Origin: What is Fentanyl?

 

Fentanyl originated in 1959 and was introduced in the 1960s as an intravenous anesthetic (DEA, 2024). Whitaker et al. (2024) found that the Fentanyl crisis started 10 years ago when the cartels started to disagree over controlling the supply chain from China, purchasing the drug’s root chemical and to make manmade Fentanyl in labs in Mexico. The United States Drug Enforcement Association (2024) defines Fentanyl as a potent synthetic opioid drug approved by
the Food and Drug Administration for use as an analgesic (pain relief) and as an anesthetic that is to be administered in a controlled environment. Fentanyl is stated to be roughly 100 times stronger than morphine and 50 times stronger than heroin, and can be consumed by snorting, smoking, orally consumed, or found in patches. (DEA, 2024).

 

Fentanyl’s original purpose was to alleviate pain in clients in controlled environments (i.e. hospitals or labs) but is now easily accessible in all areas of the United States (Whitaker et al, 2024). It is common for Fentanyl that is illegally manufactured to be found in heroin, cocaine,
methamphetamine, and counterfeit pills which causes accidental poisoning (Texas Human Health Services, 2024). The National Institute of Health (2024) found that Fentanyl has many street names such as Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, Tango and Cash, and TNT. Some of the side effects when exposed to Fentanyl include small, constricted pupils, pale and clammy face, a limp body, blue/purple fingernails or lips, vomiting sounds, unconsciousness, and decreased breathing and heartrate (Texas Human and Health Services, 2024). There are many forms of Fentanyl such as oral (i.e. lollipops, lozenges), tablets, nasal sprays, transdermal patches, injections, and powders (DEA Fact Sheet, 2024).

Further, Fentanyl can be abused by injections, snorted, sniffed, taken orally or by the skin through patches (DEA Fact Sheet, 2024).

 

 

Fentanyl’s Impact on Society

 

The National Center for Health Statistics found that the estimated fentanyl overdoses in 2023 were roughly 74,702 people across all age groups in the United States (CDC, 2024). Coy and Sugue (2024) reported that Fentanyl is considered the deadliest driver in the opioid epidemic with the 2021 death toll being the highest total ever recorded with over 107,000 Americans. Friedman and Shover (2023) found that there was a racially diverse death toll in 2021 with Fentanyl deaths including American Indian/Alaska Native (805 deaths), Asian (464 deaths), Black/African American (13,592 deaths), Native Hawaiian/Pacific Islander (57 deaths), more than one race/ethnicity (816 deaths), and White/Caucasian American (45,592 deaths). Between the years 2013-2020, there was an explosive increase in Fentanyl deaths nationwide increasing by 2,209% for males and 991% in females (D’Orsogna et al, 2023).

 

The Fentanyl pandemic impacts all people from different ages, diverse groups, and genders. The New England Journal of Medicine (2024) concluded that they have identified 1,466 cases of illicit Fentanyl exposure in children younger than 6 years of age. Further, Kuehn (2023) discovered that there was a 109% increase in average monthly overdose induced deaths in adolescents ages 10-19 years old. Adults between the ages of 35-44 had the highest rate of overdoses at 62 per 100,000, and geriatrics had the lowest rate of Fentanyl induced deaths at 12
per 100,000 (Kuehn, 2023).

 

 

 

Fentanyl and the Impact on Black Americans

 

Following the COVID-19 pandemic, there was an increase in Fentanyl use disorder among Black Americans due to the restrictions that were in place during the pandemic that disrupted transit routes along the U.S./Mexico border (Blackwood & Cadet, 2021). Mahr (2023) investigated the spike in Fentanyl deaths among Black Americans and found that more Black Americans died from Fentanyl overdoses than any other drug in 2021 and at far higher rates than Whites or Hispanics. Further, Black Americans had an increase in exposure to Fentanyl because of stressful life circumstances including access to quality substance abuse treatment, ongoing income inequality, stigmas and discrimination, and making medication more readily available for opioid use disorder (Mahr, 2023). The National Library of Medicine (2023) stated that Black males in the Midwest are the largest demographic category that is the most fatally impacted by Fentanyl with 29 fatalities per 100,000 Black males. Bank et al. (2023) discovered that the increased exposure of Black opioid overdoses alongside Fentanyl was a result of Black Americans’ lack of trust in systems and providers, drug use as a coping skill, health and social consequences, and disinvestment in the Black communities.

 

 

The death toll among Black Americans has increased because of drugs such as Opioids being found laced with Fentanyl causing opioid-related overdose deaths (SAMHSA, 2024). The Black Opioid overdose deaths were found to be greater than White Opioid overdose deaths with Blacks being 252% and Whites being 72% above their baseline (Gondre-Lewis et al. 2022). Wu
et al. (2022) found that Blacks/African Americans had the highest increase in overdose death rates involving synthetic opioids like fentanyl.

 

 

Fentanyl in the Rural Black Community

 

Cox and Tamir (2022) highlighted that Black Americans living in rural communities account for 19% of the population. The Black population is the largest populations of color that almost all the rural lowlands of the South resulting in Jim Crow and segregation laws (Rowlands & Love, 2021). The Great Migration (2021) is noted to be one of the largest movements of Black

Americans across the United States, with 6 million migrating from the American South to Northern, Midwestern, and Western states approximately around the 1910s to the 1970s. In 2019, rural Black American residents had the highest reports of poverty at 30.7% (Economic Research Service, 2021). The National Library of Medicine (2016) found that individuals who live in rural communities face many life challenges such as the need to travel out of town for healthcare, accessing transportation related to health needs or career obligations, history of racial oppressive systems, and stigmas of racial microaggressions. As a result, tof the challenges faced
in rural communities, the use of drugs at early stages of life is more prevalent due to limited educational opportunities and easier access to drug exposure. (Hoeg, 2024). There is limited research on Fentanyl in the rural Black community, and there is a need to gain a deeper insight into the impact of lower socioeconomic and educational status of the increased use of fentanyl- induced drugs.

 

 

 

Treatment Options for Fentanyl

 

Opioid Agonist Treatment is a beneficial treatment for addiction to opioid drugs and involves taking the opioid agonists methadone or buprenorphine to prevent withdrawals and cravings for the opioid (CAMH, 2024). Baldwell et al. (2019) discovered that Opioid Agonist Treatment was found to be successful for many patients, but also has many limitations such as limited ability to recruit and maintain patients in treatment and the increase of unwarranted side effects. Methadone and buprenorphine are the most effective when a patient has been tapered off of methadone (30 mg), discontinued for 48 hours to evaluate potential withdrawal symptoms,
and then initiating buprenorphine treatment (Kaliamurthy et al., 2023). Naloxone, also known as Narcan, is a medicine that rapidly reverses an overdose from opioids and restores normal breathing to an individual if their breathing has drastically changed because of a fentanyl overdose (NIH, 2024). An individual who is administering Narcan to someone who has overdosed must have training on administering the drug (i.e. nasal sprays or injections), read the instructions on the product as well as be aware of potential expiration dates (NIH, 2024). The Food and Drug Administration (2023) approved 4 milligrams of Narcan nasal spray as an over-the-counter product because of drug overdoses continuing to be a major public health issue in the United States.

 

Fentanyl addictions can be treated using psychotherapy treatment including outpatient, intensive outpatient, self-help groups, or inpatient treatments. Outpatient therapy can assist an individual in gaining a better understanding of opioid use disorder, what triggers them to use the drug, and the reason for using the drug (CDC, 2024). Following the completion of psychotherapy treatment, the patient will be encouraged to be admitted into a rehabilitation facility such as the Discovery Point retreat, in which the aim is to provide the full continuum of detoxing and rehabilitation care alongside therapy to assist an individual in changing their life
(Discovery Point, 2024).