Navigating the Fentanyl Crisis as a Young Person

Reed McCaskill was 15 the first time he went to treatment for drug addiction, brought about by painkillers after multiple severe sports injuries. From there, he shifted to heroin, then to fentanyl. 

“At that point, I'd stopped caring about doing other drugs and, any other substance, it was like, ‘Yeah, fentanyl is the thing I want to do'...Everything was okay because I was feeling like I was on cloud nine and then, pretty quickly, things started to shift.” 

Don’t worry, this story doesn’t end in tragedy, he’s now 25 and in the process of completing a social work degree while also working at the treatment center—Back2Basics Outdoor Adventure Recovery—that set him on the path to recovery, but he’s one of the thousands of young people affected by a fentanyl epidemic that the American healthcare system is struggling to manage.

The issue is particularly acute in youth and young adults and severely impacts the mental health of those who go through the experience. 

Why is Fentanyl So Deadly?

Drug overdoses are an increasingly common phenomenon and the growing presence of fentanyl in the drug supply. Data shared by the Center for National Health Statistics show that overdose deaths jumped 30% from 2019 to 2020 and then by 15% from 2020 to 2021. Experts are quick to point out that it’s fentanyl’s potency in tiny doses that makes its risk level so high. 

Fentanyl has played an outsized role in these deaths. This is because fentanyl is a synthetic opioid that is 50-100 times stronger than heroin, so it takes a tiny amount to cause an overdose. “Fentanyl is a potent opioid,” says Eric Collins (MD), an associate clinical professor of psychiatry at Columbia University and chief medical officer at RecoveryEducation.com, “By potent, We usually mean that it takes small microgram amounts to produce a significant effect. Less potent opioids, like morphine, require milligram amounts.”

Before digging deeper into the mental health impacts of fentanyl, it’s important to know the signs of an overdose. The Centers for Disease Control (CDC) has a resource that lists symptoms, including shallow breathing, and small pupils. Collins says that the issue is so widespread it’s gotten to the point where it is rational for an overdose to be a default consideration in some circumstances.

“When you see someone not breathing at all, these days especially, you should always wonder if there's been a fentanyl overdose,” he says. 

China Brezner (LMFT), a clinical director at Clear Recovery, believes that part of the issue for drug users is that many of her clients are unaware of how commonplace it is for other drugs to be laced with fentanyl. 

“What I'm seeing too, especially in detox, is that people are coming in saying, ‘I'm just a cocaine user,’ but then fentanyl is showing up on their drug test. So, they don't even realize that it's cut in the drugs they're doing.”

Collins says that mental health trauma can often occur when someone witnesses an overdose and that prevention is a key tool to support both the physical and mental well-being of those facing addiction. In other words, the consequences of addiction expand far beyond the addict themself.

“I do think this creates a real significant trauma problem for people who have witnessed even just one overdose, felt helpless and didn't know what to do, or didn't have Naloxone and watched someone not breathe and die in front of them. I mean, it's terrible,” says Collins.

Education is critical at the intersection between mental health, addiction treatment, and the rise in fentanyl, according to McCaskill.

“I felt like I was so left in the dark and I didn't have that kind of previous education. And then, once I got into treatment centers and stuff, I started to learn more,” Collins says.

The Healing Power of Community Outreach

William Perry is one of the people working on the ground to reduce fentanyl-related deaths. He co-founded This Must Be the Place, an Ohio-based non-profit that provides Naloxone (commonly known as Narcan) to people across the country while providing education about the impacts of fentanyl and other opioids. Perry says that what led him to addiction was partially the result of his lack of self-assuredness in his youth.

“I started using them just out of the spirit of camaraderie, but I realized really quickly that the drugs could validate me when I did not feel great about myself. I didn't have to make a friend [I realized] that a substance could make it for me," says Perry.

This Must be the Place partnered with Hikma Pharmaceuticals to obtain 10,000 doses of Kloxxado, which is, in effect,  a double dose of Naloxone. He says that much of the work is to educate people about just how common fentanyl is, a change from when Perry was first working on getting sober in the mid-2000s. For him, fentanyl came at a time when access to life-saving drugs like naloxone were not available. 

“To say I lost everyone is almost an understatement, and I felt helpless learning about that," Perry shares.

Perry says that stabilizing his mental health, and finding what gave him fulfillment, was what eventually led to the work he’s doing now. 

“Working on a lot of my mental health issues made me realize that what gave me fulfillment was helping others facing addiction. This also helped me maintain my own personal sobriety. I love feeling like I'm empowering them to potentially save the life of someone they love."

Howard Barker, director of community relations at New Life House echoes the sentiment that the fentanyl epidemic is getting worse. In his experience, when he first started using a wide array of drugs, fentanyl was occasionally available, via a source at a hospice care facility or somewhere similar, but it wasn’t nearly as pervasive.

He now works at the same place where he was able to get tools to manage his addiction. In his role, he goes to schools and community events to talk to youth about the dangers of fentanyl and other opioids.

He says that, prior to getting treatment, he was struggling with his mental health in combination with being physically sick—often known as dope sick—from withdrawals as it became harder to score drugs.

“There was also a level of pervasive low-level psychosis, for lack of a better word, where I truly believed that I was being targeted by governmental agencies...and I was convinced, I was very convinced that I was at the center of this web of people out to get me.”

Barker says that because of the pervasiveness of the issue, those looking for support need to have the non-profit, public, and private sectors working together. 

“Fentanyl’s put it in the news because the drug supply is poison,” Barker says, “But I'll tell you that it's not just fentanyl, the problem is much bigger than just fentanyl. And it's too big of a problem to be dealt with by just one sector. So, we need that public sector. We need access to resources, we need places where folks that are really really low and really in trouble can go to start getting access to help.”

Advice for Parents and Caregivers

Brezner, who also has her own experiences with addiction, says that parents often need or want coaching on how to do what she calls “hold the line” in order to give their children the best success in recovery. Doing so, means sharing what may be harmful to a young person in recovery. 

“‘If you love me, you wouldn't do this’ would definitely go in the no category because if love was enough to conquer addiction, we'd have a lot less people dead. Love is not enough.” Says Brezner, adding that significant boundary setting can be a good step, including making sure that they are not enabling the addiction..

“And I'm not suggesting that every family financially cut their children off, but I've sat with parents who have had the mentality of, ‘ I'm going to go help my kid get drugs because he's sick.’ Which you would think, a parent would do that? Yeah, actually.”

Perry says that, for him, one way to combat the fentanyl epidemic is to empower parents with the tools to talk to their kids and use preventative measures like naloxone. 

“They are empowered to do something about it, you know, because they've seen a whole bunch of other grieving parents on the news, and don't want to become one of those. So they're, they're already fearful, you know, but maybe they don't know how to broach or have that conversation with their children, or maybe they already have, and they know they're still going to do it [drugs].”