As Halloween quickly approaches and our nation’s fentanyl crisis continues to escalate parents fear their kids may be vulnerable to an accidental overdose. This fear only increased with the new development of ‘rainbow fentanyl’ (pictured below) which the DEA claims are marketed to children (1). While this may be questioned on the internet, the goal of this blog is to educate everyone on the dangers of fentanyl and its multiple disguises.
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| From: npr.org |
What is fentanyl?
Fentanyl is a synthetic opioid developed to help patients manage their pain (2). Fentanyl has been found to be 50 to 100 times more effective than morphine (3). When prescribed fentanyl can be given as a shot, skin patch, or cough drop. Illegally obtained fentanyl has been found in powder form, in eye drops, as a nasal spray, or in pill form. Fentanyl interacts with the areas of the brain that are responsible for our emotions and detecting pain. The effects of fentanyl are euphoria, drowsiness, nausea, confusion, constipation, sedation, difficulty breathing, and loss of consciousness.
Approximately 56,516 people overdosed on synthetic opioids, primarily fentanyl in 2020 (4). Overdose occurs when a large amount of a drug is taken, causing the drug’s effects to become harmful and even deadly. Symptoms of an overdose include: loss of consciousness, lack of responsiveness, pinpoint pupils, difficulty breathing, and blue or purple lips or fingertips (5). If you suspect someone is overdosing, first you should call 911. Second, it is recommended that you administer Narcan in the event of a possible opioid overdose. And lastly you should stay with the person until help arrives. Narcan is especially important because it can reverse the effects of an opioid overdose including a fentanyl overdose (6). Narcan is available at most pharmacies and does not require a prescription in several states.
Many drug users believe they are purchasing heroin or cocaine when instead they are given fentanyl, which produces a greater overall effect (2). This sadly often results in death caused by an overdose. It was found in one study analyzing overdoses in 10 states determined that approximately 57% of people who died from an overdose tested positive for fentanyl along with an additional drug such as cocaine heroin or meth (5). The majority of children overdosing from fentanyl occur through accidental exposure to prescribed fentanyl patches (7). However, adolescents are more prone and vulnerable to the ‘rainbow fentanyl’ marketing and at risk for other recreational drugs being laced with fentanyl. More drugs are being laced with fentanyl because it is reportedly cheaper to produce and more addictive than other street drugs (2).
With the rise in fentanyl overdoses and alleged marketing to adolescents, it is important to be aware of what your children are doing and what they receive in their baskets this Halloween. Here are some recommendations to make sure your kids are safe this Halloween (8).
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| From: greenvillejournal.com |
By Catherine (Lainie) Hew, a Master's Student in the Medical Sciences Program at the University of Kentucky
Resources:
1) Dea warns of brightly-colored fentanyl used to target young Americans. DEA. https://www.dea.gov/press-releases/2022/08/30/dea-warns- brightly- colored- fentanyl- used- target-young-americans
5) Drug overdose symptoms, risks & treatment. American Addiction Centers. (2022, September 13). https://americanaddictioncenters.org/overdose
6) Miller, L. (2022, October 7). "Rainbow fentanyl" and Halloween – how to keep kids safe. Breakthough Recovery Outreach. https://my-breakthrough.com/blog/rainbow-fentanyl-and- halloween-how-to- keep-kids-safe/
7) Stoecker, W. V., Madsen, D. E., Cole, J. G., & Woolsey, Z. (2016). Boys at Risk: Fatal Accidental Fentanyl Ingestions in Children: Analysis of Cases Reported to the FDA 2004-2013. Missouri medicine, 113(6), 476–479.
8) Cronan, K. M. Halloween safety tips (for parents). KidsHealth. https://kidshealth.org/en/parents/halloween.html.
I like how you bring up that drugs are laced with fentanyl because it’s cheaper to produce because — I know I raised this question in class, but I have always wondered why it would be remotely beneficial to kill you customer base. But, I suppose if the cost/revenue analysis come back to favor adding fentanyl…it doesn’t matter if the user base dies.
ReplyDeleteI’m particularly interested in the “marketing strategy” used to involve adolescence in drug usage. We talked about how, with vapes, the allure of the many flavors makes adolescence intrigued and therefore may lead to their addiction. In the case for vapes, I can see how some may say that this is a good way to wean (presumably adult) smokers off of cigarettes, but why do we need the flavor? Can’t they be flavorless?
I wish there was a law/regulation that restricts advertising on these kinds of abusable substances. Make the pills gray, make the vape flavorless — that way the only people who will “want them” are those who are already addicted (and we can work at helping this population) and no new adolescents (drawn to “rainbow pills” or the smell of Pacha SYN Fuji Apple Strawberry Nectarine…whatever that means) will get introduced without knowing the full implication of what they’re taking.
It is disappointing/frustrating that we have to be so cautious about kids potentially being targeted by drug dealers. It is equally frustrating that drug dealers will disguise fentanyl and other opioids so their customers do not even know what they are taking.
ReplyDeleteIn another pharmacology class, I learned about the recent increase in Carfentanil prevalence in illicit drug supplies.
According to PubMed article "Carfentanil: a narrative review of its pharmacology and public health concerns," carfentanil is a synthetic fentanyl analogue that is around 20-30x more potent than fentanyl. It is typically used as a tranquilizer for large animals such as elephants and bears. Because it is mainly used in veterinary medicine, not much is known about its effects in humans. This makes it increasingly dangerous to have in illicit drug supplies.
It is important that first responders are cautious when responding to potential overdoses because they could be exposed to powder forms of these drugs that if inhaled could be toxic to them as well. They should be prepared with personal protective equipment consisting of nitrile gloves, safety glasses, N95 mask, paper suit and shoe covers. First responders should also be equipped with multiple doses of naloxone; because carfentanil is so much more potent than fentanyl, it may take more than one administration of naloxone to recover an individual from an overdose.
It seems like we are constantly discovering new opioid analogues in the illicit drug supply. I don't know how we will end this opioid epidemic with this constant evolution.
[Carfentanil: a narrative review of its pharmacology and public health concerns, https://pubmed.ncbi.nlm.nih.gov/30666589/]
I find this topic very interesting based on that so many people have died from Fentanyl overdoses but what is the true likely hood that a child would find Fentanyl in the Halloween Candy? This blog does bring out aspects that I have not thought about including how Fentanyl can be produced in colors and look more like candy than other drugs typically do.
ReplyDeleteI think that Narcan should be more readily available than drugs that can be overdosed on, but it is not. There is a price to Narcan to get from a pharmacy whether or not the patient has a prescription, which could eliminate the patient from purchasing it and carrying it, which makes me curious on how much more we could do as a country to help make Narcan more available to not only drug users but to the community that surrounds.
To build on what is presented here, I have heard it argued that fentanyl is preferred to weaker synthetic opioids is that, due to its concentration, it is easier to hide, because less is needed on-hand for production, and drugs produced with it can be smaller and more potent. The creation of drugs that appear as candy may be an extension of this utility: drugs that don't look like drugs are easier to conceal.
ReplyDeleteThe issue with this, however, is nevertheless exactly as you described. Regardless of the reason for their creation, drugs that look like candy are more likely to be ingested by children, whether it is their expressed purpose or not.
This brings us back to the question of Narcan availability. Certainly, Narcan is a transformational drug. It is incredibly easy to use and requires next to no training to provide effective, life-saving care. This means that every Narcan kit in the hands of everyday people is one more chance for a life to be saved. The cost of producing and distributing these kits is not negligible, but is almost certainly lower than the costs, both economic and human, of the ongoing opioid epidemic.
Ultimately I agree with your premise that Narcan should be significantly more affordable for and available to everyone, and believe that an excellent place to start would be for cities to purchase Narcan in bulk and distribute it, along with brief training materials, to adults in the area. And what better time to initiate such a program than when risks of childhood overdose is especially high, on Halloween.
I believe you should always carry Narcan on you in case of any emergency but as a parent it is your duty to watch out for your kids. Since Narcan isn't accessible to all demography, maybe a cheaper route, it to purchase candy bags from the store and switch them out with those after a night of trick-or-treat. That way the kids aren't feeling left out of the fun and at the same time you don't have to worry about any candy being tempered with.
ReplyDeleteFirstly, I want to say that this reading was super interesting, and it was very real research and written.
ReplyDeleteNarcan has been a generational medication that has saved thousands of lives and will continue to save thousands. It is pretty unique that our own university came up with the formulation, so I think that is pretty cool.
However, fentanyl has also been a medication that has taken everyone by storm, but it is also important to note that healthcare workers have been using this on patients for years before it has hit the market. Fentanyl is both a devastating, but yet phenomenal drug for pain management. Everyone has heard stories after stories of people smoking marijuana, and then it was laced with fentanyl and that person passed away. It is devastating.
Going to back to the crux of your question, I believe that everyone should have Narcan on their persons. Even if it not for yourself or someone you know, we all know that overdosing is becoming more and more common. I believe that Narcan should be carried everywhere because you have no idea what the situation you will find yourself in. Additionally, GoodRX reported that the main pharmacies (CVS, Rite Aid, and Walgreens) will actually give Narcan out for free, and no questions asked (Williams, 2022). I also found from the same article that they are many states sponsored programs that supply free Narcan for residents that request it, again, no questions asked.
Williams , G. (2022, March 23). Here’s where you can get Free Narcan - GoodRx. How to Get Free Narcan to Keep at Home. Retrieved November 20, 2022, from https://www.goodrx.com/naloxone/narcan-naloxone-at-home-free
Hey I think this topic is very interesting because of how many times in the more recent years I have seen news channels have to mention to be careful about candy one's children may receive during Halloween. In fact a couple of my friends from back home have younger siblings who only went to family friends houses this previous Halloween in fear of receiving tainted candy which was disheartening to hear but a very safe alternative. I think especially in the area that we are currently located in, households should be prepared with Narcan due to the high rates of opioid abuse and death that is found in Kentucky. I think something that is even more concerning is that there are new synthetic drugs that are on the market know that are even more potent than fentanyl such as carfentanyl. In a previous class I have taken, we discussed how drug dogs would sniff out certain crime areas and if they died it was an indication that carfentanyl was present because of how potent it is. I hope that carfentanyl never becomes a prominent issue when discussing Halloween candy because even if Narcan is administered right away, it is not potent enough to displace carfentanyl and respiratory distress will occur rapidly to kill individuals. I think another thing that is important when discussing Narcan administration is some people may feel better after the Narcan is administered and not want to go to the Emergency Department. That is not the case at all and it is very important that the patient goes to the hospital anyways because if the Narcan wears off while the opioid is still in the body, the patient can go into overdose again. In the end, by allowing citizens to become educated on the signs of opioid overdose like how there is an initiative to educate citizens on stroke symptoms, people will be more likely to know how Narcan can help and when to take individuals to the hopsital.
ReplyDeleteI find it extremely crazy that it has become a concern that children will be given 'rainbow fentanyl' and that it is becoming a possibility that they should be given Narcan. However, with the current opioid epidemic, it has become a sad reality. With overdoses becoming such a prevalent issue, I think that it would be extremely useful to have Narcan on you to be able to help in an emergency. A number of my family members are firefighters/EMT and they have experience with numerous overdoses, sometimes upwards of 12-15 overdoses a day and it's crazy to imagine but it has now become the reality and because you cannot predict what will happen, I think this is more reinforcement to carry Narcan.
ReplyDeleteI also think that more needs to be done to prevent the accessibility of these drugs and substances to avoid them reaching the wrong hands, especially those of children who are not fully aware of the terrible effects that these substances have. In current society, it has become so easy to get a hold of drugs with appealing appearances, flavors, and effects. I think that if we want to have a chance at decreasing risk of overdose, it is important to target the availability of drugs.
Lainie,
ReplyDeleteThis is a wonderful piece! I remember during the halloween season, there was so much commotion on trick-or-tricking and the fentanyl crisis that was intertwined in it. It's unfortunate that the opioid crisis is THIS terrible, and it's worse how they're marketing it to kids as well. It's very sad that on a holiday like Halloween, the fun is sucked out of the best part (eating the candy) because people don't know how to act when it comes to drugs. I do hope that there are rules and laws that implement the accessibility to common drugs like this that can stop the flow. I think there needs to be a grip on how much is pushed and that it all must be prescribed and undergo a three-authentification-factor method to obtain the drug (once prescribed) and check-ins/updates when using the prescribed medication to ensure that it's being used for the right reason. However, we all know that that's not really going to stop anything (hence the synthetic drugs). So, one day, I hope that there's a change in the opioid crisis.
Great job picking this topic! I love the title, Trick-or-Treat! or Tweak? Very funny.
Great description of the drug and the discussion of the opioid crisis that we are currently experiencing. I think this was a great topic because we often only talk about adults being exposed to this type of drug, but it is also very important to think about how exposure to fentanyl may harm children as well. I have read similar articles about recent exposure of fentanyl laced candies in high schools.This is a very interesting topic, especially with Halloween recently passing. Are there any specific features to notice that may be obvious signs to someone that will let them know they may be handling a dangerous substance such as fentanyl? Is there a smell or appearance that people may need to look out for not just during halloween, but in any instance where they are receiving something not offered but a public facility?
ReplyDeleteI'm also concerned with how much fentanyl is deadly to a child versus an adult. If a child is exposed to a small amount of fentanyl, how will this affect them short term and long term?
I think this was a very interesting topic. It is known that a fentanyl epidemic is getting worse in America and is very large problem. I think that it is great to educate the public on how to keep the children who are Trick or Treating safe. I wonder what are the numbers in which children have been affecting from fentanyl during Halloween. Also, due to possibility of drugs in candy during Halloween I think that there is an increase in parents taking their children to church events because it is a more controlled area than going to neighborhoods anymore. It is horrible that we have to worry about issues like this with our children.
ReplyDeleteI think giving out Narcan could be a really good idea, however, it could pose as drug encouragement if the wrong people get their hands on it. This could promote the drug usage because then it would give others a chance to have a back up plan. Also, I think allowing people without a trained personal to administer the Narcan is a risk of the child's health especially a distressed parent.
Hey, Lainie!
ReplyDeleteI want to start off by saying this is so well written! It feels like it should be in a parent's magazine.
I appreciate the discussion of the opioid epidemic. Fentanyl specifically has been such a large drug of discussion because of how deadly it is. Younger people are so much more vulnerable to recreational drugs like the colorful ones mentioned in this blog, and they are the people who are more likely to be hooked for life. They are also more likely to overdose because they don't realize that the pills are laced with drugs like fentanyl (UCLA, 2022). There has been an exponential rise of overdose deaths in teens due to fentanyl in recent years (UCLA, 2022).
In my opinion, I think all healthcare workers should be required to have Narcan training. They should also be required to keep Narcan either on their person or at their place of residence so that it's available because opioid overdoses are so common now. I think it's somewhat irresponsible to equip anyone and everyone with Narcan because it won't do any good if it's administered incorrectly.
Adolescent drug overdose deaths rose exponentially for the first time in history during the covid pandemic. UCLA Health System. (2022, April 12). Retrieved November 20, 2022, from https://www.uclahealth.org/news/adolescent-drug-overdose-deaths-rose-exponentially-first