by Christopher S. Courtney, M.D., Arizona Mirror
March 17, 2023
Andrew was just 15 when he arrived in my Scottsdale emergency room, pale, lifeless and in cardiac arrest.
His friends, who had been joking with him on their way to school just two hours prior, told us he wasn’t a recreational drug-user. Andrew was a varsity athlete and a 4.5-GPA student. Unfortunately, he also suffered from social anxiety — shyness — and would sometimes buy Xanax from sellers on Snapchat or Instagram and use the drug to calm down before school or social events.
Tragically, this time Andrew’s pill was a counterfeit prescription pill laced with fentanyl, a powerful and often deadly opiate. His friends found the teenager unconscious in his car, and despite our frantic efforts, our team was unable to resuscitate him.
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The nationwide fentanyl crisis is killing some 100,000 Americans each year, having well overtaken COVID-19 deaths in the 18-45 age range. But it’s crucial to know that many of these victims aren’t hardline recreational drug abusers — the kind we may so easily stigmatize and despise.
More and more of them are like Andrew: Young people who are wise enough to avoid trying opioids but buy what they think are prescription medications, from friends or through social media, and become accidental victims.
It’s all part of a perfect storm spurred by our long-running adolescent mental health emergency and the rapidly increasing prevalence of deadly opioids including fentanyl. Throughout the country, the average age of opioid overdose victims has been dropping, spurred by these fentanyl deaths.
Illicit-drug manufacturers for years have added fentanyl to heroin, because it’s cheaper, more powerful and more addictive. More recently, they’ve also put it in fake prescription drugs popular among the high school set: drugs mimicking Valium, Ativan, Xanax, and even Adderall, a stimulant prescribed for ADHD that has been widely abused on high school and college campuses for years.
Synthetic opioids cause more than nine out of ten drug overdose deaths among ages 15–24 in Maricopa County. In many cases, the victims thought they were taking something else.
This alarming new trend should drive us to do more, more quickly and more strategically, to help protect our kids. Yet in Arizona, as in the rest of the country, state politicians remain locked in a battle between those who want to punish drug users — a tactic that historically has failed — and those who want to save their lives.
The only effective approach to decreasing these accidental deaths is through harm reduction: evidence-based strategies combined with the understanding that, while we’re never going to eliminate drug use, we certainly can save many lives. We can do this by doubling down on education and pragmatic strategies including wider distribution of Narcan (naloxone), which can prevent deaths from opioid overdose.
After losing her own 25-year-old son to a counterfeit Percocet, state Sen. Christine Marsh championed a successful effort to pass a law removing criminal penalties for possessing fentanyl testing strips. Marsh, who combines her political career with teaching high school, made harm reduction her mission after her son Landon’s overdose in May 2020.
Landon fit the profile of the newest fentanyl victims. He was recently married, clean-cut, and studying mechanical engineering at Northern Arizona University. Marsh has said she feels sure he would have used the testing strips if he’d had them. Indeed, a 2019 Johns Hopkins study found that fentanyl test strips led to changes in behavior for a majority of young adult illicit-drug users, some of whom discarded their drug supply as a result.
We must get the word out that the kind of drug experimentation that seemed all but benign just a couple generations ago is now so frequently deadly. The U.S. Drug Enforcement Administration recently warned that six in ten fentanyl-laced fake prescription pills contain a potentially fatal dose. What’s more, new toxic additives, including carfentanil and xylazine, are coming on the scene.
Marsh is now lobbying for Senate Bill 1159, which would counter the threat of emerging drugs and expand harm-reduction efforts by legalizing all testing and analyzing devices to test for drug ingredients and strength.
But with our state legislature divided, partisan acrimony is paralyzing even the most sensible proposals — SB1159 won unanimous support in committee, but hasn’t yet received a vote by the full Senate — at the risk of losing more of our young people.
My emergency department team is seeing more and more fentanyl-related deaths every month. Threats of arrest mean little to addicts, and probably even less to kids like Andrew or Landon, trying to medicate anxiety or acting on a momentary impulse.
These are the kids who keep me up at night. For their sake, we have to get smarter, faster.
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