Experts weigh in on the deadly effects of fentanyl

The North Fork and Shelter Island  communities were rocked late last week with six overdose deaths, caused by what police believe to be cocaine laced with fentanyl. In the wake of these tragedies, many community members have been left with questions. What is fentanyl? Why would someone mix it with cocaine, and why was the combination so lethal? We spoke to addiction experts for answers. 

Fentanyl is a “very potent opiate-type narcotic” with “similar effects to heroin,” according to Dr. Lloyd Simon, director of addiction services at Quannacut at Stony Brook Eastern Long Island Hospital.

“When it first came out, you may remember that people were overdosing because it is so much more potent than heroin and those were people with opiate disorders,” he said. “A lot of opiate-use disorder patients will actually seek it out. They like to get the more dramatic effect. So a lot of patients with opiate disorders have become tolerant of these more potent medications and higher dosing of opiates.” 

Cocaine on the other hand, he added, is a stimulant. And as tragically demonstrated just days ago, even small amounts can be life-threatening to those without an opiate tolerance. 

“If somebody is seeking the high that they get from cocaine, and is not used to taking opiates, then even what may be relatively small amounts of fentanyl mixed in, even if it was done inadvertently, as I’ve seen suggested in some newspaper articles, might be too much for them because they don’t have any tolerance to the opiate kind of drug,” Dr. Simon explained. 

This is not a new problem, nor is it unique to Long Island. Leigh Wedenoja, a senior policy analyst at the Rockefeller Institute of Government, said fatal fentanyl doses — a drug she described as a synthetic opioid originally developed to treat “extreme, debilitating, fatal pain” — started to increase rapidly between 2015 and 2017, leveling off in 2018 and 2020 in New York.

“It is extraordinarily powerful, so even the tiniest whiff of it can be lethal,” she added. On a national level, fentanyl deaths in 2020 jumped by approximately 20,000 over the previous year, according to preliminary data from the Centers for Disease Control and Prevention.

Although heroin and prescription opioid overdoses have been declining, Ms. Wedenoja said a recent increase in overall overdoses have been driven partially by fentanyl and fentanyl mixed with cocaine and methamphetamine. In Suffolk and Nassau counties, before 2015 and 2016 respectively, the number of combination deaths were low enough that their individual statistics weren’t released.

“However, those numbers have started to skyrocket,” Ms. Wedenoja said. They peaked in 2017 with 40 deaths in Nassau and 123 in Suffolk. And although national increases in general overdose deaths leveled off in 2018 and 2019, there was a nearly 30% spike in overdose deaths in 2020. 

“What aspects of the pandemic led to this spike is almost impossible to figure out. Is it the stress? Is it that people were at home? Is it the interruption of support services like medication assisted treatment, distribution of Narcan, of 12-step programs? It’s probably all of them,” she said.