Drug cartels turn to a synthetic opioid 100 times stronger than fentanyl, 'killing hundreds of unsuspecting drug users'

The chemical makeup of carfentanil. The drug is legally used to  
anesthetize large animals such as elephants and rhinoceroses. 

Carfentanil is a deadly "weapons-grade" synthetic opioid that illicit drug makers are adding to other drugs as a potent substitute for fentanyl. The drug, which authorities say is "10,000 times more potent than morphine and 100 times stronger than fentanyl, has seen a drastic resurgence across the U.S., killing hundreds of unsuspecting drug users," report Hallie Golden and Jim Mustian of The Associated Press.

Carfentanil's presence in illegal drugs sold in the U.S. has surged since the Chinese government's more recent "crackdown on the sale of precursors used to make fentanyl," AP reports. "Those regulations are likely prompting traffickers in Mexico to use carfentanil to boost the potency of a weakened version of fentanyl."

The sheer potency of carfentanil is what makes it so dangerous for anyone who takes drugs not prescribed by their doctor. Frank Tarentino, the U.S. Drug Enforcement Administration chief of operations for its northeast region, which stretches from Maine to Virginia, told AP, "You’re talking about not even a grain of salt that could be potentially lethal. This presents an extremely frightening proposition."

While some Mexican drug cartels may be making carfentanil in their own labs, others are purchasing it from darknet marketplaces. Regardless of where it originates, it's making its way onto American streets. Golden and Mustian write, "In 2025, DEA labs identified carfentanil 1,400 times in U.S. drug seizures, compared with 145 in 2023 and only 54 in 2022."

Russia used an aerosol form of carfentanil as a chemical weapon to subdue Chechen separatists in 2002, AP reports. It is legally used to anesthetize large animals, such as elephants.

Michael King Jr., founder of the Opioid Awareness Foundation, told AP, “It’s like a biological weapon. If the world thinks we had a problem with fentanyl, that’s minute compared to what we’re going to be dealing with with carfentanil.”

Opinion: Rural kids need more than trade school training to lift themselves out of hopeless circumstances

Working-class rural kids need more than trade school training to help pull themselves out of unhealthy living situations, including abject poverty, writes Jessica Grose in her opinion for The New York Times.

Grose cites the new book by Beth Macy, Paper Girl: A Memoir of Home and Family in a Fractured America, as a source for insight and solutions on how the U.S. education system could help more rural youth recover from trauma and set their lives on a different track.

"Macy, a former newspaper reporter and the author of 'Dopesick,' the 2018 best seller about how the opioid crisis ravaged Appalachia, returned to her hometown, Urbana, Ohio, for the new book," Grose explains. "She is trying to figure out how a working-class girl like her got to college and the middle class from Urbana 40 years ago, while that journey is much more arduous for today’s rural working class."

"How do young people, especially those without supportive parents, make a future for themselves? . . . While learning a trade is excellent advice for many students, it is not the cure-all for inequality that our commerce secretary, Howard Lutnick, hopes it might be when he says he wants Harvard to build vocational schools,'" Grose explains.

Grose points out that "learning a trade" isn't easy and that trade work requires "the same kinds of executive functioning, people skills and intelligence that a college education requires, just applied differently."

Giving working-class youth the help they need through rural schools is one of the best solutions, according to Macy. "Rural schools need better access to wraparound services, providing students with necessities like food, but also health care in the form of school nurses and counselors on site," Grose adds.

But providing those types of services in rural areas is a tall order. Grose writes, "Most school systems run on economies of scale and a per-student funding model; it poses a great challenge to provide wraparound services to districts with fewer students who have a lot of needs and who are also spread out."

"My dark prediction is that kids with more stable families and better developed life skills will occupy the trade jobs that used to be a reliable route to the middle class," Grose asserts. "We need to support working-class kids before the 21st century abandons them completely."

Drugged driving is difficult to detect, but it impairs drivers and contributes to accidents and fatalities

Cannabis slows reaction time and alters spatial awareness. 
 (Jason Doiy, iStock, Getty Images via The Conversation CC)

Despite its often invisible presence, drugged driving is a developing problem in most states. On rural roads where almost half of fatal crashes in the U.S. occur, the risks posed by drugged drivers may be disproportionately higher, but difficult to detect or prove.

In 2020, roughly 12.6 million people aged 16 and up drove after using illegal drugs. "Of that total, roughly 11.7 million were under the influence of cannabis," writes Andrew Yockey, a public health expert at the University of Mississippi, for The Conversation. 

While cannabis use is often downplayed, it impairs reaction time and spatial perception. Yockey explains, "Multiple studies have found that drivers with THC, the primary psychoactive compound in cannabis, in their bloodstream are about twice as likely to be involved in a fatal crash – either as the cause or as a victim – compared with those who haven’t used drugs or alcohol."

Other drugs or any mix of drugs also play a part in devastating vehicle collisions and fatalities. "Opioids can cause drowsiness and dizziness. Stimulants like cocaine or methamphetamine may lead to overconfidence and aggressive driving," Yockey adds. "When drugs are mixed — or combined with alcohol — the risks increase dramatically."

All states prohibit drugged driving, but how they enforce those laws varies, leaving "legal gray areas in how the laws are interpreted and enforced," Yockey writes.

Despite laws designed to discourage and punish drugged driving, detecting and measuring illicit drug use in drivers is tricky. "There is no standardized way to measure drug impairment as there is with blood alcohol content," Yockey explains. "Roadside tests that cops use to spot drunk drivers don’t work as well for drug impairment."

States have increasingly turned to using roadside saliva tests, which can "detect recent drug use more quickly," Yockey writes. But again, the measurement of drugs still in the bloodstream and how that translates into driving impairment or ticketed offenses isn't clear.

Report: The national cost of opioid use disorder is in the trillions of dollars each year, in addition to the suffering

Axios map, from Avalere Health data

As counties across the U.S. see many types of illicit drug deaths decrease, the country is left to grapple with the long trail of complex problems drug addictions cause, including their massive price tags.

A newly released in-depth analysis "concludes that it costs an average of nearly $700,000 to treat each affected person," reports Maya Goldman of Axios. "The cost burden falls unevenly, with states in a belt stretching through Appalachia to New England typically having bigger caseloads and a higher cost per case."

Although it's not possible to pin down the exact net dollars the country spent on opioid use disorder, the analysis from Avalere estimated 2024 costs at $4 trillion." The report's author, Margaret Scott, told Goldman, "While this is a cost to government, it's also a cost to private businesses, and the huge cost, of course, is to the individuals who have" opioid use disorder.

Comparing regional expenditures illustrates how extreme the costs for treatment can be. "The projected cost of opioid use disorder in 2024 ranged from $419,527 per case in Idaho to more than $2.4 million in D.C.," Goldman explains. "That covers lost productivity, health insurance costs, property lost to crime and other variables."

The economic losses from OUD are second only to the degree of human suffering individuals, families and friends have experienced by way of OUD trauma. Some of the sobering estimated and reported costs include:

• Economic burden on patients, including years of life lost and reduced quality of life, exceeded $3 trillion in 2024.
• Private businesses absorbed more than $467 billion in costs from lost productivity and health insurance costs.
• The federal government bore about $118 billion in Medicare and other federal insurance costs, lost taxes and criminal justice expenses.
• It cost state and local governments more than $94 billion, with about $42 billion going toward criminal justice costs.
• The Trump administration in March released its own analysis that estimated illicit opioids cost the U.S. about $2.7 trillion in 2023.

One way to reduce opioid treatment costs is to offer individuals the most effective treatment combinations possible. "Behavioral therapy alongside long-acting injectable buprenorphine — a treatment that reduces the risk of future overdoses — generated an estimated $295,000 savings per case, the biggest cost-saver of the options Avalere analyzed," Goldman reports. "Behavioral therapy alone saves a project $144,000 per case."

To use Axios' interactive state map of costs, click here.

Fentanyl imports saturate U.S. illicit drug market. U.S. tariffs aim to curb its transit as fentanyl continues to kill.

The global drug problem has ended countless lives.
(Unsplash image)

More than 70% of drug overdose deaths are due to opioids, with fentanyl as the main assailant. From August 2023 to 2024, 89,740 people died from overdoses in the United States. This number is 22% less than than the year prior, according to Centers for Disease Control and Prevention projections.

Fentanyl is a synthetic opioid that is up to 100 times stronger than other opioids like morphine, heroin or oxycodone. Its main use, as approved by the Food and Drug Administration, is as a pain reliever. Often fentanyl is mixed into other drugs as a cheap way to make them stronger. According to José de Córdoba, Vipal Monga, Julie Wernau and Brian Spegele of the Wall Street Journal, “The drug is cheap to make, provides huge profit margins and is easy to smuggle.”

“President Trump has declared that the illegal transit into the U.S. of migrants and drugs, chiefly fentanyl, is a national emergency, and he has targeted Mexico, Canada and China with tariffs to force them to halt the flow,” reports the Journal.

According to the Journal, Canada responded to the fentanyl problem in 2024, saying that it would invest "$900 million over six years to improve security." China cracked down on the production and sale of fentanyl in 2019, however it continues "to produce the chemical ingredients used to make fentanyl and to sell them to drug producers in Mexico, the U.S. and elsewhere.” Mexico also said that it would increase border security to focus on preventing drugs from crossing the border.

Mexico President Claudia Sheinbaum, “whose top security concern is a war between two factions of the Sinaloa cartel, said she asked for Trump’s help in stopping the smuggling of weapons to Mexico that end up in the hands of cartels,” reports the Journal.

A rural jail has success curbing opioid addictions: 'Jails are an incredible opportunity to help people enter recovery'

Alane O'Connor, DNP

Developing an effective and repeatable treatment for addiction sufferers has proven elusive -- until now. A rural jail in Maine has a solution that could save thousands of lives.

Addiction medicine specialist Alane O’Connor is leading a pilot program that "offers a monthly injection of the drug Sublocade to addicted inmates," reports Kristina Samulewski of The New York Times. The drug works through a time-release mechanism that curbs opioid cravings for a month. O'Connor presents her case for jails as drug recovery centers on the Times' podcast, "The Opinions." An edited synopsis of her discussion is shared below.

The state of Maine is overwhelmingly rural. It also has "one of the highest rates of opioid use disorder in the nation. And people who are incarcerated have an even higher rate, because often times the two go in tandem," O'Connor explains. "Jails are an incredible opportunity to help people enter recovery. It’s a time where motivation is often very high, but I think we don’t do a very good job, really, across the country in giving people access to the treatment that they need."

In response to the opioid epidemic's extreme reach in Maine, O'Connor suggested that Somerset County Jail try a different approach for treating inmates with opioid addictions. "I proposed an alternative medication, which I had been using in my community practice since 2017," O'Connor adds. "It’s not a pill. It’s actually an injection into the abdomen, and it’s called Sublocade."

Sublocade is gradually and continuously released into a recovering addict's system. Other opioid drug treatments can include daily methadone and/or Suboxone pills, which people can opt not to take. Sublocade does not offer a choice.

"If I have a patient that I’m prescribing Suboxone to and they don’t have that medication tomorrow or the next day, they are going to get very sick," O'Connor explains. "Sublocade slowly dissolves out of the system, and so patients will start to feel some symptoms after five or six weeks. But there isn’t this cliff that ends where people get very, very sick."

O'Connor says, "I’ve never, ever met anyone who said, I want to grow up and be addicted to drugs and end up in jail. It’s just not a reasonable thing to even think. And yet, I think society believes that patients can just make the choice to stop using tomorrow. And if they don’t have the appropriate medical treatment, that’s just a totally unreasonable expectation."

When Somerset County Jail's Sublocade treatment results were compared with another rural Maine jail where inmates received a daily pill of Suboxone, the results were striking. O'Connor notes, "We found that people treated with Sublocade were almost three times as likely to continue treatment when they leave the jail, relative to folks who were treated with the daily medication. . . . The most important finding was that we had no deaths in the people that were treated in the Sublocade pilot . . . In the comparison jail, unfortunately, there were four deaths."

A little-known pharmaceutical company that made billions selling opioids 'escapes' billions in fines and IRS payments

Endo began in 1920 as "Intravenous Products of America." Its website does not mention opioids;
instead it highlights the company's "past successes and history of expertise." (Endo photo)

A lesser-known pharmaceutical company named Endo made billions of dollars during the U.S. prescription opioid crisis by marketing its flagship opioid, Opana ER, as safe and non-addictive.

Despite whistleblower suits from Endo employees, the U.S. Department of Justice failed to pursue Endo, even as it vigorously prosecuted Purdue Pharma for its part in the opioid crisis, report Bob Fernandez of ProPublica and Craig R. McCoy of The Philadelphia Inquirer. The DOJ's investigative delay and the company's clever bankruptcy exit strategy allowed Endo to "escape $1.5 billion in fines and forfeitures" it owed and billions more "officials said it owed the U.S. government."

When the DOJ finally moved to prosecute Endo for its part in the opioid crisis, the company was bankrupt. "In what amounted to a liability fire sale by the Justice Department, the company’s woes with the federal government would all be resolved by a $200 million payment," Fernandez and McCoy explain. "In sentencing Endo in federal court Judge Linda Parker wondered how the amount paid to the U.S. could be so low. Parker said, 'I just don’t understand how it went from $1 billion to $200 million.' Federal prosecutor Benjamin Cornfeld explained: Endo was broke."

While Endo's 2024 financial troubles were real, a deeper look at the DOJ's delay after winning a criminal case against Endo in 2014, revealed how in those intervening years allowed Endo "vastly expanded its narcotic-pill empire before executing a corporate escape plan," Fernandez and McCoy write. "The plan allowed Endo to restructure its debt to retain control of the company and hand out $95 million in executive bonuses before seeking protection in bankruptcy."

DOJ's settlement with Endo concluded some of the company's financial troubles and "also mostly erased claims of another $1.5 billion for false health care billing and Medicare costs generated by the opioid crisis." In addition, "Endo paid a tiny fraction — three pennies on the dollar — of the $7 billion that officials said it owed the U.S. government, including $4 billion in taxes," Fernandez and McCoy explain. "Hundreds of lawyers, paralegals and financial advisers litigated Endo’s bankruptcy, billing more than $350 million. . . . Individual opioid victims didn’t fare as well. They got just $40 million from Endo — a sum that works out to about $1,000 per victim."

Expert, best practices resources for journalists from Reporting on Addiction are available and free

Reporting on Addiction is a collaborative movement staffed by media professionals working to decrease addiction stigmas by sharing leading practices for covering all types of addiction.

Photos can help readers connect and
remember. (ROA photo)

 

One of the project's best offerings is its website's visual guide, which allows journalists to access photo portrayals that illustrate addiction experiences from multiple real-life angles. This addiction-sensitive photography helps journalists report on substance use while sticking to a principle of "do no harm."

The photos also help readers develop a more memorable and connected understanding of how illegal drugs harm individuals and communities. Access their one-page visual style guide here.

Applying for Reporting on Addiction's expert database
takes less than five minutes. (ROA photo)

The project also gives options for newsrooms of various sizes, including professional and student newsroom training, research-based reporting resources, and an active expert database for question-and-answer sessions.

For journalists covering the opioid settlement's terms, disbursements and news, the site has a series of recorded "Fireside Chats" and a Slack channel to help reporters inform readers about where, when and how opioid litigation money will be handled in their community.

As added support, Reporting on Addiction offers downloadable, free resources that include:

• Language style guide
• Digital Security Toolkit
• Trauma-Informed and Empathetic Reporting Toolkit

They also offer one-to-one and group training for individual journalists or their newsrooms.

A glimmer of hope for U.S. overdose deaths: They are at their lowest levels since 2020, but officials warn to press on

A snapshot of overdose deaths from January 2015 to January 2024
(CDC graph, based on data available for analysis)

The U.S. opioid epidemic isn't over, but national totals for overdose deaths have declined for 12 months in a row, with current numbers "slowed to the lowest levels since 2020," reports Alexander Tin of CBS News. The decrease in deaths is attributed to several factors; however, experts warn that now is a time to "double down" on current efforts and keep looking for new ways to prevent drug abuse from starting.

American overdose deaths peaked in 2023, but the latest trend offers hope and some reassurance that current treatments are saving lives. "Around 70,655 deaths linked to opioids like heroin and fentanyl were reported for the year ending June 2024, the Centers for Disease Control and Prevention now estimates, falling 18% from the same time in 2023," Tin writes. "Almost all states, except for a handful in the West from Alaska through Nevada, are now seeing a significant decrease in overdose death rates."

In Appalachian states, such as West Virginia, where opioid addiction among residents was disproportionately high, overdose deaths have steadily declined with the rest of the nation. Emily Rice of West Virginia Public Radio reports, "A Sept. 1 analysis of provisional overdose death rate data from the CDC shows a rapid decrease in the number of drug overdose deaths in the U.S. and this time West Virginia appears to be keeping pace."

Even with good news, the current rates remain grim. Dr. Allison Arwady, head of the CDC's National Center for Injury Prevention and Control, told Tin, "We are encouraged by this data, but boy, it is time to double down on the things that we know are working. It is not a time to pull back, and I feel very strongly, and our data shows, that the threat continues to evolve." Brian Mann of NPR reports, "Roughly 100,000 deaths are still occurring per year. . .fentanyl, methamphetamines, xylazine and other synthetic chemicals are more poisonous than ever."

But the roughly 10.6 percent decline in overdose fatalities still speaks to some success. Tin writes, "Arwady pointed to a long list of factors that officials hope are contributing to the decline, ranging from broader availability of the overdose-reversing spray naloxone, also known as Narcan, to efforts to ease gaps in access to medications that can treat opioid use disorder."

Youth education programs may be contributing to the decline. Tin explains, "Trends in what health officials call 'primary prevention' have also improved in recent years — meaning fewer people using the drugs to begin with. As an example, Arwady cited CDC surveys showing a clear decline in high school students reporting that they have tried illegal drugs."

Rural jail offers newly released prisoners with addiction disorders a long-lasting drug to prevent relapse

Cost is a major barrier to using Sublocade as an
addiction treatment for prisoners. (Adobe Stock photo)

In rural Maine, a county jail began giving a long-lasting form of buprenorphine to inmates with drug addictions before they left incarceration. The medicine, which curbs opioid cravings for 28 days, helps past inmates avoid "withdrawal, relapse and overdose — dangers that newly released prisoners confront nationwide," reports Jan Hoffman of The New York Times.

Once out of jail, addiction sufferers can face several obstacles to staying in recovery while re-entering their communities. Maine's Somerset County sheriff, Dale P. Lancaster, was discouraged by the number of inmates who would leave prison and die from overdoses. Lancaster pushed for the extended-release medical treatment. Hoffman writes, "According to a recent analysis in Health and Justice, the switch had a remarkable effect. The long-acting injection afforded newly released prisoners a crucial buffer period after they were discharged, with more time to set up continuing addiction treatment and stabilize their lives."

People suffering from drug addictions are more likely to end up on the wrong end of the judicial system. "Of the more than 1.2 million prisoners in the United States, up to 65 percent of prisoners have active substance use disorders, according to some studies," Hoffman explains. And while those institutions have an opportunity to treat the addicted, few have the resources or staffing. In the case of extended-release shots of buprenorphine, known as Sublocade, the treatment's cost remains a big barrier, with the list price for a monthly injection about $2,000, while a month's supply of pills ranges from $90 to $360.

But the success of Maine's program may help turn the tide. "After being released, the Somerset County prisoners who got the shot were three times as likely to continue treatment as those at another rural Maine jail who received the daily pills" [which are discontinued upon release], Hoffman adds. "Between September 2022 and September 2023, three prisoners from the jail where the pills were dispensed died from overdoses within three months of being released; a fourth died by suicide. None of the former Somerset prisoners who had received the injections died."

Dr. Alane O’Connor, co-chair of Maine's Opioid Response Clinical Advisory Committee, said that "as word of the Somerset program spreads, she is getting inquiries from other county sheriffs about how to bring the shots on board," Hoffman reports. "She is also hearing from former prisoners." O'Connor told Hoffman, "Many wanted to stay on the shots, so they would come back to the jail asking our help in finding a provider."

Friday quick hits: Rural top-flick picks; dairy funds; heat can kill; racial voting division; bread debate; hop on a new train

Eita Okuno, Anna Sawai, and Hiromoto Ida in 'Shōgun.' (FX /IMDb image via The Daily Yonder)

On steamy days when the pool is too crowded and you can't handle any more of Mother Nature's energy-sucking heat, it might be time to chill indoors and take in a rural flick. From the "Mad Max Saga" to wrestling's fierce Von Erich family drama to the stunning "craftsmanship and costuming" in "Shōgun," Adam B. Giorgi of The Daily Yonder has some fine movie picks that will make relaxing in the AC much more fun.

In states with the highest number of drug overdose deaths, patients in treatment for mental illness often live with an opioid use disorder that mental health clinics are unable to treat, a study showed. "Despite high rates of opioid use disorder among people with mental health disorders, only a third of community outpatient mental health treatment facilities in 20 high-burden states offered medications for OUD," reports Shannon Firth of MedPage Today. "Among the 450 community outpatient mental health treatment facilities surveyed, weighted estimates showed that 34% offered medications for OUD, reported study co-author Jonathan Cantor, PhD. JAMA Network Open published the study in June.

Jersey Scoops capitalized on the USDA's new small
dairy initiative. (Jersey Scoops photo)

What's better than locally made ice cream or homestead cheeses? More of both. At least that's what the Department of Agriculture seems to think. The USDA is funding a new initiative that "aims to transform and diversify the dairy industry, one small producer at a time," reports Naoki Nitta of Civil Eats. "At 'Jersey Scoops' in Loleta, a small, unincorporated community in Northern California’s Humboldt County, the ice cream is as fresh as it gets. From pasture to parlor, its organic, butterfat-rich milk travels less than 10 miles, produced by a herd of Jerseys pasture-raised on the misty coast. . . . But Jersey Scoops didn’t get here on their own; they leveraged a $60,000 grant from the Pacific Coast Coalition’s Dairy Business Innovation Initiative to secure both the space and equipment." Learn about how local cheese ventures are leveraging this funding here.

As global temperatures continue to spike, awareness of heat-related illnesses is especially vital for outdoor workers and their employers. Heat can make workers sick, but it can also be deadly, reports Seth Borenstein of The Associated Press. "With much of the United States, Mexico, India and the Middle East suffering through blistering heat waves. . . several doctors, physiologists and other experts explained what happens to the human body in such heat." To find out how heat kills, click here.

Handmade bread is much different than mass produced
loaves. (Bluegrass Baking Company photo)

Bread is considered a U.S. family staple for affordable nutrition, but the processing that creates a uniform and stay-fresh loaf has landed "packaged bread in the middle of a fraught debate over 'ultra-processed food,'" reports Jesse Newman for The Wall Street Journal. "Less-processed foods tend to be more expensive and quicker to spoil. . . . For bakers like Jim Betts, owner of Bluegrass Baking Company in Lexington, Ky., most packaged bread is a far cry from the food that has been sustaining humanity for at least 10,000 years." To read why homemade bread is so dramatically different and more pricey than store-bought loaves, click here.

The U.S. rural-urban voter divide primarily exists among whites, a new study published in Politics, Groups, and Identities found. Kate Blackwood for PHYS.org reports, "When it comes to politics, Black and Latino residents of rural America differ far less, if at all, from their urban counterparts than do non-Hispanic white residents, the researchers report." One of the study's authors, Suzanne Mettler, told Blackwood, "Rural and urban Americans began moving apart politically in the late 1990s, and the division has widened and deepened since then. . .We wanted to know whether all Americans, regardless of race and ethnicity, are swept up in this growing cleavage.

A Borealis Amtrak train rounds the corner
surrounded by Midwestern fall colors. (Amtrak photo)

Midwestern states have been busy working to add more train services to their transportation portfolios. The new Amtrak Borealis service between Chicago and St. Paul opened last month after 12 years of planning, reports Daniel C. Volk of Route Fifty. "The new service was also a breakthrough. It is the first new passenger route launched in Minnesota since 1975, and the first in Wisconsin in more than two decades. . . . Officials in both states — like dozens of others across the country — are now planning for even more new passenger routes, because of incentives in President Joe Biden’s 2021 infrastructure law." Borealis trains include wide reclining seats, ample legroom, free Wi-Fi and views of the Mississippi River between St. Paul and La Crosse, Wisc., in daylight in both directions across Wisconsin.

The number of children who have lost a parent to drug overdose or firearms climbs; overdose loss is up 345%

Nearly 100,000 children lost parents to a drug overdose
or gun violence in 2020. (Adobe Stock photo)

Over the past 20 years, the number of U.S. children who have faced a parent's death from drug overdose or firearms has increased at an alarming pace. These children are left to grapple with a loss that impacts how they thrive or don't thrive throughout their developmental years and into adulthood.

"Nearly 100,000 children lost parents to a drug overdose or gun violence in 2020 alone – almost three times more than in 1999," reports Deidre McPhillips of CNN. "Overall, more than 1 million children have lost a parent to a fatal drug overdose or gun violence over the past two decades, according to the study published in the Journal of the American Medical Association.

The increase in the number of parent-age deaths from drug overdose is staggering. McPhillips writes, "About 72,800 children lost a parent to a drug overdose in 2020, up 345% from the 16,000 children affected in 1999, according to the study."

The percentage increase in gun-related deaths is not as high as that for drug overdoses, but it's still startling. "There was a 39% increase in children who lost a parent to gun violence – from 18,000 in 1999 to 25,000 in 2020," McPhillips reports. By comparison, the number of children who lost parents due to other causes increased 24% between 1999 and 2020.

"Other research has shown that losing a parent can have negative effects on a child's health, education and livelihood – in both the short and long term," McPhillips adds.

Deaths due to drugs, guns or crime are not as acceptable for children and adults to discuss. Robin Gurwitch, a psychologist and professor at the Duke University School of Medicine, told McPhillips: "When it can't be talked about openly and freely, it makes it harder for children to get the support they need. For children who hold those things inside, the risk of it leaking out into everything from severe behavior challenges to bereavement disorders to other types of mental health challenges – anxiety, depression or their own substance abuse – goes way up."

Opioid settlement funds won't be enough for some of the country's hardest-hit regions to rebuild and recover

For many counties, the opioid settlement funds won't be
enough to address the losses. (Adobe Stock photo)

As the first $50 billion in opioid-related settlement funds gets distributed to states, counties and municipalities, a painful reality is setting in: It won't be enough for these places to rebuild or recover what has been lost, report Arian Campo-Flores and Jon Kamp of The Wall Street Journal. 

Community leaders are finding that "the funds only cover a fraction of their wish list. Some of their projects likely aren't even eligible because of confusion over restrictions on how the money can be used."

Whitley County, Kentucky, is an example of a region that received settlement funds, but county leaders quickly recognized that the money would only scratch the surface of what is needed to spur recovery, the Journal reports. Whitney Wynn, a Horizon Health outpatient facility director, "wants to establish the area's first detox facility. Ideally, she said, such a center could send patients to a residential treatment site. But the settlement money wouldn't cover both projects."

Other regions are using the settlement money paired other funding to create facilities and programs to support change. "In Dickenson County, Va., officials are allocating $250,000 of roughly $330,000 in settlement funds received thus far for the rural area's first residential treatment facility," Campo-Flores and Kamp write. "The project's price tag is $7.7 million, so the remainder is coming from sources including a loan from a regional economic development authority."

Kentucky is expected to receive about $900 million in settlement funds, with "half administered by the state and half going to local governments," the Journal reports. While that sounds like big money, it isn't when compared with what the crisis has cost. "In 2017, Kentucky's estimated cost from deaths and lives undermined by addiction exceeded $24 billion. Per-capita costs there were among the nation's highest."

Robbie Williams, a judge-executive in Floyd, Kentucky, told the Journal the $1 million the country has received so far is just "a drop in the bucket" compared with what the opioid crisis has cost the community. He added, "We have so many unmet needs; we really don't know where to start."

The Journal reports, "Meanwhile, the opioid crisis — which started with pain pills and is now fueled by fentanyl — continues killing at a record pace. "

California prosecutors charge fentanyl suppliers with murder. The legally unsettled approach is catching on.

Prosecutors in California are forging a path to make fentanyl dealers accountable for their part in overdose deaths by filing homicide charges against them. In Riverside County, California, county district attorney Mike Hestrin "has charged 34 suspected fentanyl suppliers with murder and is said to be the first prosecutor in California to achieve a guilty verdict from a jury in a fentanyl-related homicide trial," reports Michael Corkery of The New York Times. Some critics fault the prosecution of street dealers "as a misguided return to the aggressive approaches of the 1990s, which failed to curb drug use and swelled state prison populations."

But even in boldly liberal parts of the state, murder investigations of fentanyl overdoses are being used to discourage fentanyl sales and provide some level of justice for families. Corkery writes, "Some other counties — like San Diego and Placer, near Sacramento — that have also brought murder charges against fentanyl suppliers have sizable numbers of conservative-minded voters who tend to favor more punitive approaches to crime." Even in San Francisco, the district attorney's office is planning to prosecute fentanyl dealers for overdose deaths.

While prosecutors pursue murder charges against fentanyl dealers, their cases are on murky legal ground. "Prosecutors have been working around the fact that California does not have a law that specifically allows fentanyl deaths to be charged as murders," Corkery explains. 

Defense attorneys have responded to the prosecutions as "overbroad and unconstitutional," Corkery reports. But their complaints are being drowned out. "Parents whose children died from fentanyl are a driving force behind new laws and stepped-up prosecutions just as the parents of drunken-driving victims swayed the nation to crack down on alcohol-fueled traffic deaths decades ago."

To read more on how California prosecutors are using the Watson murder rule to prosecute fentanyl suppliers, click here. 

Drug Enforcement Administration statistics draw a startling picture of fentanyl's lethal power: It is the leading cause of death for Americans ages 18 to 45, and it's responsible for nearly 70 percent of the United States' 107,000+ drug overdose deaths in the past year. A educational warning video is shared below.

Prenatal drug exposure is found in thousands of babies each year; rural babies are more likely to have problems

More research is needed on prenatal drug exposure.
(Photo by Jill Sauve, Unsplash)

Amid rural hospitals and clinics ending prenatal care and closing labor and delivery units, unborn children face a quieter threat -- exposure to drugs that limit their in-utero development, can cause lower birth weights and contribute to post-birth disabilities, writes Amna Umer for The Conversation, a journalistic platform for academics. Umer is an associate professor of pediatric epidemiology at West Virginia University. 

Umer writes: "Nearly 1 in 12 newborns in the United States in 2020 – or about 300,000 infants – were exposed to alcohol, opioids, marijuana or cocaine before they were born. . . . These substances can have direct and indirect consequences on fetal development."

When it comes to drug exposure, rural unborn babies are particularly vulnerable. "This includes West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis," Umer explains. "As an epidemiologist, I study the relationship between substance use during pregnancy and infant health outcomes. Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was nearly 50% higher, at 124 per 1,000 births, than the national rate of 80 per 1,000 births."

Poverty and ongoing regional economic stress are part of West Virginia's drug crisis, which extends to pregnant mothers, but there are other factors at play. Umer writes, "Nearly half the population lives in rural areas with limited hospitals and clinics. The geographic isolation limits access to health care and substance use treatment services. Finally, stigma and judgment within close-knit rural communities may discourage these mothers from seeking help."

The body of research on prenatal drug exposure is still growing, and depending on the substance babies were exposed to in the womb, the outcomes vary from low birth weights to withdrawal to developmental delays. Some exposure has a lasting impact on children. Umer explains, "Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as six months old and persist into adolescence. These include delays in learning and language skills, physical growth and motor skills, and difficulty regulating behavior and emotions."

Investigative report examines where fentanyl comes from, how it's made and how it is spread throughout the U.S.

Fentanyl ingredients travel thousands of miles before
crossing into the U.S. (El País graphic)

In trying to encapsulate how much harm fentanyl has done to Americans, the Spanish daily newspaper El País has produced a detailed report, "Fentanyl: The Portrait of a mass murderer," by Iker Seisdedos, David Marcial, Pérez Carlos Rosillo, and Guillermo Abril. Their investigation looks at where fentanyl ingredients come from, where it is made and how it enters the United States.

They write, "It's a big threat. A cheap, white powder — 50 times more powerful than heroin — which kills more than 70,000 people each year in the United States and countless others across the rest of the Western Hemisphere. El País, in a long-term investigation that spanned two continents and included interviews with anti-drug czars in the U.S. and China, visited the clandestine laboratories in Sinaloa, Mexico, where fentanyl is manufactured."

They use as an example how the crisis has affected people in Philadephia. El País reports, "Hundreds of people who are addicted to the powerful opioid live and die on these streets. . . .The fate of all of them begins about 2,500 miles away, next to a different set of train tracks: those that cross Culiacán, in the heart of Mexican drug trafficking territory."

State of Sinaloa within Mexico
(Wikipedia map)

In Culiacán, the capital of the Mexican state of Sinaloa, a drug cartel makes "cuts" of fentanyl, which is tested on human "guinea pigs" until it is deemed potent enough to ship to the U.S. But while a "cook" in Mexico has created the batch of fentanyl, its chief ingredients, called precursors, were made in China. "A kilo of Chinese precursors costs the cartel — about $800," El País reports. "From there, four kilos of fentanyl come out. The profit can be between 200 and 800 times what they paid. That is, from $160,000 to $640,000 per kilo."

El País reports, "Fentanyl that enters the United States from Mexico comes in powder or, increasingly, in the form of fake pills, which are camouflaged as commercial brands such as Xanax, Vicodin or OxyContin. Drug traffickers press them with machines that they also buy from China."

The point of entry is the hardest for fentanyl traffickers. "According to U.S. authorities, more than 90% of fentanyl enters the country via official ports of entry, hidden in private vehicles or cargo trucks, In 2018 — according to data from Customs and Border Protection — 600 kilos of the substance were intercepted. In 2022, the amount rose to 7,200 kilos."

To read more in-depth about how cartels infiltrate the U.S., and China's involvement in fentanyl trade, click here.

After at least 3 fentanyl deaths in 7 months, weekly in small Kentucky county alerts its readers to dangers, details

Most of this week's front page; click it to enlarge.
Photo illustration is based on a DEA image. 

After three fentanyl overdoses since June in Crittenden County, Kentucky, the first recorded in the county of 9,000 people, and another death in which fentanyl could have been a contributing factor, the local editor-publisher thought it was time to alert his readers to the danger.

"Considered by some as the grim reaper of recreational drugs, fentanyl has hit Crittenden County like a reaper’s scythe over last the few months," Chris Evans of The Crittenden Press began his story, which reported the deaths without the victims' names, noted that the county normally has about three overdoses of any drug in a year, then gave a rationale for the story and made it an implicit example to follow: "Observers say small communities like Marion should raise awareness or prepare to see more deaths in their neighborhoods."

Evans quotes local and state officials and writes, "Fentanyl is approximately 100 times stronger than morphine and 50 times more potent than heroin. Illegal manufacturers often lack understanding, ability and precision to make fentanyl. It’s not a forgiving drug. One minuscule mistake is irreversibly deadly."

Dr. Christopher Kiefer of the state medical examiner’s office told him, “High-school-age kids might be swapping pills. That’s not uncommon. They might think they’re getting a mild painkiller pressed in a lab. They might think it’s Oxycodone or Lortab, but it ends up being fentanyl. You don’t have to be using a needle to die of an overdose. . . . It is a dangerous time right now because people don’t know what they’re getting,”

Crittenden County (Wikipedia map)

Evans adds, "The doctor further explains that fentanyl made and distributed on the black market can be dressed or disguised as just about anything. Someone may think they’re getting a pill from a friend’s mom’s medicine cabinet when it’s something far more sinister and deadly." He quotes Marion Police Chief Bobby West as saying that families and friends of drug users can be the best preventers of overdoses, and “Conversations need to be had about this drug and how it can kill you.”

Evans concludes, "The stark reality of this drug is that it can creep undected into any corner of society and become an instant killer. Now, it’s in Marion." His package also includes sidebars about synthetic opioids (fentanyl is one) and a quick-look box giving street names for the drug, how it is used, what it does and what an overdose can look like: "Stupor, changes in pupil size, clammy skin, cyanosis, coma, and respiratory failure."

Evans has made this week's issue available online, here.

New Mexico schools use wastewater testing to identify student drug use; the science is catching on in other places

Wasterwater testing can pinpoint drug use in schools
and communities. (N.M. Health Dept. photo via WP)

School administrators in New Mexico are using wastewater testing analysis to learn more about student drug use and to help inform their decisions on how to respond. "Using a technique that became popular nationally to spot Covid-19 outbreaks, New Mexico appears to be the first state to test wastewater at public high schools for a range of opioids and stimulants," reports Sara Randazzo of The Washington Post. "Initial data released since last week from more than three dozen high schools. . . included what school leaders and state officials called a surprise: cocaine use in nearly 82% of the campus communities."

Health and school officials plan to use testing results to "guide drug-prevention programs and pinpoint how to allocate resources for addiction services," Randazzo writes. "The tests aren't meant to assist in punitive measures, but to give a snapshot of campus drug use. . . . Fentanyl, a synthetic opioid that has led to a surge in overdoses nationwide, and its metabolite appeared at nine of the 38 New Mexico schools. None showed a heroin presence."

Europe and Australia began deploying wastewater testing to measure illicit drug use around 2010, but the method has been slow to "catch on in the U.S.," Randazzo reports. 

New Mexico may be the first to use wastewater testing in schools; however, "communities in California, Delaware, Virginia and elsewhere started broader municipal wastewater drug-testing programs this year focused on the opioid epidemic, some of it funded by the federal government," Randazzo writes. "Drug overdoses killed more than 100,000 people in the U.S. in 2022, federal data shows, more than two-thirds of those from fentanyl and other synthetic opioids."

The wastewater testing company Biobot Analytics "is working with Marin County, an affluent area north of San Francisco, where drug overdoses are now the leading cause of death for those 55 and under," Randazzo adds. "Matt Willis, Marin County's public health officer, said weekly testing over the past year helped them see in May that xylazine, a powerful horse tranquilizer that is dangerous to humans, was entering the community. . . ."

Drug overdose deaths don't just happen to adults; dozens of teens die each month, and boys are especially vulnerable

The U.S. continues to see overwhelming numbers of drug overdose deaths, but one of the most jarring statistics is the number of adolescents dying from overdoses every month, reports Ty Schepis for The Conversation, a journalistic platform for academics. "Drug overdoses are killing young Americans in unprecedented numbers: The monthly total rose from 31 in July 2019 to 87 in May 2021, the period with the most recent data. As a scholar of substance use who focuses on patterns that vary between age groups, I’m struck by how adolescents’ overdose deaths differ from adults’ in terms of gender, race and ethnicity and the drugs causing these fatalities."

The Conversation graph, from CDC data

Who is dying? "When the Centers for Disease Control and Prevention examined data for Americans 10 to 19 years old, it found that, as is the case for adults, most adolescents dying from drug overdoses are male. However, the share of girls among these fatalities is larger than the share of women," Schepis writes. "More than twice as many boys who are tweens or teens are dying of a drug overdose for every girl in that age group."

Which drug is most involved in teen overdose deaths? Fentanyl. "For teens, 84% of fatal overdoses involved fentanyl, and 56% of all overdoses involved only fentanyl," Schepis explains. "Many adolescents accidentally take fentanyl when they ingest counterfeit pills that they believe are prescription opioids or stimulants, or other illicit drugs that are laced with the drug. . . .In 67% of adolescent overdose deaths, a bystander was present who could have intervened. Naloxone was administered in less than half of cases where a bystander was present."

Is there a common thread among adolescent overdose deaths? Schepis reports, "Little or no prior drug use. Only 1 in 10 teens and tweens who died from a drug overdose had a history of treatment for a substance use problem, and only 1 in 7 had ever experienced a prior nonfatal overdose. . . . This pattern underscores the importance that all parents proactively talk with their children about substance use by the time they are 12 years old."

What can parents and extended family do to help change this pattern? "Having naloxone available can also be important. It prevents fentanyl and other opioids from causing an overdose by blocking access to opioid receptors in the brain," Schepis writes. "Think of naloxone like car insurance: You don’t want to use it, but it’s important to have in case something goes wrong. . . . There’s also a strong link between mental health conditions and drug overdoses among adults. . . . I recommend that all adults – whether caregivers or other people in an adolescent’s life – check in on their mental health regularly and recommend or seek treatment for any concerns as early as possible."

The overdose crisis isn't over, it's evolving

Suboxone is less effective in treating
some additions. (Drugs.com photo)

Powerful synthetic drugs such as fentanyl, xylazine and stimulants are undercutting the effectiveness of prescription drug treatments, leaving programs and patients struggling, reports Taylor Sisk of KFF Health News. Vermont, a state that pioneered prescription addiction treatments, is facing new challenges to help substance-abuse victims avoid overdoses and succeed in recovery.

Vermont's "Hub and Spoke" program is part of the statewide Blueprint for Health, with "hubs in relatively populous areas of this largely rural state," Sisk writes. "A patient enters the system for assessment and initial induction at one of nine hubs and then, once stable, is transferred to a spoke. If that patient relapses or needs more intensive care, they can be transferred back to the hub. The spokes typically offer Suboxone — the brand name for a combination of buprenorphine and naloxone -- and the most effective for those with mild to moderate opioid dependence — but not methadone, which is more regulated."

The mix of street drugs combined with their potency limits the impact of prescription care. "Suboxone has proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal," Sisk explains. "Neither Suboxone nor methadone is designed to treat addiction to xylazine or stimulants. . . . The nation has also seen a significant increase in overdose deaths from co-use of stimulants and opioids."

Without effective prescriptions as part of a withdrawal plan, people with an addiction are less likely to succeed during the early days of recovery. "Those who seek help breaking their addictions face treatment options rendered less effective by the prevalence of fentanyl, xylazine, and other synthetic drugs," Sisk reports. "The Centers for Disease Control and Prevention estimates that of the more than 111,000 drug-overdose deaths in the U.S. in the 12-month period ending in April, more than 77,000 involved fentanyl and other synthetic opioids."

Jess Kirby, director of client services for Vermonters for Criminal Justice Reform, which offers services to counter substance use disorder, told Sisk: “There was a time when we couldn’t have pictured things being worse than heroin. Then, we couldn’t picture things being worse than fentanyl. Now, we can’t picture things being worse than xylazine. It keeps escalating. . . . We have a drug supply that’s contaminated with xylazine and fentanyl, and we know that people are struggling a lot more and are at a lot higher risk. It’s not just an overdose to be concerned about anymore. It’s life-threatening wounds and infections."

Tony Folland, clinical services manager with the Vermont Department of Health’s Division of Substance Use Programs, "said fentanyl is now implicated in about 96% of overdose deaths."