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4 Strategies for Combatting the Third Wave of the Opioid Epidemic: Fentanyl

Caroline Carney, MD, MSc, is the chief medical officer for Magellan Rx Management, the pharmacy benefit management division of Magellan Health. She joined Magellan Health in 2016 and previously served as the chief medical officer for Magellan Healthcare. In her current role, Carney is broadly responsible for supporting Magellan Rx in building differentiated, industry-leading clinical programs and services. Prior to joining Magellan, Carney served in chief medical officer roles, working with Medicare, Medicaid, commercial, and exchange populations. She was trained in and practiced psychiatry, internal medicine, and psychosomatic medicine. Carney has a Master’s degree in preventive medicine, focusing on health services research and epidemiology. She also brings strong public sector expertise having served as medical director for Indiana’s Office of Medicaid Policy and Planning where she oversaw quality, pay for performance, and initiatives for behavioral and physical health.
In recent years, fatal overdoses from fentanyl have drastically increased across the nation, with the number of deaths nearly doubling each year from 2013 through 2016. The data point to the emergence of the third wave of the nation’s opioid epidemic—fentanyl.

A recent report released by the CDC highlights alarming trends characterizing this third wave and its impact across a wide variety of demographic groups:
  • Three times as many men as women are dying from fentanyl, although death rates have increased exponentially among both genders.
  • Death rates among teens and young adults (ages 15-34) are especially steep. Among 25- to 34-year-olds, the percentage of deaths involving fentanyl doubled each year from 2011 to 2016.
  • Recent increases in fentanyl deaths among 35- to 44-year-olds are also of grave concern: Death rates for this age group rose more than 123% per year from 2013 to 2016.
  • From 2011 to 2016, the number of fentanyl deaths was higher for whites than for other ethnic groups. However, overdose deaths rose faster year over year for blacks (140.6% per year) and Hispanics (118.3%) during this period.
Why are fentanyl death rates increasing so rapidly? Fentanyl is 50 to 100 times more potent than morphine, meaning it takes very little of the drug to cause a fatal overdose. Not only is it extremely addictive and dangerous, with the potential to slow or shut down breathing, but it can also be manufactured cheaply and easily in a synthetic formula in a lab, substantially increasing its availability. Because it comes in many forms—tablets, powders, liquid, and patches—synthetic fentanyl is often mislabeled or mixed with other drugs on the black market. As a result, many people who have overdosed on fentanyl are unaware the drug that was taken was laced with fentanyl.

Further, our country’s laws and medical guidelines have made access to prescription opioids much more difficult—and that’s a good thing. Unfortunately, decreased access has prompted many people suffering from substance use disorder to turn to heroin. This, in turn, has increased exposure to fentanyl.  

While the rapid rise in deaths due to fentanyl is another tragic outcome in the growing opioid epidemic, it’s a crisis that can be combatted with education, awareness, and the right precautions. The following are 4 key strategies that can make a material difference.

1. Recognize opioid addiction and encourage evidence-based treatment
A critical step in combatting the rise of fentanyl and opioid overdose starts with education. Educate members and their families, friends, and loved ones on the signs of opioid addiction—and support access to evidence-based treatment. Common signs of addiction can include:
  • Regularly taking an opioid in a way that was not intended
  • Mood changes (from elation to hostility)
  • Changes in sleep patterns
  • Borrowing medication from other people or "losing" medications to gain additional prescriptions
  • Poor decision making
When addiction is detected, one of the most effective ways to combat opioid addiction is through medication-assisted treatment (MAT), an evidence-based approach to help those with opioid use disorder (OUD) return to health. When combined with psychosocial interventions like psychotherapy and contingency management, MAT empowers those with OUD to recover from their addiction while allowing them to rebuild their lives.

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