Medicine news

News: A family’s promise to educate on fentanyl : Emergency Medicine News

fentanyl, drug use:

Eli Weinstock with his family at his high school graduation.

The photograph on the website of BirdieLight, a nonprofit organization dedicated to raising awareness of the dangers of fentanyl, shows Beth Weinstock, MD, and her daughter Olivia sporting smiles that cover their grief.

Dr. Weinstock’s son Eli died at his home in Washington, DC, in March 2021, where the 20-year-old was a sophomore at American University and an intern at the Spanish Education Development Center. She’s not sure how Eli came into contact with the fentanyl, but said it’s unlikely he knew anything he was taking was mixed with it.

“We have a story to tell and a promise to make. We made this promise to Eli Weinstock and to our bereaved hearts: a promise to build something good, real and honest atop this devastated landscape. Our job is to raise awareness of the dangers of fentanyl in drugs and distribute tools to prevent overdoses, so you have the power to save your own life. (Birdie Light. www.birdielight.org.)

Eli was not alone. The Centers for Disease Control and Prevention’s National Center for Health Statistics reported on May 11 that 107,622 people died from overdoses in the United States in 2021, a 15% increase from 2020. (https://bit.ly/3w4FjZB.) An estimated 75% of those deaths were attributed to synthetic opioids or fentanyl, according to the CDC.

The personal nature and enormity of the problem prompted the Weinstocks to act. “We formed BirdieLight as a nonprofit to educate young people,” Dr. Weinstock said. Their target demographic is 15-25 years old. “The knowledge gap is so wide. Many people think of fentanyl only in relation to heroin use. They try to teach young people that fentanyl is found in heroin, cocaine, counterfeit Xanax and oxycodone, Adderall, methamphetamine, ecstasy (Molly or MDMA) and popular party drugs as well .

She also said that she would like to eliminate the term “overdose”. “For many people, that means the person is using the drug daily or regularly. But it’s more like poisoning,” Dr. Weinstock said. “I get backlash about it, but the wording is important. Many people die because they are not used to opioids, and fentanyl is the strongest opioid.

Security testing

She and her daughter make education about the risks of fentanyl their primary focus. Fentanyl test strips, which can be 92-96% sensitive at detecting the presence of the drug, are one tool people can use to stay safe. “They’re very adept at identifying fentanyl, but they’re not perfect,” Dr. Weinstock said.

Several manufacturers make fentanyl test strips, but the most commonly used are those from BTNX, Inc., in Canada. They were originally designed as urine test strips, but found they could also detect fentanyl before ingestion.

“We always tell people they’re working if the stuff you’re taking is dissolved in water,” Dr. Weinstock said. If the person takes a pill or powder, they should dissolve it in water and test it. Cocaine must be tested in several places in its container. That can mean using many test strips for a single bag of cocaine, she said.

Whether people who use the drugs will take the time to test themselves is another issue, she said. People have learned to use seat belts and condoms to reduce risk, and they can do the same with test strips. Some states approve the tapes, but others have bundled them with paraphernalia of illegal drug use. Dr Weinstock said she hoped that would change due to the current drug-related death crisis.

“Culturally, we try to make it something standard that everyone talks about,” she said. This means making them more readily available. BirdieLight distributes them in colleges and hopes to make them available in all student dormitories and health centers.

Unpredictable overdose

A study conducted in a Baltimore emergency department found that four out of five patients who reported using opioids had detectable levels of fentanyl in their urine. (Clin Toxicol [Phila]. 2020;58[6]:460.) “The majority of participants were aware of its high potency, the dangers of its use, and the risk of death from overdose,” the authors wrote. “However, approximately one in three subjects intentionally purchased fentanyl despite awareness of its dangers.”

“I don’t think we can say the patients were ‘sophisticated’ or familiar with using fentanyl to avoid an overdose,” said Hong Kim, MD, MPH, study author and associate professor of medicine. Emergency and Pharmacology at the University of Maryland School of Medicine. “Because fentanyl is mixed with heroin or adulterants, the dose of fentanyl from a sample purchased for abuse is unpredictable. Some samples may have a higher dose of fentanyl while other samples may have low doses due to inconsistency in the mixing of fentanyl in the adulterants. Thus, the overdose event itself is unpredictable.

The study did not ask how patients use or avoid overdoses. “There is no better way to reduce opioid/fentanyl use and overdose deaths,” Dr. Kim said. “There are socioeconomic, environmental and individual factors that contribute to the development of substance use disorders. Therefore, local, state, and federal governments and NGOs have engaged in public health interventions and attempted to address opioid use disorder from multiple angles.

“Supervised injection sites can also help identify overdose events since opioid use is supervised and intervention (e.g., naloxone administration) is possible to reduce death from overdose. Some cities in Canada and Baltimore have distributed fentanyl test strips. I don’t know to what extent they are accepted or used by opioid users. »

The DOPE project in San Francisco and the Syringe Access Collaborative conducted a pilot project donating test strips to syringe access sites. The strips were provided through a program supported by the California Department of Public Health.

Syringe access providers worked with participants to test medications and complete a brief survey regarding the results, including how finding out that a sample was positive or negative affected participants’ drug use . Providers used the strips to test medications, and participants also received strips to test their own medications. Seventy-eight percent of speed and meth samples and 67 percent of crack samples tested positive for fentanyl.

“Providing the test strips, overdose prevention training, and naloxone continue to honor the autonomy of people who use drugs, empowering them to make informed decisions with the most accurate information available to them and prevent and respond to overdoses,” the DOPE project wrote. managers. (National Harm Reduction Coalition. https://bit.ly/3dsTlOk.)

“Fentanyl is everywhere”

Dr. Weinstock said she hopes to educate students before they experiment with drugs that could be contaminated with fentanyl. “The most powerful thing we do is go to high schools and colleges,” she said. “We come in front of the students and talk about all things experimentation and what it means in 2022 to use drugs recreationally. When we hand out strips, we like to sit down and talk about drug use. »

Getting into high schools and colleges can be difficult due to the stigma around drug use and institutional denial. “I think they don’t want to admit that there are students who take drugs. But we’re trying to push,” Dr. Weinstock said. The current focus on the risks of fentanyl strikes a chord, she said, and their schedule of presentations is starting to fill up.

Educating the medical community on the use of test strips to identify fentanyl can also help. “I recently spoke to a group of doctors, hospitalists, nurse practitioners, and medical assistant students in southern Ohio. It was surprising how many of them had never seen or heard of a fentanyl test strip. I realized how much education we need to do in the healthcare community,” Dr. Weinstock said.

She and her daughter Olivia started the project, but the rest of the family supports their activities. Her husband Michael is an emergency doctor, Theo is 18 and Annie is 14.

Their goal is simple: they want to reduce the death toll from fentanyl.

“Eli took risks like any other student, he didn’t want to die. It takes a seemingly innocuous choice. Fentanyl is everywhere,” Olivia told the BirdieLight website.

Ms. SoRellehas been a medical and science writer for over 40 years, formerly at the University of Texas MD Anderson Cancer Center, The Houston Chronicle, and Baylor College of Medicine. She has received more than 60 awards, including the Texas Human Rights Foundation Award. She contributed to REM For more than 20 years.