Fentanyl leading cause of opioid overdose deaths

May 1, 2023

At the outset of the opioid epidemic, overdose deaths resulted mainly from prescription opioids, including natural and semi-synthetic opioids. Soon, heroin was the top culprit. Now, fentanyl is the leading cause of opioid overdose deaths, according to speakers at the 22nd Annual Rural Health Conference, held April 12-13 at The University of Alabama and hosted by UA’s Institute for Rural Health Research, which is part of the College of Community Health Sciences.

Conference speakers noted that fentanyl, a synthetic opioid used for pain relief and as an anesthetic, is 50 times more potent than heroin.

Bridget Brennan, a special narcotics prosecutor in New York City who spoke at the conference, said New York City has become a regional hub of fentanyl distribution and that illegally manufactured fentanyl is made to resemble prescription opioids.

Another conference speaker, Dr. Mercy Mumba, associate professor and director of the Center for Substance Use Research in UA’s Capstone College of Nursing, said fentanyl is also being mixed with xylazine, a tranquilizer used in animals and not approved for human use.

The conference, “Turn the Tide: Preventing, Treating and Investigating the Opioid Crisis,” featured keynote speakers, as well as breakout sessions and student and faculty research poster presentations.

The annual Rural Health Conference is attended by health care professionals, community leaders, researchers, government officials and policymakers working together to share information and knowledge and make a difference in the health of rural communities. The Institute for Rural Health Research is part of UA’s College of Community Health Sciences.

There were 107,622 drug overdose deaths in 2021 resulting from prescription opioids, heroin and fentanyl.

Conference speakers said some of the reasons for the opioid crisis include the overprescribing of opioid medications to patients, and the difficult process to withdraw from the medications. Opioids can make the brain and body believe the drug is necessary not only to relieve pain but for survival, speakers said.

Dr. Boyde Harrison, a family physician, said treatment of chronic pain with opioids has become the gold standard, with hydrocodone being the most frequently prescribed opioid in the United States. Among all states, Alabama has the highest prescribing rate of hydrocodone.

But since 2017, fentanyl has bypassed prescription opioids and heroin to become the highest cause of overdose deaths, while at the same time treatment is challenging. Conference speakers said barriers to treatment include the high cost of treatment and a lack of health insurance coverage.

When people are not able to get the treatment they need, they can go into a state of withdrawal and become “dopesick,” said Dr. Stephen Loyd, chair of the Tennessee Opioid Abatement Council and vice president of the Tennessee Medical Board, who spoke at the conference.

Alabama Drug Evaluation Instructor Paul Thompson said withdrawals can include aches, chills, insomnia, nausea, anxiety and restlessness. Signs of a drug overdose can include blue lips, pale or blue body, clammy skin, convulsions and slow and shallow breathing, he said.

Mental health challenges can offer insight into the opioid crisis and substance abuse disorders. During COVID-19, studies showed that opioid use increased among teens and adults. Kim Boswell, commissioner and director of the Alabama Department of Mental Health, said the COVID-19 epidemic increased depression and anxiety, affected caregivers’ mental health and offered few socioeconomic resources. Boswell said young people with mental health challenges can experience a higher risk for early and regular substance use and substance use disorder.

“Early investment in mental health care yields up to 10 times the savings in health care and juvenile and criminal justice,” she said.

Boswell said the federal Substance Abuse and Mental Health Service Administration (SAMHSA) has awarded her agency a specially designed certified community behavioral health clinic planning grant that receives flexible funding to expand the scope of mental health and substance use services available in communities. The goal is to ensure that there is high-quality care and health equity in mental health and substance use services, particularly for underserved populations.

Boswell said Alabama’s Crisis System of Care focuses on “Someone to Call, Someone to Come to You, and A Place to Go.” People can call 988 to access services for substance use disorder and mental health services, and there is a 24/7 helpline to speak to a person in recovery who can assist with navigating the treatment process.

“It takes the public health community to be a part of this fight,” said Alabama Attorney General Steve Marshall. “It is a part of mental health and those that deal with addiction. This is an issue that affects our country as a whole. Getting treatment and access to health care should be a number one priority.”

Other conference and breakout session speakers included: Dr. Josh Eyer, director of the UA Southern Regional Drug Data Research Center; Dr. Curt Harper, chief toxicologist at the Alabama Department of Forensic Sciences; Dr. Melinda Carter, professor of anatomical sciences at the Edward Via College of Osteopathic Medicine; Dr. Edward Reedy, senior medical examiner of the Alabama Department of Forensic Sciences; Dr. Lilanta Bradley, engagement lead for the All of Us Research Program; Dr. Maggie Davis of VitAl Alabama: Improving Wellness in Alabama; Dr. Erin Shonsey, director of Research for the Alabama Department of Forensic Sciences; and Alabama Deputy Attorney General Joshua Hayes.