Putting an End to the Opioid Epidemic in Emergency Medicine

What we're seeing as a trend is this significant increase in synthetic opioids, specifically fentanyl, being contaminated and causing severe overdoses.

Pharmacy Times spoke to Jake Deutsch, MD, Emergency Medicine Physician, Mount Sinai Hospital System NYC, and Founder & Clinical Director, Cure Urgent Care, about the opioid epidemic and resources pharmacists and health care providers should use to educate their patients.

Jill Murphy: Hi, my name is Jill Murphy and I'm here with Jake Deutsch. And today we're gonna be talking about the opioid epidemic and also different resources that we can use as patients and healthcare providers for different ways to stop this opioid epidemic. Jake, how are you doing today?

Jake Deutsch: I'm good. Thank you.

Murphy: Thank you so much for joining me, I just wanted to ask you, if you could really just give us a background really quickly about you and how you got to where you're at today with your career?

Deutsch: Sure. So I'm a physician. So I'm trained as an emergency medicine physician, I've done that for 20 years. And, you know, kind of my basis of all things that I relate to in medicine is, my training, which, as an ER physician, were trained to be able to take care of all sorts of emergencies. So that is sort of my foundation, I have clinics where we give IV medications, biologics, particularly to people with chronic illness. And then I have a small men's practice focused on men's health and wellness. So I have a lot of different interests, but always the core goes back to emergency medicine. And that's why I think, you know, I could shed some light about what we're going to talk about today.

Murphy: Absolutely. So like I said, the opioid epidemic, it's been taking over the United States and continues to grow with each year. With your perspective in the emergency room as a physician, how do you see this impacting patients and the healthcare world?

Deutsch: So you know, overdoses is an issue that we deal with commonly in emergency medicine. But typically, it's been from particular types of substances, so your heroin, alcohol, you know, sometimes benzodiazepines, like Xanax or Valium. But what we're seeing as a trend is this significant increase in synthetic opioids, specifically, fentanyl, being contaminated and causing severe overdoses. More importantly, fatal overdoses. So typically, an overdose can be tolerated to some degree and if caught early enough, a patient can be resuscitated and survive. The issue with these synthetic opioids is that they're so strong, that they can easily and quickly be fatal. And you don't have time to get people to the hospital so that the doctors can do what they need to do to save them.

Murphy: And is there any resources out there that can help educate patients and healthcare providers to continue to combat this epidemic?

Deutsch: I mean, CDC, you know, has great information about the overall opioid and sort of just drug epidemic, you know, I think the key is understanding that just a small amount of this contamination of fentanyl can cause a fatality. So what we're seeing is a tremendous increase of people who aren't particularly familiar with using recreational drugs who've had an exposure, and then it's fatal, because the significant potency of this synthetic opioids. So you know, that's really the key is that we get people to understand that it can be in powders, it can be in pills, it can be in liquids, and just a small amount is enough to cause a fatality. So if we don't get people to understand that this is a problem, we're not going to see a significant drop in the number of overdoses. And by the way, in 2021, we had the highest number of recorded overdoses in history since we started recording that over 100,000 deaths. And what's startling is that 70% of those are thought to be related to fentanyl contamination or fentanyl overdoses. So we're seeing this very high traffic overdoses and the majority of them being related to fentanyl. So we need to get people to understand, this is how this happens. And then the next step is how we prevent it.

Murphy: Absolutely. And I know that you probably work with emergency medicine pharmacists as well. Is there anything that they should know to help educate their patients who may be trying to overcome these addiction to opioids?

Deutsch: So, I mean, certainly, I think the most important thing is that we have some sort of resources, should there be an overdose. So Naloxone/Narcan, can reverse an opioid overdose. The problem is oftentimes, you know, people don't have access to it, it's expensive, it's not readily available, it has to be administered, intramuscularly or inter nasally. And the common person doesn't have access experience to be able to take care of that. And just say to somebody, let's say you have a patient who you're worried about that, has had a history of abuse and you're worried that they may be abusing drugs, either illicitly your prescription drugs and certainly with the contamination issue. Advising them to have Narcan- Narcan isn't necessarily feasible. So the other option is testing drugs. So while we never are advocating for people to be taking drugs, abusing them whether prescription are listed, at least having some sort of knowledge that you can prevent an acid unnecessary death, you can reduce harm is, I think, a key element. So I think that that's the message that people should be empowering people with is: if you choose to do this, which is not a recommendation whatsoever, but if you choose to do this, make sure that you're at least protecting yourself. We want to reduce harm, because one less person who's dying each day is going to is going to be significant. And by the way, we're seeing on average, 150 overdoses a day in the United States from prescription/non-prescription illicit drugs.

Murphy: So with all that being said, what other preventative measures do you recommend or advocate for that you've seen in your position that you have in the hospital?

Deutsch: Certainly having resources like, rehabilitation and other types of harm prevention elements. So, the reality is, people have to want to make a change. But those changes are easier when there's additional resources. So counseling, detox programs, access to treatment, that can be therapeutic, when receiving detox, I think that that is really important, as well. And we're certainly not doing well in the United States about offering those type of things readily available, making it, talking about it. This should be a conversation that's happening on every level, not just by a parent who's really vigilant. But in schools, commercials, what, where do we get attention? For the people who are most affected? The number one cause of overdose, for people between 18 and 25, is related to opiates and an illicit opiates like fentanyl? So how do we get in touch with that category of people? Is it through social media, does a company like Facebook saying, what, we're going to put some sort of information that's coming across our platforms, TikTok, whatever, in order to really get people aware. And also, hopefully, there's people who are in those spaces that are going to get this message: if we can get influencers to be talking about this, it's great to talk about a hack that makes your iPhone work better, or a makeup tutorial, but in sort of a public service realm having this information readily available. And that's all of the things I was talking about how to get help, what you should be worried about, what you could do to prevent. I don't think that most people between 18 and 25 even know what Narcan is or even know that there is testing kits that you could use to be able to test if you were taking some sort of drug that wasn't a prescription drug. So that's really where we should be putting our efforts.

Murphy: So I know that you work with a company that focuses on harm reduction. Can you go more into detail about this, and how exactly you test these drugs?

Deutsch: Yeah, so basically, they provide testing kits, which are compact and easily used, they're very simple. They're what we call a point of care test. So essentially, you would just need to take a small amount of powder, or swipe a little piece of a pill, have contact with it, it gets diluted in water, and then the strip is dipped into the water, and you need to keep it there for five to 10 seconds, and pretend to 15 seconds, I should say. And then you let it develop. So at about five minutes, you'll be able to see the marks on the strip, there's a control, and then there's a positive and then you know negative, essentially. So what you're seeing is a very quick result in order to detect it with 98% accuracy. So when we talk about bentonite, I think people need to understand we're talking about they're like a speck of sand is enough to be potentially fatal. So it's 100 times more powerful than morphine. So this testing is able to pick up with 90% accurate, 98% accuracy if there was some contamination, and so the kit is designed to be super simple. And that would be something that you know, pharmacists should probably be familiar with. So if somebody came to them and said, “Okay, tell me about this kit,” you would know what's a great resource, like Signify Analytics, and also kind of have a general idea about how to use it. You know, again, the idea is harm reduction and prevention. Unfortunately, people are going to take drugs, abuse drugs, that is a problem that we need to fight on a bigger level. But having a solution to reduce harm for those who choose to participate is really the mission of where Signify Analytics has come in. And it basically, it's a crazy story, but the founders of the company had lost a friend to an overdose that was related to fentanyl. And that was the motivation to start this company. And whenever there's a fatality and overdose and it's personal, it changes everything. So these statistics, 100,000 deaths in the US last year, may not resonate, until it's somebody that you know, somebody in your community or somebody that you love. So that's why, this is so important. And as an ER physician, if I can make a difference if I could kind of be part of that voice that gets that message out there. That's incredibly important. That's incredibly powerful.

To access or learn more about the fentanyl testing products discussed in this interview, visit SignifyAnalytics.com.