Fentanyl: Rising risks and community approaches

By Richard Uri, Substance Use Disorder Professional and Behavioral Health Coordinator at San Juan County Health and Community Services

Fentanyl is a powerful synthetic opioid, like heroin, only 50 times stronger. This high potency makes it more addictive and dangerous. It is used clinically as a pain reliever but over the past few years this drug has been manufactured illicitly and is flooding the market. Because of its high potency, a little goes a long way which means it can be added to other drugs cheaply. Cartels have latched onto it because they can smuggle it in smaller amounts for greater profits. It may be in powder form but typically reaches the market in homemade tablet or capsule form. Because the pills are made crudely there is no way to know how much ends up in each dose.

According to a study by the University of Washington, fentanyl use increased from 18% of intravenous (IV) drug use to 43% from 2019 to 2021 in King County. Seattle Police seized ten times as much of the drug in 2021 compared to 2020 and the numbers are still rising. A shift from IV use to smoking fentanyl has led to a disconnect between harm-reduction services, which have been primarily targeting people who inject drugs, and those at risk. The alarming rise in drug overdoses from smoking the drug is forcing communities and authorities to look for new ways to mitigate harm.

I have been a licensed Substance Use Disorder Professional for nine years. I now work in public health and maintain my connections to our recovery community. Based on my work in our county and my conversations with users the availability of opioids here is much more prevalent than when many of us were growing up here. Things have changed and we must change as well if want to prevent harm to our families and neighbors. This means trying new approaches and working together to help those suffering through substance use disorders.

If you read the recent articles in this publication about changes in the law, you know simple possession of narcotics is no longer a ticket to jail. I applaud Washington state for working to recognize substance use disorders as a health issue rather than a moral failing requiring punishment. If you have ever known someone going through it, you know they are already suffering. Unfortunately, options for treatment have not kept pace with the needs of our state. This means prevention and harm reduction may be our most effective tools against this health crisis.

Those of us who grew up in the era of the D.A.R.E. campaign and “Just Say No” had it drilled into us that substance use meant certain death or incarceration. This approach didn’t work. The war on drugs is over and as one of my past clients told me, “Drugs won.”. The new strategies are based on early education, promoting healthy choices, harm reduction, and making sure the tools for treating overdose are readily available. We have some proven, effective tools including work done by our local Prevention Coalitions, The Recovery Navigator Program at Compass Health, the Medically Assisted Treatment Program (Suboxone) at Peace Island Medical Center, and NARCAN. Participating in your local Prevention Coalition and learning about NARCAN, which saves lives by administering a powerful opioid blocker nasally, are our best lines of defense right now.

We are close-knit community. We can each make a difference. Now that people won’t be arrested for possessing or using drugs, we no longer need to worry about ruining someone’s life

by stepping in when we know something is wrong. Learn the signs of opioid use and talk to your families and friends just as you would talk with them about any other health concern.