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Practice Perspectives

The Impact of Fentanyl on the Opioid Crisis and Role of Social Workers

Makeba Royall LCSW - Senior Practice Associate, Behavioral Health

July 1, 2024

Fentanyl has been permeating the illicit drug market causing an increase in dependency and high rates of overdose. The opioid crisis has been compounded with the increased misuse of fentanyl and the mixing of it with other dangerous substances. Heroin and illicit fentanyl have been a common mix; however, it has also been found in supplies of cocaine, methamphetamine, counterfeit prescription pills, laced with oxycodone, morphine, Xanax, stimulants such as cocaine and methamphetamines and consumed while also drinking alcohol. Individuals have unknowingly used fentanyl while consuming other substances resulting in a need for public awareness. This has become of great concern because individuals who do not use opioids lack tolerance, placing them at high risk of fatal overdose unknowingly. Fentanyl cannot be seen, taste or smell resulting in unwanted use by those who may be consuming what they thought might have been something else. The potential for overdose is high. This practice perspectives shares information on what fentanyl is, its impact on communities, and the role of social workers.

What Is Fentanyl

Fentanyl is a synthetic opioid, not from the opium poppy plant, made in laboratories. Its origin dates to 1959 when it was developed to be used as an anesthetic and later began to be used for chronic pain for health purposes. Although there seems to be a rise in the use of fentanyl, the drug has been around and has been overused for many years. At that time, the drug itself was overly used because of its intense potency and rapid effects for pain management. Around the 1980s synthetic fentanyl became a popular street drug.

According to the United States Drug Enforcement Administration (DEA), fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. Illicitly manufactured synthetic fentanyl can be in the forms of powder, dropped onto blotter paper, eye droppers, nasal sprays, candies, or tablet. Because of its potency, illicitly manufactured fentanyl is being used to replace or adulterate other drugs of abuse. As a result, there has been a rise in mixing the drug with other substances causing an increase in overdose.

With the use of fentanyl, it takes little to produce a “high,” which is one of the reasons it has been a popular mix for heroin and cocaine. Additionally, it has been used to create counterfeit prescription pain pills and sedatives. These common yet dangerous mixes have led to faster addiction, an increase in overdoses and has had a major impact on communities.

The Impact of Fentanyl on Communities

With the increased use of fentanyl and the mixing of fentanyl to enhance the potency of substances on the market, the opioid crisis began to take a turn. According to the Centers for Disease Control and Prevention (CDC) fentanyl was the cause of approximately 2,600 deaths in both 2011 and 2012, however the rates increased tremendously between 2012 through 2018 resulting in approximately 31,335 overdose fatalities. Accordingly, the increase between 2012 through 2018 was in part due to a rise in trafficking and the use of illicit fentanyl. According to the National Institutes of Health fentanyl was involved in more deaths than prescription opioids (40% in 2016) or heroin (36.6% in 2016). Overdose rates increased by 21.5% year-over-year from June 2018 to June 2019. While the overdose rates were increasing and data lagged in overdose surveillance, fentanyl seemingly impacted some groups more than others.

During 2015-2017 opioid-involved deaths increased amongst minority populations including non-Hispanic blacks and Hispanics, groups that have historically had low opioid-involved overdose death rates. Non-Hispanic Black people had the largest annual percentage rate, followed by Hispanics, however; in 2016 the rate was highest for non-Hispanic whites. According to the study from the National Vital Statistics System, the rate of overdoses by fentanyl continued to climb over the course of years and fentanyl was the leading cause of deaths in comparison to other drugs amongst non-Hispanic Black, American Indian, Alaska Native, non-Hispanic White, and Asian people. During 2011-2016 drug overdose deaths increased for both sexes, increasing more rapidly for males than females. Rates increased across all age groups with the greatest increases for those aged 15-24 and 25-34. However, by 2021 according to a study from the National Vital Statistics System, the drug overdose death rates were highest for fentanyl for those aged 25–34 and 35–44. In large central metro areas, persons aged 45-54 years of age where synthetic opioid were involve resulted in 70% of deaths among blacks, 54.2% among whites, and 56% among Hispanics. The National Forensic Laboratory Information System (NFLIS), a voluntary program of the Drug Enforcement Administration (DEA) Diversion Control Division, report in 2019 that four of the five states with the most fentanyl reports are the same states with the most heroin reports including New Jersey, New York, Ohio and Pennsylvania. Most regions saw an increase, however, the areas with the most impact were Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New York to include NYC, New Jersey, Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, Illinois, Indiana, Michigan, Minnesota, Oklahoma, and Wisconsin [The East Coast and Upper Midwest Regions].

Fentanyl has exacerbated the opioid crisis. The influx use of illicitly manufactured synthetic fentanyl, the increase in overdose rates, and the disproportionate impact fentanyl has had on communities requires social work involvement. Social workers can help with and do have a role in the opioid crisis.

Role of Social Workers

Social workers have the skill set and knowledge to help with the opioid crisis. With the use of evidenced based practices, social workers provide assessment, support, and follow-up treatment to individuals in recovery. Cognitive behavioral therapy (CBT) has been utilized by social workers to help individuals manage their substance use behaviors, triggers, and stress. This treatment modality allows social workers to explore both internal and external triggers that evoke cravings for use. Negative feelings, thoughts and behaviors are explored to help develop mechanisms to address issues of concern while also helping to diminish or alleviate the need to use substances. McHugh et al. noted in, Cognitive Behavioral Therapy for Substance Use Disorders, the core elements of CBT aim to mitigate the strongly reinforcing effects of substances of abuse by either increasing the contingency associated with non-use or by building skills to facilitate reduction of use and maintenance of abstinence, and facilitating opportunities for rewarding non-drug activities. CBT combined with other tools such as motivational interviewing, contingency management which provides incentives for targeted goals, and harm reduction efforts can play a vital role in the journey to recovery.

As social workers engage with individuals who are in recovery or seeking treatment, discussing the dangers of mixing fentanyl with other drugs could be lifesaving. To help with the opioid crisis social workers can also do the following:

  • Assess substance use and misuse.
  • Have knowledgeable conversations about fentanyl to diminish high risk use and reduce potential overdose.
  • Enhance their knowledge and understanding of the health and pharmacological aspects of substance use.
  • Research treatment options available in local communities.
  • Be accessible and available to those seeking help.

Social workers are encouraged to stay informed and up to date on current trends, issues and policy efforts related to substance use. This can be done by attending substance use conferences, taking continuing education courses, and reading peer review journals and articles. Social workers are essential and have a crucial role to play in the opioid crisis.

References

American Medical Association. (2023). Overdose Epidemic Report 2023. Retrieved May 15, 2024, from https://www.ama-assn.org/system/files/ama-overdose-epidemic-report.pdf

DEA Strategic Intelligence Section. 2020 Drug Enforcement Administration National Drug Threat Assessment. Retrieved from https://www.dea.gov/sites/default/files/2021-02/DIR-008-21%202020%20National%20Drug%20Threat%20Assessment_WEB.pdf on 2022, October 5.

Lippold KM, Jones CM, Olsen EO, Giroir BP. Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid–Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019; 68:967–973. DOI: http://dx.doi.org/10.15585/mmwr.mm6843a3

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012

National Center for Drug Abuse Statistics. Fentanyl Abuse Statistics. Retrieved from https://drugabusestatistics.org/fentanyl-abuse-statistics/ on 2022, September 28.

NIDA. 2018, May 1. The True, Deadly Scope of America’s Fentanyl Problem. Retrieved from https://archives.nida.nih.gov/news-events/noras-blog/2018/05/true-deadly-scope-americas-fentanyl-problem on 2022, September 20

Spencer MR, Warner M, Bastian BA, Trinidad JP, Hedegaard H. Drug overdose deaths involving fentanyl, 2011–2016. National Vital Statistics Reports; vol 68 no 3. Hyattsville, MD: National Center for Health Statistics. 2019. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf

Spencer MR, Warner M, Cisewski JA, Miniño A, Dodds D, Perera J, Ahmad FB. Estimates of drug overdose deaths involving fentanyl, methamphetamine, cocaine, heroin, and oxycodone: United States, 2021. Vital Statistics Rapid Release; no 27. Hyattsville, MD: National Center for Health Statistics. May 2023. DOI: https://dx.doi.org/ 10.15620/cdc:125504. https://www.cdc.gov/nchs/data/vsrr/vsrr027.pdf

Whitehead, Nadia. (25 August 2015). How the prescription painkiller fentanyl became a street drug. NPR. https://www.npr.org/sections/health-shots/2015/08/26/434867357/how-the-prescription-painkiller-fentanyl-became-a-street-drug Retrieved 20 September 22