Fentanyl contributing to rise in overdoses, overdose deaths

WICHITA, Kan. (KWCH) - A substance the size of two grains of salt is enough to be deadly and officials are seeing it more often.

Last month the Drug Enforcement Administration (DEA) issued a public safety alert due to a sharp increase in the number of fake prescription pills that contain fentanyl or meth. The DEA says through September, it’s seized more than 9.5 million of those fake pills. That’s double the number seized during the previous two years combined.

A local drug treatment provider reports seeing the impact from that in Kansas. Dr. Greg Lakin, D.O. serves as medical director for Center for Change, medication-assisted outpatient treatment for opioid addiction with counseling services.

He said, “Assess and treat underlying mood disorders cause so often, people who have an anxiety disorder, they take opioids to calm their nerves.”

Dr. Lakin said the situation he’s seeing with the growing prevalence of fentanyl-laced drugs leading to overdoses and deaths, impacts all walks of life.

“It’s anybody. It’s healthcare workers, it’s professionals, it’s construction workers, it’s the people in our aircraft industry,” he said. “...Nobody’s immune.”

The CDC says fentanyl has a potency of 50 to more than 100 times greater than morphine, typically used to treat advanced cancer pain. But most of the fentanyl leading to overdoses and deaths is made illegally. The DEA says often, the ingredients are made in China and shipped to drug traffickers in Mexico who make and add the fentanyl to fake prescriptions and other drugs before sending it to the U.S.

“They’re made to look like prescription pills, prescription pain pills, but they’re not,” Dr. Lakin said. “When they’re manufactured by drug dealers, you’ll have the same set of pills you off the street and one will be a dud or very low, low potency and the other could be deadly.”

He reports seeing more people at the Center for Change, seeking help. As part of the effort to reduce the number of fentanyl overdoses and deaths, Dr. Lakin is advocating for the wider availability of naloxone products like Narcan, an overdose-reversal drug, to save lives.

“Numerous patients have been revived from the brinks of an overdose death from either the fire department or one of their friends,” he said.

There is a standing order allowing most people to purchase Narcan at pharmacies. Dr. Lakin said one of the first steps of recovery is showing people that it’s possible and helping spread that message with a podcast and YouTube channel called Lakin Chronicles.

Dr. Lakin said, “Now is the time to get treatment and it’s so much more dangerous out there now than it was just a few days ago.”

Sedgwick County tracks the number of NARCAN doses are administered by first responders:

Year: 2017

Patients that received Narcan – 291

Does administered – 374 doses

Year: 2018

Patients that received Narcan – 282

Does administered – 366 doses

Year: 2019

Patients that received Narcan – 347

Does administered – 451 doses

Year: 2020

Patients that received Narcan – 602

Does administered – 816 doses

Year: 2021 (January – September)

Patients that received Narcan – 671

Does administered – 938 doses

*Caveats for interpretation of this data…

The best data for analyzing opioid overdose frequency would be obtained from the Health Department as they have the ability to obtain hospital ER and admission/diagnosis data.  The overdoses that EMS responds to only represent one portion of overdoses that occur, e.g., some patients are driven to the hospital via private vehicle.  The Health Department data would also capture EMS data if a patient was transported.  From 2017 through September 2021, we have 171 events where naloxone was administered and the patient was not transported to the hospital.  This does not mean necessarily didn’t go to a hospital, just that they didn’t go by EMS.

Furthermore, EMS frequently encounters situations whereby patients are unresponsive for unknown reasons, and naloxone may be administered empirically (to “rule out” overdose as one reason that the patient is unresponsive).  If there is no positive response to the medication, one still cannot rule opioid overdose out completely, since response can be dose-dependent.  We give naloxone at 0.5 mg IV or intranasally, and repeat if needed.

Lastly, there was a study published in 2018 by Grover et al., that concluded (in brief) the following: “Among patients receiving care in this large urban EMS system in the United States, the overall sensitivity and positive predictive value for naloxone administration for identifying opioid overdoses was low. Better methods of identifying opioid overdose trends are needed to accurately characterize the burden of an opioid overdose within and among communities.”

Having said that, clearly, the data demonstrates that there is an increase and this warrants further investigation and evaluation of the causes.

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