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As fentanyl kills record numbers of Americans, experts see ways to stop its menace

Lethal doses of heroin, left, and fentanyl, right. Fentanyl, a synthetic opioid painkiller, is up to 50 times more potent than heroin.
Provided by the New Hampshire State Police Forensic Lab
Lethal doses of heroin and fentanyl. Fentanyl, a synthetic opioid painkiller, is up to 50 times more potent than heroin.

At least 100,000 Americans died of drug overdoses between April 2020 and April 2021, according to the CDC. That’s a record-high number.

Percy Menzies, president and founder of St. Louis-based Assisted Recovery Centers of America, said the pandemic had a lot to do with the increase in overdoses.

“What the pandemic did was increase the access to drugs, and there's very little supervision in the sense that there were no cops on the street. So the drug dealers were able to just have a heyday,” Menzies told St. Louis on the Air. “And the big factor that has thrown everything out of whack is fentanyl. Nobody expected this to hit us so badly.”

Approximately two-thirds of the nation’s overdose deaths were attributed to the synthetic opioid fentanyl. Ben Westhoff, the St. Louis-based author of Fentanyl, Inc., said fentanyl is much stronger than other opioids and is often used to cut other drugs.

“This is the third wave of the opioid epidemic following the pain pills like OxyContin and then heroin,” Westhoff said. “But now you can't find pure heroin almost anywhere in the country. It's all cut with fentanyl because fentanyl is so cheap. It's made synthetically in a lab, and drug dealers adulterate not just heroin but meth, cocaine and in particular prescription pills [with it].”

Medical fentanyl is a pain reliever that’s used safely in hospitals every day, Westhoff explained. Illicit fentanyl generally begins in labs in China and is then bought by cartels in Mexico that finish it and bring it to the American market. Because of how easily fentanyl can be manufactured, Menzies said, it’s nearly impossible to cut off the supply.

Fentanyl is now the common denominator of patients who come to ARCA for treatment, Menzies said.

“It's rare for us to find a urine specimen that is not contaminated with fentanyl. And this is causing complete chaos in the field, and we do not know how to react to it,” Menzies said.

However, he added, some tools already at our disposal can be used to save people from overdose and addiction. And prevention, he said, is key.

"We just need to devote the resources and the outreach to people who need help."

Medications like Narcan are effective for reversing the effects of an opioid overdose. The drug, which comes in a nasal spray, has become more common as the opioid epidemic has continued to spread. But what many people aren’t as familiar with is Naltrexone.

Naltrexone is “a preventative form of Narcan essentially,” Westhoff said. “Basically, it makes it so you can't be affected by opioids at all.”

Naltrexone lasts up to 25 days, while Narcan lasts more like 30 minutes to quickly help revive someone. The idea with Naltrexone is that if opioids don’t get users high, they have no reason to take them and can wean themselves off.

However, Menzies said, it’s hard to incentivize people to do that.

“Addiction is tricky. It's like asking people to stick to a diet and there’s junk food everywhere,” he said. “So asking them to stick to a diet that does not allow them to use opioids, it's not an easy task.”

Menzies suggests giving people cash incentives for getting treatment.

“We have to make treatment attractive, giving them a small cash incentive as little as $1 a day, maybe a $25 gift card can work miracles to get them in that door, because they feel rewarded,” he said. “They're not looking at the value of the cash, but just the fact that somebody is appreciating what they're doing.”

Westhoff added that people often say the opioid epidemic is hopeless. But to him, people aren’t looking hard enough at the issue.

“The big problem right now is that we're not taking the opioid epidemic seriously, like we are, say, COVID,” he said. “Drug deaths have killed more people than COVID, since the year 2000. And yet, when COVID hit, it was an all-hands-on-deck situation, so much money, so many resources were poured into it.”

The opioid epidemic should be easier to handle, Westhoff posited, because we don’t have to wait for a vaccine like we did with the coronavirus. We already have the tools we need.

“We already have this drug Naltrexone which essentially functions as a vaccine. Not only that, we have other medication-assisted treatment drugs like methadone and buprenorphine,” he said. “And so when people say, ‘There's nothing we can do about this,’ when they throw their hands up, it's crazy. We just need to devote the resources and the outreach to the people who need help.”

St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill and Lara Hamdan. Jane Mather-Glass is our production assistant. The audio engineer is Aaron Doerr.

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