

Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. What is the impact of its potency on the opioid epidemic?

O’Brien: When you obtain drugs off the street, you have no idea what the potency is. Two people could take a dose of a drug from the same dealer. One of them could feel a minimal high, whereas the other could overdose. That is one of the things that makes it so dangerous. No one can say, “This is how much you need to do to be safe.” It is so unknown. 

Someone who thought they were getting Percocet off the street might be shocked when they learn that it was actually fentanyl. 

Fentanyl production is continuously growing. So you’re seeing younger kids and older adults who are checking into treatment. And there are more and more people who are dying from it.

What led to your interest in the opioid epidemic? 

O’Brien: I got into addiction treatment from my own experience. I struggled with substance use for over 10 years. I went from going off to college to becoming addicted to OxyContin and then got introduced to heroin. That addiction continuously progressed and got worse. 

When I got sober, I had a lot of rebuilding to do. I was 30 years old and had to finish college. I got the opportunity to start working in an admissions department at an addiction treatment facility. I began doing admissions. I really liked being in the community, being part of the recovery base program. I try to help as many women as I can, so I got into the alumni portion of our treatment center. I helped with follow-ups and helped them find jobs or finish college. I started family meetings. Slowly but surely, I got pushed in the direction of community outreach. Now, I work with hospitals, unions, first responders and veterans. I got my bachelor’s in psychology, and I just started diving into ways and means that we could help individuals with whatever they need, whether it’s substance use or mental health. I try to find options, whether it is in-state or out-of-state or with or without insurance. 

Do you have any insight on what the pharmaceutical industry could do to continue addressing the opioid crisis?

O’Brien: Now, with fentanyl, the manufacturers are often not pharmaceutical companies. But the pharmaceutical companies can provide resources and education to help people understand the risks involved with these substances. 

I don’t necessarily think that pharmaceutical companies creating abuse‐deterrent opioid formulations will stop individuals from using these substances, but it could help a little bit. But these substances have been around for centuries. And now more than ever, we need to band together on substance use, health and mental health for individuals who want to get sober. Some people want help but don’t know where to turn or don’t have the finances or resources to get help.

Fentanyl has been around since the 1960s, but its use has ramped up in the past decade or so. What can you say about the surge?

O’Brien: It is so widespread. It seems like it is on every corner. If people checking into treatment have an opiate problem, fentanyl is often in their system. It shows up in fake prescription pills. Fentanyl is so inexpensive. 

Fentanyl also results in an extreme high with an extreme withdrawal. The window of seeking treatment in between doses is short because of the half-life.

Kids, college students — really everyone — needs to be educated on the dangers of fentanyl. For example, someone might think they are buying cocaine, ecstasy, benzos, stimulants or marijuana and realize a few minutes later that they are overdosing because those drugs were laced with fentanyl. 

MedPage Today recently ran an op-ed titled “Blame won’t curb the fentanyl crisis.” What do you make of that statement? 

O’Brien: If you are blaming, you are not taking accountability and responsibility. Everyone has issues they’ve been through, whether it’s childhood trauma or trauma that came into play when the addiction started. Someone might have been prescribed a medication at a young age after a sports injury, and that spiraled. But at the end of the day, it’s essential to take ownership and responsibility. By facing what I’ve done head-on, I can no longer blame anyone. I had to change the way I was. 

There is still a stigma around both substance abuse and mental health disorders. What role does that play in perpetuating the opioid epidemic? 

O’Brien: There has always been this stigma surrounding mental health, but I think it has gotten better in the past 20 years or so. I don’t think it’s where it should be — especially with the mental health crisis. I believe that there’s a huge lack of resources. I think the ability to seek help is extremely difficult for individuals. 

I think people are starting to understand that this opioid addiction is not just something certain types of people struggle with. People from every walk of life are affected. Substance abuse hits everyone. 

You mentioned that fentanyl withdrawal can be intense. Can you say more about that? 

O’Brien: When it comes to any sort of opiate withdrawal, the withdrawal symptoms can last for a couple of days to a couple of weeks. It depends on the person’s use, age and what their body’s been through. 

From my own experience, when I was 19 and going into treatment, the withdrawal from opiates was a lot different than when I was 30. It was a lot easier for my body to bounce back. 

When it comes to fentanyl withdrawals, they’re extremely intense. Not only is the body affected, but the mind is affected, too. 

Then you have cold sweats, headaches, nausea, vomiting, pain in the joints and the inability to sit still. And then, on top of it, your mind is racing. You are wondering, “How am I going to get through this?”

It is something like a terrible version of the flu, but with added mental torture. 

With fentanyl, you must be very careful with withdrawal maintenance drugs such as Suboxone, methadone, Sublocade and Subutex. An individual on fentanyl seeking help with withdrawal must have full-blown withdrawal for 24 to 48 hours. If you have Suboxone too soon, you can make things worse. It can be tough even to find, you know, medications to assist in the beginning stages of treatment of individuals.