The illicit opioid called “a scourge” by local law enforcement became more available and abused in Washington state during the COVID-19 pandemic, according to recent reports from the Drug Enforcement Administration and a national firm monitoring drug positivity tests.
Social isolation and disrupted supply lines of other pharmaceuticals led to an increase in the use of fentanyl, according to anecdotal and statistical accounts in Washington, and the deadly synthetic opioid was already ticking up in use before the pandemic.
A recent study by the firm Millennium Health found that positive tests for fentanyl in the urine of people seeking treatment for pain, substance abuse disorders and other health needs rose more sharply in Washington than any other state in 2020, and the Spokane Regional Health District’s Opioid Treatment Program saw local positive tests for the drug double in 2020.
“I think the drug trafficking organizations have continued to seek new markets, they’re eyeing the states out West, and that is why we’re seeing the growth out West,” said Eric Dawson, vice president of clinical affairs for Millennium Health.
Positive tests for fentanyl, which has a legal clinical use as a painkiller typically for cancer patients but in recent years has seen an increase in street prevalence after being smuggled from Mexico, increased 236% in Washington between 2019 and 2020, according to Millennium’s statistics, and initial reports for this year indicate that alarming trend is continuing, Dawson said.
Millennium Health works with the U.S. Department of Health and Human Services to identify potentially troubling trends in drug addiction nationwide. Local testing agencies and those involved in treatment of opioid addiction echoed Dawson’s concern, but noted that experts have anticipated a spike in the use not only of fentanyl, but other illicit substances in large part due to conditions caused by the pandemic.
“When someone is desperate to feel better, they don’t care what they’re putting in their body,” said Dan Barth, director of business development at Inland Northwest Behavioral Health and a leader of the local task force set up in the pandemic’s early days to address mental health issues.
Studies have shown that chronic substance users experience changes in the way their brains work, said Kristin Simpson, medical manager of treatment services for the health district’s treatment program.
“Their brain pathways do change, which impacts their coping mechanisms,” Simpson said. “So, a situation such as 2020 – that really stressed even the strongest-willed of us – it can really impact how they’re feeling, and it can increase their need for a substance use as a way to protect themselves, as a way to find that comfort they’re used to having.”
The danger with fentanyl is that users may not know they’re taking it. Fentanyl is being mixed with other drugs and sold in forms that can be confusing.
A national Drug Threat Assessment released this month by the DEA specifically cites the prevalence of blue pills that appear identical to oxycodone, but have been laced with synthetically manufactured fentanyl. Because of their likely place of origin and appearance, such drugs have earned the nickname “Mexi-blues.”
Fentanyl is between 80 and 100 times stronger than morphine, according to the DEA, and because of its potency can be mixed with other drugs to increase their effect, both to maximize profits and as a way to fortify illicit substances when there’s a disruption in supply lines, like what was seen during the lockdown orders just as the pandemic hit.
The result is an overdose, sometimes very quickly. The user may not even know they’re taking fortified drugs, said Shane Brickner, a national sales manager for the firm Cordant Health Solutions that, like Millennium, provides nationwide drug testing and pharmaceutical services.
“Imagine somebody that has been addicted to oxys, they take four or five oxys a day,” Brickner said. “If they take four or five Mexi-blues, they’re not going to survive.”
Drug overdose data from the Centers for Disease Control and Prevention mirror both the positivity rate seen in urine tests and the increasing amount of pills and powder seized by law enforcement and reported by the DEA. For a 12-month period ending in August 2020, the most recent numbers available, the CDC reported 561 deaths in Washington state attributable to a synthetic opioid other than methadone, the category that includes fentanyl. That was more than double the number of deaths for the 12-month period in August 2019, and the CDC cautioned that the number is likely higher because its data is not complete.
Mexi-blue pills have found their way to the streets of Spokane, according to clients of the opioid treatment program at the health district. Patients in the treatment program receive medications, including methadone and buprenorphine, as part of their therapy. If a person doesn’t know they’ve been taking fentanyl, it can present challenges in trying to fine-tune those medications, especially if they return to using while trying to get better.
“Knowing that fentanyl, being so potent, is out there, and being laced with other substances, or lacing other substances, it is a concern,” said Misty Challinor, director of treatment services for the Opioid Treatment Program at the health district. “Because it puts our population that are trying to change their lives, and get help, and make a difference, it puts them at a higher risk of an overdose, or lethal outcome.”
The availability and use of fentanyl is likely to mirror that seen in the eastern United States, where the drug arrived on streets earlier and where test positivity rates are four and five times greater than on the West Coast, according to Millennium’s data, said Dawson.
“It is the worry that I have for the Pacific Coast, that it is coming,” Dawson said.
The warning signs have been apparent for a while, though, Brickner and others said. What the epidemic of opioid abuse has shown is that law enforcement, medical professionals and treatment centers need to work together to care for people who are already addicted and to dissuade dealers, who can turn unfathomable profits preying on a population made even more vulnerable by a global pandemic.
“You have got to take away the demand,” Barth said. “You’ve got to heal people.”