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Overdose deaths, fentanyl and stigma — realities and opportunities

Use of fentanyl, either intentionally or unintentionally, is the leading cause of drug overdose deaths in Massachusetts. The state has seen a significant rise in opioid-related fatalities in recent years, largely driven by the drug supply containing more highly potent synthetic opioid drugs, like fentanyl. These overdose deaths are preventable, but the stigma of drug use mirrors the stigma of its treatment, and few people who want treatment actually get it. To end this stigma, we must treat the chronic disease of addiction with the same aggressive approach that we use for other potentially fatal chronic diseases, like diabetes, cancer, and heart disease.

Data collected from The Nation Center for Health Statistics (NCHS) shows drug overdose deaths rose from 2019 to 2021 with more than 106,000 drug overdose deaths reported in 2021. Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 70,601 overdose deaths reported in 2021.

Over the past 5-7 years, synthetic opioids like fentanyl and others have made their way into the Massachusetts drug supply. Because these novel synthetic opioids are much more potent than traditional opioids like heroin or oxycodone, it costs less for dealers to ship and distribute the tiny amounts necessary to produce the euphoria that people who use drugs seek. At the same time, there is no way for a drug user to determine the actual potency of the drug they have which would allow them to decide how much to use to obtain the desired results.

Unfortunately, there is a too fine a line between euphoria and death.

Even those people who are not trying to use opioids but instead are seeking to use cocaine, methamphetamine, or benzodiazepines, are being sold drugs that have synthetic opioids present. This may be in the form of pressed pills that are purely fentanyl, or the fentanyl may be cut into the other drugs.

Although fentanyl is the most recognized synthetic, potent, and highly addictive drug that is present in the supply, it is far from the only risk for people who use drugs. There are many other synthetic opioids and other classes of drugs that are readily available from dealers and the internet that are putting drug users at risk for accidental and preventable death from overdose and toxicity.

Massachusetts Public Health Commissioner Margret Cooke recently reported that Xylazine, a veterinary pain reliever and sedative that is not considered to be safe for humans, began being significantly detected in toxicology screens last year, and was present in 5% of opioid-related overdoses in 2022. There have also been reports of Carfentanil, an even more potent analogue of fentanyl, in the drug supply.

It is critical for everyone to know that people who have a substance use disorder (SUD) have a chronic disease that is treatable. Treatment providers have an obligation to remain vigilant about changes in the supply so they can adapt treatment to meet the needs of the patients seeking care. People who have been using potent synthetic opioids may need a different approach to managing withdrawal symptoms and titrating Medication for Addiction Treatment (MAT), like buprenorphine and methadone. They also need clear harm reduction education to keep them alive, such as using fentanyl test strips, carrying naloxone (Narcan), and never using alone.

According to the Substance Abuse and Mental Health Services Administration, MAT has been clinically effective in helping people achieve and maintain recovery. Because MAT provides a comprehensive, individually tailored program of both medication and behavioral therapy, this formula is often the key people need to stay in long-term recovery.

The stigma surrounding this devastating disease keeps people from getting treatment and finding recovery. We must make sure that people wrestling with this disease — like those fighting diabetes, cancer or heart disease — are treated with dignity and respect when they seek treatment. We need to provide quality, effective, affordable treatment options in every neighborhood, so every individual and every family has the chance to heal and recover.

We need to provide families and their loved ones with the tools and resources they need to help support them in their life of recovery. We also must work together — at home and in the community — to help eliminate the stigma around addiction and encourage those struggling with substance use disorders to seek help.

You can help right now by adopting non-stigmatizing language to describe people with this deadly chronic disease. A person who has stopped using drugs is abstinent, sober, in recovery or in remission. A person with an SUD who is currently using drugs or has resumed drug use after a period of abstinence is experiencing a recurrence. They have an active disease and need aggressive treatment to prevent overdose and death. Drug use is an emergency in SUDs just like chest pain is an emergency in someone with heart disease.

It is time for us to end SUD stigma and stop overdose deaths in the Commonwealth. If you or someone you know is suffering from addiction, now is the time to get help. Everyone deserves to survive this disease and live the life they desire.

Dr. Heidi Ginter is the Chief Medical Officer at Recovery Centers of America’s Massachusetts facilities in Danvers and Westminster.

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