As the patient is wheeled into the emergency room, Dr. Jared Stone, MD, takes one look and immediately recognizes what he’s dealing with.
“The pupils are typically very small,” Stone explains. “The breathing is very slow. Their mental status or their ability to interact is minimal. They’re very depressed, almost as if they’re in a very deep sleep type of state.”
The diagnosis is painfully short and simple: It’s yet another fentanyl overdose.
Dr. Stone has seen this sad scene play out many times. As an emergency physician at South Carolina’s award-winning Lexington Medical Center (LMC), he’s often the first doctor overdose patients see when they’re brought in for treatment. He also deals with this worsening epidemic in his other position as a board-certified emergency medical services physician with Calhoun County’s EMS.
Fentanyl is a synthetic opioid which is anywhere from 80-100 times stronger than morphine, according to the U.S. Drug Enforcement Administration (DEA). Developed for cancer patients – including terminally ill cancer patients – it is being produced in massive quantities by black market drug dealers because it dramatically enhances the potency and the addictiveness of a wide range of their more conventional offerings.
“This whole fentanyl epidemic is tragic on so many fronts,” Stone said. “It’s permeated every part of our society. It’s in the urban areas, it’s in the rural areas. It’s affecting people of all ages, all socioeconomic classes. I see professionals coming in and people who have housing insecurity, people of all ranges. It’s not just the stereotypical street person struggling with it.”
As this news outlet has documented in recent years, fentanyl is killing growing numbers of South Carolinians. The S.C. Department of Health and Environmental Control (SCDHEC) reported in February of this year that fentanyl overdose deaths shot up 35 percent in just one year; from 2020 to 2021, there were nearly 1,500 fatalities.
It’s no coincidence this spike occurred during the recent pandemic, Stone pointed out.
“I saw a very clear shift as soon as COVID-19 hit," he said. "And as horrible as COVID was, and how it was awful seeing so many people die from the virus, it was equally tragic that so many people were struggling with mental health and substance use at a level we had never seen before. It brought on so many mental health issues and other issues that people turned to illicit drugs to cope with. During my meetings with the coroner, there was a very clear correlation in months when stimulus checks were released and the number of fatal overdoses; you could tell when the stimulus checks were released.”
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The pandemic may be over, but the wave of addiction it helped unleash still rages as destructively as ever. Pick any corner of the state, and the results are almost identical. Take York County, for instance, where 90 of 111 overdose deaths last year were attributed to fentanyl.
In response, the state is stepping up its efforts on the enforcement side. On August 1, governor Henry McMaster signed H. 3503 into law. This bill put fentanyl-related substances on the list of Schedule I controlled substances - and made it a felony offense to traffic in fentanyl. Penalties for fentanyl offenses were also increased, and minimum sentences were established.
Important as those steps are, will they be effective in fighting an addiction that has such a strong head start? Fentanyl abuse is so widespread now that when first responders reach someone who is unresponsive, many automatically act on the presumption that they have overdosed from it. Narcan is often immediately administered on the scene.
But while Narcan is a useful antidote in addressing overdose’s immediate effects - assuming the fentanyl hasn't been laced with a powerful sedative like xylazine - it is not a solution for the underlying epidemic.
“I think of it a lot like an EpiPen that’s used for somebody with a very severe allergic reaction,” Dr. Stone explained. “You give the EpiPen, and that can help to restore someone’s breathing and help temporarily bridge them to recovery. It’s the same thing for Narcan. But it only fixes that initial overdose. It’s an emergency treatment medication, but it’s not the long-term solution.”
That’s where addiction recovery treatment comes into play. However, fentanyl’s grasp on addicts is so strong there’s no guarantee of success.
“What I see very often is as someone is on the journey of recovery, they may have a period of abstinence, and they go several days of having this drug washed out of their system," Dr. Stone said. "Then they go back to trying to use the amount of fentanyl they were used to, and they end up either coming back to the emergency room or being seen by the coroner.”
Making a bad situation even worse, the drug is growing more potent than ever.
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“Unfortunately, it’s now being replaced with other versions of fentanyl where it can be modified to increase its potency even more," Dr. Stone noted. "The goal being to increase the euphoria the drug provides. However, it also makes it that much more deadly.”
Several years into the fentanyl onslaught, the situation has grown increasingly dire - but not hopeless. As Dr. Stone sees it, the solution lies in a community-wide response.
“It’s important for people to be educated on a number of things," he said. "First, there are people who otherwise can have a very long, healthy life ahead of them if they can just receive the support that they need to bridge the recovery. There should be an understanding by family members, friends, and others that this is not a moral failure; this is not a weakness. They badly want to get free from these drugs. Encouragement and support can go a long way to help."
“If you know somebody who’s in the middle of that battle, people do recover - there is hope," he added.
Those dealing with addiction are encouraged to reach out to the S.C. Department of Alcohol and Other Drug Abuse Services (SCDAODAS) for information on nearby organizations that provide prevention, treatment and recovery services. Working together, we can fight - and win - this battle.
ABOUT THE AUTHOR ...
J. Mark Powell is an award-winning former TV journalist, government communications veteran, and a political consultant. He is also an author and an avid Civil War enthusiast. Got a tip or a story idea for Mark? Email him at [email protected].
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