When I was a young nurse working in the Emergency Department and I heard about a person who had died or was unconscious, my first thought was always trauma. Things like car wrecks, falls from a height, and motorcycle accidents. As much as I hate trauma, I wish that was where my mind still went. But its not. Now when I hear about a person who has died or is unconscious, my first thought is drug overdose. Drug overdoses are becoming far, far, too common. In 2022, nearly 110,000 people died from drug overdose in the U.S. That is more deaths related to drug overdose than any other year since we started tracking it as a cause of death.
The change in my thought process regarding unconscious people has been driven by that increase in overdose deaths and because of the way we are now expected to react as health care providers because of that increase. It is now standard of care when someone is found unconscious and we are not 100% sure why, we give the antidote for opiate overdoses, Narcan, immediately. I cannot say how very sad it makes me that to do everything possible to save someone’s life, we must include treatments for overdose, even when we have no reason to suspect drug use.
The 110,000 deaths in 2022 is not the only scary statistic when it comes to drug overdose. In a recent survey by the Kaiser Family Foundation (KFF), more than 25% of respondents stated that they or a member of their family has been addicted to prescription painkillers or other illegal opioid drugs. The same survey found that 1 in 10 people has had a family member die of a drug overdose. The main culprit according to experts in the number of drug overdose deaths is fentanyl. Fentanyl and other synthetic opioids account for more than two thirds of the overdose deaths in 2022.
I don’t know if the average person truly understands how powerful of an opioid fentanyl is. Most of the drugs that we take normally are dosed in milligrams. For instance, an extra strength tablet of acetaminophen (Tylenol) is 500mg. There are 1000 milligrams in a gram. A standard paperclip weighs about a gram. That means 500 mg is about half of a paperclip in size. I can see that, I can hold that in my hand, I can compare it to other things. But fentanyl isn’t like that. In hospitals, because it is so very powerful, fentanyl is not dosed in milligrams, it’s dosed in micrograms. A microgram is one-one millionth of a gram (1/1,000,000). A common dose of fentanyl is about 100 micrograms. Essentially that equates to cutting that one-gram paperclip into 100,000 pieces and picking out just one of those pieces. There is no way you could see that or hold it in your hand. In hospitals, there are multiple safety layers from the manufacturers to the way we administer fentanyl to make sure we are giving those very tiny amounts accurately and safely. But when fentanyl is gotten from illegal sources, those safety measures don’t exist, and there is no way to know if what a person thinks they are taking is really what they are getting. That is a big part of why fentanyl causes overdoses so easily. Add into the problem that fentanyl is getting mixed into other drugs, we are also seeing overdoses in people who had no idea they were even taking fentanyl.
The KFF survey also asked about concerns regarding substance abuse and addiction. One-third of the respondents stated they are worried someone in their family will overdose on opioids and 40% are worried that someone in their family will unintentionally consume fentanyl. Two thirds of the respondents say they have had someone in their family who was addicted to drugs or alcohol, has experienced homelessness due to addiction or experienced a drug overdose that led to an emergency department visit, hospitalization, or death. The respondents who said they had experienced addiction in their family also stated that addiction had major impacts on their mental health, relationships within the family, and on the family’s finances.
I don’t have the answers to the drug overdose problem. It’s a huge national problem with a massive number of issues that contribute. What I do know is this is not a “them” problem, this is an “us” problem. Every single person has a distinct possibility of having a substance abuse and addiction problem among their loved ones. We have an absolute obligation to talk to our loved ones about the dangers of drugs and substance abuse. We must work on healthy ways to cope in times of stress, and we can’t hold to stigmas about mental health that force people to “self-medicate” with street drugs rather than getting treatment. We must because with some of these drugs, like fentanyl, all it takes is one try, one experiment, one bad decision, and that person is addicted, or they are dead.
I also encourage everyone possible to carry Narcan, the antidote to opiates. The sooner a person who has overdosed on an opiate receives Narcan, the less likely they are to die or to have severe complications from that overdose. Narcan is now available over-the-counter as a nasal spray, so it is easy to get and easy to give, if you suspect a drug overdose. CVS and Walgreens both advertise they have Narcan in stock, and I am sure other pharmacies carry as well. I also advising that you check with your insurance carrier to see if they help cover the costs of Narcan. I like to think of Narcan like a fire-extinguisher. You never want to use one, but you always want to have one around because having it can save a life.