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

June 13, 2019
Caroline Carney, MD, MSc, FAPM, CPHQ
Caroline Carney, MD, MSc, FAPM, CPHQ

Magellan 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.

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.

2. Support access to naloxone

Naloxone can save lives by reversing the effects of an opioid overdose. It’s important to proactively speak with health providers and insurance companies to ensure access to naloxone for those battling opioid addiction.

The US Surgeon General recommends the following groups of people keep naloxone on hand for emergency use:

  • Those currently taking high doses of prescription opioids for pain
  • People who are misusing prescription opioids
  • Individuals taking illicit opioids, such as heroin or fentanyl
  • Healthcare providers
  • Family members whose loved ones suffer from OUD
  • People who regularly come into contact with those at risk of an opioid overdose

Health plans can support access to naloxone through policies that make this medication readily available to those suffering from OUD and their support teams. They should also seek to educate providers on the benefits of access to naloxone for high-risk individuals.

3. Foster safe opioid usage, when necessary

When opioids must be used in treatment, work with providers to establish safe guidelines for use. For example, take steps to ensure the morphine milligram equivalent dose, duration of treatment, and type of opioid prescribed (eg, long- or short-acting opioids) follow the CDC and CMS best practices.

Additionally, pairing those taking opioids with chronic pain management coaches and offering these individuals 24/7 access to healthcare professionals, such as a hotline staffed by nurses or an outside service, will provide a critical resource for members who need help understanding their opioid prescription or feel as if they have a problem managing their response to their medication.

4. Community involvement

Stay up to date on community, medical, and legal resources directed at combatting addiction and limiting the availability of opioids. For example, the SUPPORT for Patients and Communities Act passed last year provides practical policy solutions for addressing the opioid crisis, including the use of telehealth services for OUD treatment. In communities with limited resources for one-on-one OUD support, telehealth services or a combination of virtual and in-office services provide the basis for an evidence-based approach to care.

It’s also important that health plans, providers, and community groups work together to identify specific populations at risk and develop targeted outreach and recovery support. Such initiatives can help members feel more empowered to successfully recover and transition back into society.

Breaking the Cycle

With new factors continuing to emerge every day in the growing opioid epidemic, now is the time to take proactive measures to better protect communities across the nation. Through education, support for evidence-based treatment and naloxone access, and partnership with families, providers, and community service agencies, we can help ensure those with OUD receive the right support at the right time, putting them back on a path of sobriety and health.