Prescription pills are strewn across a table. Along with other powerful drugs, fentanyl is becoming an increasingly dangerous substance among young adults. Photo by Kimmie Johansen
By Elise Laharia
One pill. One life.
One hundred times more potent than morphine, fentanyl and fentanyl-laced street drugs are killing thousands and it’s already happening at schools in Texas.
At Carrollton-Farmers Branch ISD this school year, three students were killed and at least six others, in both middle schools and high schools, were hospitalized after taking fentanyl-laced drugs. These are not lone cases.
Dr. Kunal Karamchandani, an associate professor in anesthesiology at UT Southwestern, says that fentanyl is an opioid drug used in the medical setting to manage acute pain.
“It acts on what we call opioid receptors in the body, and those opioid receptors are primarily responsible for pain management,” Karamchandani said.
According to the National Institute on Drug Abuse, the most recent data shows 106,000 deaths from drug overdoses were reported in 2021, the majority, 70,601 of those involving synthetic opioids, primarily fentanyl.
As Karamchandani said, pharmaceutical-grade fentanyl is used in the medical setting, however, illicitly-made synthetic fentanyl is responsible for more deaths.
Because of its potency and cheap production costs, street fentanyl is often mixed with other street or prescription drugs.
“So if you're selling it you can say ‘my drugs are stronger than everybody else's’ or ‘mine are better than everybody else's,’” Physician’s Assistant Jennifer Holland said. “So it's mixed in a lot of things and nobody knows about it. People don't realize that it's even in what they're taking.”
Holland has been working as a PA in an emergency room for 15 years. Now at Texas Health Presbyterian Hospital Allen, she has seen countless overdose cases, many of them resulting in death.
“It is always really hard when something happens to a kid, because in the emergency department, we see a lot of death, we see a lot of end of life,” Holland said. “But that life has been extinguished, that had so much promise just because of a mistake.
Holland explained that teenagers who come in for overdoses are not usually initially addicted to drugs, so they don’t have a tolerance. She sees a lot of first-time overdoses, when teenagers don’t even realize what they have taken or that they are overdosing
“It's incredibly, incredibly hard to see families go through it, because I have parents that come too and oftentimes siblings,” she said. “So, I mean, I've been doing it long enough now that I know you can't get too emotionally invested in all of your patients, or you don't make it home mentally.”
While Holland thinks a lot of teenage overdoses stem from mistakes rather than addiction, addiction is the main driver in the purchasing of illicit fentanyl.
"It is always really hard when something happens to a kid, because in the emergency department, we see a lot of death, we see a lot of end of life."
Karamcharandi explains that in his profession of anesthesia, fentanyl is only used sparingly and is not prescribed for at-home usage. Addiction rates with this usage of fentanyl is low. However, when fentanyl is prescribed for at-home usage, after a patient’s pain has stopped, the risk of addiction significantly raises.
“One of the reasons for the original opioid epidemic was indiscriminate prescription of opioids by physicians and physician extenders, like nurse practitioners,” he said.
Holland mentioned that she has prescribed fentanyl to patients before if they come in with a broken bone, and believes the medication is a great resource in a controlled setting. She goes on to explain the science behind the addiction.
“They'll typically use it because it gives you a high and you feel good. It attaches to those receptors in your brain that give you that euphoric feeling, and it takes away pain,” Holland said. “But it's a highly addictive medication, so if you use it once or twice, you can [harm] those receptors in your brain and you can't feel happiness without the medication.”
Holland further explains that every emergency room department has been noticing the fentanyl crisis and increase in overdoses. There are a few indications of an opioid overdose that allow medical professionals to treat overdoses, including unresponsiveness or sleepiness and slow or shallow breathing. However, the tell-tale sign of an opioid overdose is pin-point pupils.
Karamcharandi emphasizes that the main reason people die on fentanyl is because of their inability to breathe.
“It is a very potent respiratory depressant, so it acts on the receptors in the brain and it causes your breathing to stop,” he said. “If you give a low dose, it can slow your breathing down, but iff you give it too much. It just stops your breathing.”
If medical professionals suspect that a patient has overdosed on fentanyl based on the above symptoms, they then administer the drug called Narcan.
“Narcan is a medicine that binds the receptors in your brain that the opioids are bound to, and it will reverse the receptors so that the fentanyl is no longer bound in your brain,” Holland said. “It's very fast acting and if they get it to you in time, then a lot of people will wake up within a few minutes after being given Narcan.”
There are no negative side effects to the drug, so even if the patient is suspected to be overdosing, but not confirmed, there is no harm in administering the drug. After the drug is administered, patients must continue to be monitored.
“Narcan wears off pretty quickly, so you have to give it maybe every few minutes and monitor someone for upwards of a few hours after you've given the first dose,” Holland said. We give them a dose to try to keep them alive until they get to the hospital.”
All treatments after that, are a response to symptoms of the overdose such as breathing issues and low blood pressure. Holland explains that kidney failure can occur if they don’t get enough blood, and brain injuries or damages can occur after prolonged periods of low oxygen in the brain. However, Narcan is the only medication administered to counteract the effects of fentanyl, and its life-saving properties are highly effective. Schools, businesses and public spaces are petitioning for permission to hold Narcan in order to efficiently counter any possible overdoses.
“I know there have been some propositions to make Narcan available to the general public, and I think with as pervasive as fentanyl is, that would be a terrible idea,” she said. “Narcan is not a medication that is going to be abused.”
In his time at the school, and his years as an active member of the bomb dog patrol team of DART, Officer Bridgewater has come to learn a lot of information about the dangers of overdosing and fentanyl laced drugs. In his opinion, carrying Narcan can be vital to ensuring that students don’t overdose.
"If a student comes in and they're exhibiting [overdose] symptoms, it's good to have [Narcan] there so you're not waiting on the ambulance. We can administer it right now, because it works that fast.”
“I carry Narcan on me as well because especially with fentanyl , as popular as it's getting, every second counts,” Bridgewater said. “If a student comes in and they're exhibiting [overdose] symptoms, it's good to have [Narcan] there so you're not waiting on the ambulance. We can administer it right now, because it works that fast.”
As fentanyl related hospitalizations and deaths have impacted school districts nearby, Bridgewater has faced growing concerns about the threat of such cases at the school.
“The problem is, so many kids have access to everything,” he said.
Knowing these dangers, Bridgewater believes kids need to be educated early on about the dangers of drug abuse and overdoses. Although schools can hold assemblies and teach students, he believes that at the end of the day, parents need to step in to educate their kids.
“So I think one thing that can be done is making the parents aware by telling them, bringing them into [an] assembly, talking to them about it, letting them know about awareness, then that would give them more of an incentive to talk to [their kids] about it,” Bridgewater said.
In order to prevent the issue of fentanyl related deaths impacting the school, Bridgewater believes that it is crucial for all adults in the community to communicate about the dangers.
“School and the parents have to be a team to make all of that work,” Bridgewater said. “That's the biggest thing.”