Fentanyl & Harm Reduction
Updated: Mar 11
Harm reduction practitioners accept that not all substance use is problematic. Perhaps this is a crude metaphor, but let’s compare it to gambling. We know the odds are slightly in favor of the house. You might win, but it is a little more likely you will lose (especially if you keep going back to the table instead of taking your win out the door with you). And some people ultimately lose it all.
Fentanyl is not like gambling at a casino. Fentanyl is like one of those cheap carnival games that is rigged—almost impossible to win. The odds of losing are exceedingly high.
Fentanyl has been gaining more attention in the media due to the mass of overdose deaths it leaves in its wake. In the last few years, fentanyl played a role in the deaths of Lil Peep, Prince, Mac Miller, and Tom Petty. Not to mention thousands upon thousands of other people whose names we do not know.
What is fentanyl?
Fentanyl is a synthetic opioid (terminology help) 50-100 times more potent than heroin. It was developed by a Belgian physician in 1959. Fentanyl produces effects similar morphine, heroin, or oxycodone, but because it is so much stronger the risk of overdose is much higher.
What is fentanyl used for?
Its primary medical uses are acute pain treatment for people in post-op or people with severe pain associated with cancer. The most common forms of fentanyl are injection, lozenge, or a transdermal patch. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.
The fentanyl crisis
Most of the street use of fentanyl does not come from prescription diversion. It comes from fentanyl that is being illegally produced overseas. This kind of fentanyl may come in many different forms including powder, liquid, or even produced to look like other prescription pills.
In April 2020, here in Austin, there were 5 overdose deaths in a two-week period believed to be caused by counterfeit prescription pills laced with fentanyl.
Another concern are fentanyl analogs, such as carfentanil. Carfentanil is similar to fentanyl and used by veterinarians for large animals like elephants. It is 10,000 times more toxic than morphine and not meant for human use. In addition to illegally produced fentanyl, carfentanil is also sometimes added to illicit drugs—often without the buyer being aware.
Because fentanyl can be cheaply produced overseas dealers are adding it to the heroin supply because it is cheaper and more potent.
According to the CDC, in 2018, 67,367 drug overdose deaths occurred in the United States. Synthetic opioids (other than methadone) are currently the main driver of drug overdose deaths. Opioids were involved in 69.5% of all drug overdose deaths and two-thirds of those deaths involved synthetic opioids.
Although 2019 data is still preliminary, the CDC estimates that 71,000 people died of overdose (a likely undercount, per the CDC) and over 36,000 of those deaths are from synthetic opioids.
In British Columbia, they saw over 340 fentanyl related deaths in 2 months over May and June 2020.
Fentanyl overdose prevention
It is safest to avoid fentanyl all together. However, even if that is your intention, it can be added to drugs without your knowing it. The following steps do not eliminate the risk of overdose, but they can help make use safer.
Before snorting or shooting, do a tiny amount or a tester shot, especially if you are getting drugs from a new source.
Get fentanyl testing strips. You can purchase these online to test your drugs. It is important to get testing strips only from reliable sources. A reliable place to purchase these is from Dance Safe.
Avoid using alone—especially if you are choosing to use fentanyl or you think your drugs might contain it.
If using with others, stagger your use so you can keep an eye on each other
Know the signs of an opioid overdose. Fentanyl overdoses happen fast.
Have naloxone on hand. Per SAMSHA guidelines, anytime someone does not respond within 2-3 minutes after administering naloxone, administer a second dose. For fentanyl overdoses, you may need to administer more than one dose.
When you call 911, be sure to tell them if the person has taken fentanyl or you suspect their drugs might be contaminated with them.
Support if you need it
Wherever you are on the continuum of use, Substance Use Therapy is here for you. You may want to explore your use, learn safer use practices or work toward ceasing your use. Whatever you are facing, you do not have to face it alone.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.