Why are synthetic opioids so dangerous? An ER doc explains

By Katia Hetter, CNN

(CNN) — The United States is facing an alarming increase in overdose deaths among young people due to synthetic opioids.

The rate of drug overdose deaths involving synthetic opioids, which include fentanyl and fentanyl analogs, increased more than 20-fold between 2013 and 2022, according to the US Centers for Disease Control and Prevention.

Overdoses and drug poisonings are now the third leading cause of death in people under age 20, behind firearms and motor vehicle crashes.

The overdose death counts among US youth ages 15 to 24 rose from 4,652 to 6,723 between 2018 and 2022, according to a new study in the journal Pediatrics. (A slight decrease occurred between 2021 and 2022.)

The largest increase was seen in deaths involving only synthetic opioids: Since 2020, fatal overdoses involving only these substances were higher than overdoses in which multiple substances were implicated. Overdose rates were nearly 2.5 times higher among male youths compared with female youths and more than two times higher among those ages 20 to 24 compared with those ages 15 to 19.

As a parent, I wanted to know more about synthetic opioids and their uses. Why are they so dangerous, and how are overdoses treated? How can people tell if the drugs they are taking contain synthetic opioids? Crucially, what can parents and other family members do to help reduce the risk of overdose?

To help us answer these questions, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and adjunct associate professor at the George Washington University. Previously, she served as Baltimore’s health commissioner, where she oversaw the city’s opioid prevention strategy.

CNN: What are synthetic opioids? What are they used for?

Dr. Leana Wen: Prescription opioids are medications used to treat severe pain. They must be used with caution, however, because if they are used in higher than prescribed doses or otherwise incorrectly, they can result in drowsiness, slowed and shallow breathing, and even death.

Opioids can be classified by where they originate. So-called natural opioids are derived from the poppy plant and include drugs such as morphine and codeine. Semisynthetic opioids include oxycodone and hydrocodone. Synthetic opioids are made in the laboratory.

The synthetic opioid most implicated in fatal overdoses is fentanyl, according to the National Institute on Drug Abuse. There are other synthetic opioids too, such as tramadol and methadone. Methadone is also used as a treatment for people with opioid use disorder. Notably, the CDC’s statistics and the new study in Pediatrics do not include methadone in their calculation of fatal overdoses due to synthetic opioids. The majority of synthetic overdose deaths in the US involve fentanyl or fentanyl derivatives.

CNN: Are there legitimate medical uses of fentanyl?

Wen: Yes. Fentanyl is often used in emergency settings to treat acute pain. For instance, someone who was in a high-speed car accident and just broke their hip needs immediate pain relief. It is also given to patients who have chronic pain that is not relieved by other methods. Some cancer patients with intractable pain use a fentanyl patch or fentanyl lozenge, for example.

The current trend of youth overdoses is probably not mostly due to fentanyl being diverted from legitimate medical purposes. In recent years, there has been a significant problem with fentanyl being made in illegal labs.

Synthetic fentanyl is sold illegally as a powder dropped onto blotter paper, put in eyedroppers and nasal sprays or, perhaps most terrifyingly, as pills that resemble other prescription pills, according to the National Institute on Drug Abuse.

In addition, fentanyl is often mixed in with other drugs. People who think they are taking amphetamines, oxycodone, cocaine, heroin, MDMA (also known as ecstasy) or other “party drugs” may be unknowingly taking fentanyl. Depending on the amount of fentanyl they are ingesting, they could overdose and die.

CNN: What makes fentanyl especially dangerous?

Wen: To begin, fentanyl is an extremely potent opioid. It is 50 to 100 times more potent than morphine. A small amount can lead to oversedation and death. People may not realize how dangerous fentanyl is or even that what they are taking has fentanyl in it. There have been numerous cases of high school and college-age students who have died after being given fentanyl-laced pills.

CNN: How are overdoses treated?

Wen: The treatment for opioid overdose is the medication naloxone, also sometimes referred to by its brand name Narcan. It is available as a nasal spray and as an intramuscular injection. The nasal spray is available over the counter for under $50. Some health insurance plans will cover naloxone, and some state and local health departments may give out this medication free of charge. If given immediately after someone loses consciousness, it could reverse the overdose and save someone’s life.

Individuals who come to after getting naloxone should still receive immediate medical care. They may need additional doses of naloxone, and they could need treatment for other potentially dangerous substances they have taken.

CNN: How can people tell if the drugs they are taking contain synthetic opioids?

Wen: This is an important question — the answer is that people can’t easily tell if the drug they are taking contains fentanyl. Counterfeit medications can look exactly like the prescription form. If fentanyl is mixed in with cocaine or other illicit drugs, it’s not possible to tell based on simply looking at the substance, as fentanyl is odorless and colorless.

Fentanyl test strips can check for the presence of fentanyl in the drug supply. While the use of these strips can reduce overdose risk, know that just because one pill in the supply doesn’t contain fentanyl doesn’t mean that others all don’t. Moreover, these strips don’t test for other contaminants that can also be deadly.

I want to share another key number: Of the fentanyl-laced fake prescription pills analyzed in 2022 by the US Drug Enforcement Administration Laboratory, 6 out of 10 contained a potentially lethal dose of fentanyl. This is a sobering statistic and should be reason enough for people never to use illicit prescription pills or other illegal substances.

CNN: What can parents and other family members do to help reduce the risk of overdose?

Wen: Parents should speak with their children about the danger of counterfeit and illicit drugs. It doesn’t matter if parents used drugs when they were younger. Drugs today are so much more powerful and dangerous.

People should never take medications that don’t belong to them. They don’t know where the medications came from, if the medications are really what they claim to be, and whether they have contaminants such as fentanyl in which even a small amount could be fatal.

I think it’s also good practice to have naloxone accessible. As I mentioned, this medication is now available over the counter. Everyone can learn to use it and have it in their medicine cabinet.

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