Fentanyl is hurting Tennessee. Here are some ideas for fighting the problem. | Opinion

• Shane Reeves is a trained pharmacist and CEO of Twelvestone Health Partners.
• He is also a Republican state senator representing District 14 (Bedford, Cannon, Moore and Rutherford Counties) in the Tennessee General Assembly.

Perhaps you saw Hulu’s limited series “Dopesick,” starring Michael Keaton. It’s based in part on material by journalist Beth Macy, who has written extensively about the opioid crisis in Appalachia.

But the opioid crisis is not the stuff of TV series and is certainly not contained to Appalachia. The opioid crisis is nationwide.

The opioid fentanyl was developed in the 1960s and approved for use in 1968. Created to manage cancer pain via a transdermal patch, fentanyl is also used in anesthesia. In 2019, it was the 278th most prescribed medication in the United States, with more than a million prescriptions.

Unfortunately, dealers started using illegally manufactured synthetic fentanyl to lace heroin. As it is 50 to 100 times more potent than heroin or morphine, just a few milligrams of Fentanyl, which, for comparison, is approximately the size of Lincoln’s ear on a penny, can be lethal.

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Why Americans should worry about fentanyl?

You may be wondering, if synthetic fentanyl is so deadly, why dealers are distributing it. Because fentanyl is highly addictive, dealers use it to improve their bottom line.

According to a report from the Office of National Drug Control Policy, evidence suggests that fentanyl is being pressed into pills that resemble Oxycontin, Xanax, Hydrocodone, and other sought-after branded medications, as well as being cut into heroin and other street drugs.

There are indications that drug trafficking organizations are explicitly targeting kids and teens by creating counterfeit pills — often sold online — in various shapes and bright colors to appeal to that age group.

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Where is fentanyl coming from?

Another question I’m often asked is how illegal fentanyl gets to the United States. China remains the primary source of fentanyl and fentanyl-related substances trafficked through international mail and express consignments to Mexican drug cartels for manufacture.

Seizures of fentanyl sourced from China average less than one kilogram (2.20 pounds) in weight and often test above 90% concentration of pure fentanyl. And while the Chinese government has cracked down on the manufacture, drug cartels have diversified their sources of supply to India.

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How it’s affecting Tennessee

The Metro Public Health Department in Nashville has reported that in the first quarter of 2022, there were 173 suspected drug overdose deaths in Davison County. Seventy-nine percent of overdose-related toxicology reports in 2022 detected fentanyl as the main driver in Nashville’s 20% increased drug overdose deaths.

Sixty-one percent of overdose-related emergency room visits in 2022 involved non-heroin opioids, followed by heroin (32%) and stimulants (7%). This finding indicated a continued shift away from heroin and toward synthetic opioids and stimulants in Nashville alone.

Sadly, Tennessee ranks No. 5 in the country for overdose deaths.

What’s being done?

We need to attack the problem on multiple fronts with multiple actions.

First, if a fentanyl overdose is suspected, naloxone (Narcan), an opioid overdose reversal medication available either as a nasal spray or an injector, must be administered. Available without a prescription at pharmacies, anyone can carry it, including those prescribed an opioid or those who suspect a friend or family member is using illegal fentanyl.

Many insurances, including TennCare, cover naloxone at a minimal cost. Unfortunately, increasingly lethal doses of fentanyl require more than one to two doses of naloxone, making it crucial that a suspected fentanyl dose is reported when calling 911.

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At-home fentanyl test strips work similarly to an at-home pregnancy or COVID test, with simple instructions. The drug is mixed with water, and the strip is dipped in the solution for 15 seconds. If lines appear, the drug contains fentanyl.

Far from encouraging fentanyl use, such strips can save lives, especially when an illicitly manufactured drug, such as Xanax or Adderall, may be laced with fentanyl. Testing may make users reduce their dose or not use the drug altogether.

A Tennessee law adopted in March 2022 excludes such strips from the definition of “drug paraphernalia,” eliminating prosecution as a drug-related offense of those in possession.

Strips are distributed in opioid overdose reversal kits the Tennessee Department of Mental Health and Substance Abuse Services distributes to individuals and nonprofits.

We need a multiprong strategy to combat this problem

Fentanyl is making its way from China to Mexico, moving across the border into the U.S. While we’ve heard stories of sophisticated underground tunnels, most fentanyl seized is coming into the U.S. via legitimate ports of entry, smuggled in vehicle tires, gas tanks, machinery, vegetables, and even coconuts.

At the World Trade Bridge Port of Entry in Laredo, Texas, which sees 10,000 trucks daily coming from Mexico. Sophisticated technology is screening drivers and cargo like never before. The Multi-Energy Portal transmits energy that can scan the driver, the vehicle, and even the load to detect the presence of illegal narcotics and opioids.

Securing our border and introducing more sophisticated screening technology as well as more significant penalties for traffickers is not a political statement it is life and death for young Americans.

A single-prong approach will not eliminate fentanyl smuggling, sales, addiction, and overdoses. But by working in tandem, these approaches can stop the flow, prevent addiction, and stop the deaths—and make the fentanyl crisis a thing of TV fiction.

Shane Reeves is a trained pharmacist and CEO of Twelvestone Health Partners. He is also a Republican state senator representing District 14 (Bedford, Cannon, Moore and Rutherford Counties) in the Tennessee General Assembly.