Everything you need to know about Fentanyl and Narcan
A talk by West County Health Centers at Analy goes over the dangers of Fentanyl and the life-saving potential of Narcan
The numbers regarding fentanyl speak for themselves.
Between April 2019 and April 2023, annual overdose deaths in the U.S. nearly doubled from 68,647 to 112,470. Two-thirds of last year’s overdose deaths involved fentanyl.
“It is an epidemic,” Sebastopol Police Captain Jim Hickey said at a talk for parents at the Analy Library on Monday night.
Hickey said that while crack/cocaine, methamphetamines and heroin have all caused concern among law enforcement and parents over his career, fentanyl blows them out of the water.
“It’s the worst thing I have seen,” he said.
The use of synthetic opioids such as fentanyl spiked in 2021, when overdose deaths involving such substances rose by 55.6 percent, and has stayed steady as the deadliest drug in America ever since.
The talk at the library was partially to educate parents on the severity and ubiquity of fentanyl, but also to spread the gospel about a “miracle” drug known as Narcan (Naloxone) which, as of last year, is available for purchase over the counter.
“I have been involved in over 50 overdoses in my 24-year career, and I've seen 15 people come back by the use of Narcan,” Hickey said.
After Hickey spoke, Geoffrey Davis and Alexandra Swan, the substance use liaisons for West County Health Centers, gave a presentation to the parents in attendance on fentanyl and Narcan. A similar presentation was given to this year’s incoming freshman class at Analy.
This article will expand upon the key points from that presentation.
What’s the deal with Fentanyl?
Fentanyl is a synthetic opioid that can be found in some prescription medications but is most dangerous when mixed with counterfeit drugs purchased on the street. These are mostly other popular opioids such as Oxycodone or Percocet or other drugs such as methamphetamine, ketamine and cocaine.
Fentanyl has also been found in street-dealt amphetamines like Adderall and marijuana, which are among the most popular drugs for teenagers and young adults today.
As a result of it being mixed in with other drugs, many who overdose on fentanyl were not necessarily aware that the drugs they took contained a lethal dose of fentanyl, let alone a trace of any fentanyl. This harms those who most prominently have no or little experience with opioids, and thus have not built up a substantial tolerance.
Because of its low cost, fentanyl is used instead of more expensive, authentic opioids which come from the juice of the opium poppy. But, because of its potency, just a little bit of fentanyl can cause an overdose.
Depending on one’s weight, just two milligrams of fentanyl (see photo below) can be lethal, and, according to the DEA, 42 percent of pills tested for fentanyl contain at least 2 milligrams of fentanyl.
While testing strips can be used to see if a certain pill or tablet has fentanyl mixed in, they are not always accurate. Moreover, like chips on a chocolate chip cookie, the fentanyl can be unevenly distributed within the drug.
“Counterfeit pills are being made to look exactly like whatever real medication they're trying to imitate,” said Davis of West County Health Centers. “They're being hand pressed, which means that [the drug dealers] are basically adding a bunch of fentanyl into whatever substance it is, and they're pressing the pills themselves. They can't regulate how much fentanyl is getting into each pill, and that's where it becomes extremely dangerous.”
Where is all this fentanyl coming from?
“Most [counterfeit] drugs right now that we're seeing are coming from Mexico,” Hickey told the Sebastopol Times after the meeting. “We're not finding labs and things [in America] like we used to.”
“These things are being made in basically warehouse labs, not like chemists, but by guys that are calling themselves chemists,” Hickey added. “So that's why it's not an equal distribution of the drugs.”
Because the drugs are coming from out of the country, they often pass through multiple hands before being acquired by the person who is actually using them. This means that there are also many dealers across the country who are unsure whether or not their products contain fentanyl.
“It’s a food chain,” Hickey said. “Usually, you're dealing with a dealer who's dealing with a sub-dealer who's dealing with another sub-dealer who's dealing with the cartel. It's at least three to four people removed from the cartel most of the time.”
This makes it nearly impossible to know the source of the drug.
“The cartels don’t care,” Hickey said. “They are in it for the money.”
How to use Narcan
While Naloxone (Narcan) has been legal since the early 1970s, Narcan was FDA-approved only in injection form until 2015.
Now, giving someone Narcan is as easy as giving yourself a nasal spray such as Flonase. All it takes is one pump into the right or left nostril, and the Narcan will be absorbed by cells inside one’s nose.
Given how easy the nasal spray is to use and how widely available it is, anyone has the potential to save the life of a stranger or a loved one who has overdosed on an opioid such as fentanyl—which is why West County Health Centers distributed free Narcan at the event and recommended keeping it on your person at all times.
To use Narcan, it is best to lay the person who is overdosing on their back. Since there is only one dose per spray, it is important not to test the Narcan before administering.
Opioid overdoses happen as a result of clogged vessels and a lack of oxygen in the brain. Narcan unclogs those vessels in the brain for a period of 30-90 minutes, according to Davis of West County Health Centers. Thus, it is also important to administer Narcan every half-hour—there is no such thing as too much Narcan—and to get someone to the hospital immediately, whether by calling 911 or driving them there, even if the Narcan has worked temporarily.
There are also no side effects for Narcan, so there is no need to worry about using it on someone who may not be experiencing an overdose.
“A person gets permanent brain damage after 4 minutes without oxygen, so things have to happen quickly,” Davis said.
It takes anywhere between one and three hours after one takes something with an opioid for an overdose to happen, so if you are with a friend who is vulnerable to an overdose it is important to stay by their side for a few hours.
It is also important to administer CPR (if you know how) if the overdose victim isn’t breathing, whether or not you’ve already used Narcan. If the victim starts breathing again and regains consciousness, they may experience withdrawal symptoms because their pain receptors are no longer blocked. Since the Narcan eventually wears off, this state will not be permanent. It is important to not be surprised if this happens and to keep the victim calm.
One of the parents in attendance at the talk noted that the peers of those experiencing an overdose—whether it is from an opioid or a different drug—are often worried about calling for medical assistance lest they get in trouble.
In such a situation, Swan of West County Health Centers suggested that when on the phone with 911, it is best not to mention anything about drugs and rather to only note that someone is unresponsive and needs immediate attention. Hickey added that no matter what, there will be a medical response before any sort of investigation.
“Almost all agencies carry Narcan, with Fentanyl being in about 80 percent of the illegal drugs,” Hickey said. “We dose people when it didn't help them at all, and it didn't hurt them at all….If we end up showing up because, unfortunately, somebody has passed away, well then that investigation is going a lot deeper.”
Narcan can be purchased at Sebastopol’s CVS, located at 6877 Sebastopol Ave. or picked up for free at the Gravenstein Community Health Center, which is located at 652 Petaluma Ave, Suite H in Sebastopol.