No one – in Alabama or elsewhere – should be ingesting any drug not prescribed by a medical professional, a group of health experts said Wednesday during a discussion about illicit fentanyl and its contribution to an explosion of overdose deaths.

“There is a percentage of the population that believes it’s OK to take medication that is not prescribed to you,” said Ian Henyon, executive director of the Birmingham Recovery Center. “We try to educate the families that you need to see a doctor when you need a prescription for something.”

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Counterfeit pills make using someone else’s medication “even riskier.”

For emphasis, he added, “Do not take medication that is not prescribed to you, no matter what.”

Henyon joined other professionals as part of a Facebook Live discussion about deadly synthetic fentanyl. The event was hosted by the Medical Association of the State of Alabama.

‘One Pill Can Kill’

The overriding theme of the discussion was to provide information about a drug contributing to a nationwide surge in overdose deaths.

The discussion also comes at a time when lawmakers in Alabama scramble for solutions and warnings to parents about the growth of illicit fentanyl use. In recent days, for instance, some lawmakers have warned about the circulation of so-called “rainbow fentanyl” that looks like candy, ahead of the holiday season.

But the overriding message emphasized by the medical experts was this: Do not take any medicine that is not prescribed by a doctor.

That messaging was amplified last year by the U.S. Drug Enforcement Agency, which released a public service announcement called “One Pill Can Kill.”

“For most people, at some point in life, they borrowed medication from someone else,” said Darlene Traffanstedt of the Jefferson County Health Department. “Five to 10 years ago, that was less of a concern than it is today. If your college roommate purchases something that appears to be a legitimate (pill) and offers to share it with you, it might be the last decision you ever make.”

She said, “If you take a pill that did not come from the pharmacy itself, it could have fentanyl in it.”

Richard Tucker, former special agent with the U.S. Drug Enforcement Agency and a consultant with the Drug Education Consulting Group, said recently in St. Louis, 500 people overdosed on suspected fentanyl. Of those, 50 percent “did not know what they were taking.”

“They are in social situations, or they were sold a bill of goods that this is OK and won’t hurt you,” Tucker said.

‘Acute crisis’

Tucker said that education about the illicit use of the drug is key toward reversing some startling statistics that include:

• Fentanyl deaths in Alabama skyrocketed by 136% between 2020-2021. Officials are anticipating even more deaths this year.
• Treatment center admissions rose by 170% between 2020-2021, from 150 two years ago to 417 last year, according to the Alabama Department of Mental Health.
• Deaths in Jefferson County rose 223% since 2019, from 95 that year to 316 in 2021, Traffanstedt said. So far in 2022, she said there have been 283 overdose deaths with 56 additional deaths pending certification. Of those, Traffanstedt said, 230 are related to fentanyl, or 81%.

“For us, it’s an acute crisis of very significant proportions,” she said.

Medical experts say the cause for concern is the potency of the drug, and the fact that it’s mixed with other illicit medication and drugs like methamphetamine and marijuana.

Fentanyl is used legally by doctors to treat severe pain and other advanced-stage cancers. But when it’s used in an unregulated setting or manufactured illegally, a tiny amount – 2 milligrams, for instance, or an amount that can fit on the tip of a pen – can kill someone.

The drug has long been described as 50 times more powerful than heroin, and 100 times more powerful than morphine.

“This stuff is so strong and hits the (brain) receptors so fast,” said Tucker. “For the heroin user, it takes time for the effect (to occur). The fentanyl users are getting an instant euphoria. They want speed and efficiency, and that is what they want in fentanyl.”

Education and Narcan

The drug’s explosive use is leaving professionals scrambling for solutions and seeking ways to educate the public about how to combat it.

In Alabama, state lawmakers are looking for solutions that include punishing traffickers of fentanyl and issuing mandatory-minimum sentences against people to distribute the drug throughout the state.

Said Tucker, “There are smart people in Alabama tackling this. You have the resources. We’ll never arrest ourselves out of this situation. Education and treatment is the only way.”

Traffanstedt noted the accessibility of naloxone, marketed under the brand name Narcan, which is available in pharmacies and free through the Jefferson County Health Department.

Naloxone is a medicine that rapidly reverses an opioid overdose, quickly restores normal breathing to a person if it has slowed or stopped due to the drug use.

Narcan’s popularity has risen within the past year. During Spring Break in South Florida, drug outreach teams distributed Narcan to visitors. Florida is also planning to distribute Narcan nasal sprays to all 67 counties and allow them to be used without oversight of a health provider.

“In the state of Alabama, all barriers are removed to obtaining naloxone,” said Traffanstedt.

Tucker, though, said Narcan is not effective with some other synthetic opioids, like nitazene, that are now in circulation.

He said there are about 15 or so varieties of fentanyl in circulation that are leading to overdose deaths.

“These are chemicals we are not used to dealing with,” Tucker said. “There are different varieties out there now. It’s a horrific drug.”