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On August 31, International Overdose Awareness Day, we all have a chance to learn about opioid overdose and how to prevent it. It’s also an opportune moment to educate ourselves about the role of fentanyl as the main driver of the current stage of the opioid crisis in the United States, why the drug is so dangerous and what we can do to mitigate its dangers.
This summer, the New York City Council passed a law that requires the Department of Correction (DOC) to provide annual training to all uniformed staff in city jails on the proper use of Narcan—the over-the-counter remedy containing an anti-overdose drug called naloxone—and make the training available to incarcerated individuals as well. The DOC will also be required to provide kits to every individual when released from DOC custody.
“The new law is a step in the right direction,” says Dr. Jonathan Avery, Vice Chair of Addiction Psychiatry, Stephen P. Tobin and Dr. Arnold M. Cooper Professor in Consultation-Liaison Psychiatry and Program Director of the Opioid Overdose Prevention Program at Weill Cornell Medicine.
Keep reading for Dr. Avery’s responses to your FAQs, along with his best, most timely advice around an issue that can affect anyone, anywhere, anytime.
Fentanyl is a powerful synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is used medically to treat severe pain, often after surgery or for advanced cancer pain.
Even a tiny amount of fentanyl can cause a fatal overdose, says Dr. Avery. That’s because it suppresses breathing. “Illegally made fentanyl is often mixed into other drugs without the user knowing, increasing the risk of accidental death,” he explains.
Pharmaceutical fentanyl is safer when used exactly as prescribed, but it still carries a high risk of addiction and overdose. Doctors are prescribing it less frequently these days due to heightened awareness of the fentanyl-driven opioid crisis and the risks of misuse.
No, fentanyl is usually indistinguishable by sight alone from other powders, pills or counterfeit medications. This makes unintentional exposure a clear and present danger.
“Yes,” Dr. Avery says, “test strips can detect the presence of fentanyl in pills, powders or injectable drugs. These strips are inexpensive, easy to use and increasingly available through harm reduction programs. We provide them to people at Weill Cornell Medicine-affiliated hospitals.”
Opioid addiction remains a major public health crisis, with millions affected and close to 100,000 opioid overdose deaths reported annually, although there have been small improvements in overall deaths.
Earlier waves of the opioid epidemic were characterized by heroin and prescription pain medications. Now, says Dr. Avery, “we’re in the third wave, driven overwhelmingly by fentanyl—a drug so potent that it’s equivalent to a huge increase in opioid supply.”
If a person takes too much of an opioid or mixes an opioid with other substances, they may end up in a state where their breathing slows down. They may start turning blue, and their pupils may look abnormally small. “Left untreated, an opioid overdose slows everything down to a point of no return, he says.”
Overdoses can be prevented by avoiding drugs from unknown sources, never using drugs when you’re alone and making sure to carry Narcan with you at all times.
Narcan is available at most pharmacies without a prescription and through community harm reduction or public health programs. Many hospitals, including those overseen by Weill Cornell Medicine, also provide free Narcan kits.
The OTC Narcan package comes with two nasal spray devices containing 4mg of naloxone apiece.
Narcan is short-acting, and its effects only last from 30 to 90 minutes. When it wears off, the person could go right back into an overdose. That’s why it’s so important to call 911 right away.
Hold the nasal spray with your thumb on the bottom of the plunger and two fingers on either side of the nozzle. Place the tip of the nozzle in either of the person’s nostrils until your fingertips touch the bottom of their nose. Press the plunger firmly to release the dose.
If the person doesn’t wake up or respond within 2 to 3 minutes after the first spray, use the second device to administer another dose in the person’s other nostril.
This can prevent them from choking if there is any vomiting. At this stage, they should be breathing normally, getting reoriented and able to sit up. Keep observing them until the emergency care team arrives.
Effective treatments for opioid use disorder include medications like buprenorphine, methadone and naltrexone, all of which reduce cravings and the risk of overdose. Counseling, peer support and behavioral therapies are also key parts of recovery.
People with substance use disorder are dealing with a double burden: the disorder itself and being blamed for it. “If people are deemed unworthy, why should they receive the help, care and compassion that other patients expect to receive?” asks Dr. Avery. “But they do deserve that care, just as surely as patients with diabetes, heart disease and cancer do.”
Stigma isolates people with substance use disorder by making them feel ashamed, judged or blamed for their use. This often prevents them from seeking medical care, accessing treatment or reaching out for support, increasing the risk of ongoing use and overdose.
“Here at Weill Cornell, we have one of the only centers in the country dedicated to understanding and alleviating the stigma leveled against those who suffer from substance use disorder,” he says. See what the center offers here.
“We recommend that doctors and families start talking about these topics with children as young as 9 years old,” Dr. Avery says. “That’s what needs to happen to erase stigma and improve the way people with substance use disorder are viewed and treated in our society,” he says—and even to prevent the disorder from taking hold in younger generations.
It's heartening to know that there’s a psychiatrist in a position of leadership at Weill Cornell Medicine, Dr. Avery, who advocates for the health, dignity and recovery of people with substance use disorder and for those who love them, as well as for accidental overdose victims across our communities.
If you have substance use disorder and are ready to seek treatment, learn about the clinical services available through Weill Cornell Medicine’s Department of Psychiatry here.