August 20th, 2021

Writing About Drugs: Fentanyl 101

By Miffie Seideman

The other day I found three little blue pills strewn on the ground at my local gas station. As soon as I saw them, my heart skipped. As a pharmacist, I can spot oxycodone tablets a mile away -- little round blue tablets with an “M” imprinted on one side, and “30” on the other.

But the coloring on these were off…just enough.

These were lethal fentanyl-laced counterfeit oxycodone, the pills causing fatal overdoses in high schools and showing up in national headlines. Just one can kill an adult, so imagine what these three could do to a passing kid or dog.

The police confirmed my fears and came to scour the area for more.

Sure, we’re all authors looking for great new plot twists, and this would surely count. But we also need to know the facts about fentanyl for the safety of ourselves and our loved ones.

Important Questions and Answers

Would you know how to save your loved one’s life, if they overdosed on fentanyl?

If not, keep reading. It no longer matters if that person would never touch fentanyl or street oxycodone. Finding those tablets so close to home highlighted that real and present danger for me.

Here are 3 things you need to do regarding fentanyl and opioid overdose dangers:

  • Arm yourself with knowledge
  • Arm your family with an open door to discussion
  • Arm yourself with the antidote

1. Arm Yourself With Knowledge

I asked several authors what they wanted to know most about fentanyl. The top seven answers are below.

What is fentanyl?

  • Medical fentanyl is an opioid painkiller 100 times more potent than morphine. It is completely synthetic (made in a lab).
  • Illegal ‘street’ versions of fentanyl (and some of its cousins) are even more potent than medical fentanyl and are being laced into street drugs. One cousin is carfentanil(a large animal veterinary tranquilizer) 100 times stronger than fentanyl.

Yes, that should scare you. Elephant tranquilizers are ending up in street drugs.

Fentanyl and its cousins are now responsible for the majority of opioid-related overdose deaths:

  • At least 50% of all opioid deaths in 2018 involved fentanyl(s)
  • 36,000 US overdose deaths in 2019 involved ‘synthetic opioids’, such as fentanyl
  • Overdoses soared by 38% during covid, heavily boosted by fentanyl-related deaths

What does fentanyl look like?

Well, that’s a tough one. Fentanyl comes in several forms: injection, skin patch, nasal spray, and a lozenge. Illegal fentanyl also comes as a powder.

The real question isn’t what does fentanyl look like, but what are street fentanyl(s) laced into?

It’s a long list, including marijuana, cocaine, methamphetamine (‘meth’), heroin, fake Xanax, fake Vicodin, and fake Adderall* (the ADHD drug), among other drugs. Fentanyl powder has been colored, pressed, and imprinted to look almost identical to real oxycodone (OxyContin). This so-called “Mexican Oxy” is what I found at the gas station. (*Fake Adderall has also contained lethal amounts of methamphetamine).

Why is fentanyl so dangerous?

  • Used the right way, medical fentanyl isn’t.

It’s great for severe pain, during surgery, and some cancer pain. But it does need to be measured carefully, since just 2 mg can be fatal to an adult.

  • The true danger comes from street fentanyl(s).

Drug traffickers aren’t exactly worried about careful measuring- they get paid all the same. Some street doses have very little fentanyl. Some have been found with 5 mg of fentanyl in a single tablet- more than twice a lethal dose. With carfentanil, a dose the size of a grain of salt can be lethal. How are they going to measure that safely?

  • Toxic doses of fentanyl(s) make the body stop breathing. If breathing isn’t restarted rapidly with naloxone (Narcan), the brain dies from lack of oxygen. It has taken 4-5 doses of Narcan to save some victims of these potent street drugs. In some cases, even that hasn’t been enough.

Why would a lethal drug get added to street drugs?

It’s all marketing and profit. If traffickers add the right amount, the fentanyl gives the drugs a bigger kick, a bigger high, and it’s cheap to add. A bigger high also raises demand. Users just hope they get a great high. Some are willing to buy it knowing the risk of a poorly measured batch. In some cases, fentanyl leftover from a previous counterfeit batch contaminates a new batch made in the same container.

How are people getting it?

  • Most abused fentanyl is from street drug supplies.

In the US, most of these supplies come across the Southern border. Some comes from China. From there, supplies flow to other markets in the US.  

  • Some users actually seek out fentanyl-laced batches!

Buyers and sellers can even connect via social media apps and subgroups, using special emojis.

  • But most people getting fentanyl don’t even know until it is too late. By then they could be dead or addicted.

It could be in the heroin they bought. It could be in the pain pill the football player bums from a friend so he can make it through the game. It could be in the weed at a weekend party.

Or little Timmy could pick up a little blue-grey tablet off the ground at the gas station while Mom is turned away for a second or two.

So…how much is actually getting into the US?

Much more than is being stopped. If you have a strong countenance (or a good glass of scotch), do a quick google search of your own state. I did that for Arizona and the data was pretty sobering:

  • 170,000 fatal fentanyl doses found in one drug bust (Jan 2020)
  • 22 pounds of fentanyl found (enough for 4 million lethal doses) on one traffic stop (June 2021
  • Another 22 pounds of fentanyl powder captured just last month

What do I look for in my kid, friend, spouse?

  • Similar to other abused drugs, the basic recommendations include (see full check list here):
    • Changes in mood (depression, mood swings, anger, hostility)
    • Changes in behavior/ sleep patterns
    • Drop in school grades/school attendance
    • Changes in friend circle
    • Missing money/ increased need for money
    • Odd smells in room or clothing (or sudden use of scents to mask smells)
    • Secretive conversations

2. Arm Your Family With an Open Door to Discussion

  • It’s never too soon to talk to kids about drugs

The National Institute for Drug Addiction has sobering statistics for 8th graders (Yes, that’s 8th grade – 13 year-olds!):

  • 15% admit to having used illicit drugs in 2020
    • Almost 3% have used Adderall when not prescribed
    • 2% have used hallucinogens

ANY of these drugs could have been fentanyl-laced.

  • Open a door to safe communication

Share the dangers of drug use. Let them know they can talk with you openly about drugs, what they see at school, and ask their questions without judgment. Let them know that door is open, even if they make a mistake and try drugs. They need to know you will be there to help them.

If that door is closed, they will go somewhere else.

My family and friends know they can call if they are in or near this kind of danger or have had too much to drink. We will come get them any time of day or night. We won’t judge. We just want them alive. If you offer this, make sure you follow through. Or that door will slam.

  • Educate yourself about drugs

The best way to talk to your loved ones is by having at least some basic information. What is going on in your neighborhood? Your local schools? What do those drugs look like and what are the dangers? It’s a bit scary to read at first, but it’s better to know and be prepared.

It’s easy to get overwhelmed. So, pick just a few drugs to get started. I might suggest: oxycodone, fentanyl, Adderall, marijuana, and methamphetamine.

These sites can get you started:

3. Arm Yourself With the Antidote

  • Get Narcan (naloxone) AND learn how to use it!
  • Narcan is available at many pharmacies without a prescription. State programs or insurance often cover the full cost and some drug manufacturers offer free naloxone.
  • Have the pharmacist show you how to use it or watch an online instruction video. You do not want to start figuring it out when someone you love has stopped breathing.

Plotting with Fentanyl

While I am passionate about the drug overdose problem, I’m still a writer at heart!

After the initial shock of finding street oxy (literally on the street) at my regular gas station, I started plotting the incident into a scene.

How authors can weave a few basics into plots:

1. Use your imagination to decide how your character gets exposed to fentanyl.

Is he smoking tainted marijuana? Did he bum some tainted Adderall off another student? Inject fentanyl-laced heroin?

2. Give your character some basic quick symptoms.

Your character can develop some basic symptoms that evolve over several minutes, including feeling that euphoric ‘high’, difficulty concentrating, and feeling very drowsy. Are you putting the character into lethal peril? Does the reader know the batch was tainted?

This is where you can have you character progress to unconsciousness and more toxic symptoms, with your reader at the edge of their seat.

3. Use current news headlines.

For additional scene ideas, contemporary news headlines are unfortunately full of drug busts and local cases to pick from. In my own town, street oxy was recently handed out at a teen party. No one knew it was fentanyl-laced until 4 teens died.

4. Research historical drug use.

Historical searches may also be useful, such as the famous Moscow Theater attack by Chechen rebels in 2002, ultimately resulting in Russian forces releasing carfentanil into air vents, killing about 129 hostages and 33 rebels.

Have you seen this growing fentanyl danger where you live? Have you addressed it in conversation or in the pages of your story? Please share your experiences with us down in the comments!

* * * * * *

About Miffie

Miffie Seideman has been a pharmacist for over 30 years, with a passion for helping others. As a published non-fiction author, her articles have appeared in several professional pharmacy journals. When not training for a race, her writing projects include a (soon to be announced) writer’s handbook and a fantasy adventure that started as “What if Romeo and Juliet didn’t live happily ever after they died?” An avid triathlete, she spends countless hours training in the arid deserts of Arizona, devising new plots.

Miffie can be found hanging around her blog onwemerrilystumble.com examining the intersection of triathlon and writing and on Twitter @MiffieSeideman…you know…tweeting.

26 responses to “Writing About Drugs: Fentanyl 101”

  1. Thanks for the information on naloxone. I wish we could figure out how to provide necessary drugs for legitimate uses - and keep people from getting addicted or worse. The supply/demand pair is key. I can't imagine taking anything, especially not knowing what it is or where it came from - I understand the 'kids' do it, but I never was even interested. But I know what can go wrong. Eek!

    • Hi Alicia- I completely agree about needing to figure out the legitimate users. It is hard when you do need medication and now it is so restricted. Many do not get the treatment they need out of fear of addiction. Thanks for joining the conversation.

      • Thanks for the detail you provided.

        The current novel trilogy has a character with fairly constant pain problems (she has ME/CFS), but there are so many themes already that addiction isn't one of them - she's a former physician who can't practice her profession because of lack of energy, and the brain fog, and so turns to writing, where she runs head on into the world of Hollywood and movies. And tries to duck back out. She is extremely leery of even taking enough pain medication - it dulls the mind.

        I've bookmarked this post - never know when you'll need the information!

  2. V.M.Sang says:

    This is very worrying. I hadn't heard of fentanyl before. I get so angry that some people are prepared to potentially kill others for money.
    In my current book, waiting to be published, I have one character become addicted. As it's fantasy, the drug isn't a regular one, but I did research a number of drugs. And one critiquer gave me some tips from personal experience of dealing with drug users.
    This is an important post, so I'll share it when I get on my pc.

    • Hi! Yes, even if it is a fantasy-world drug, having some of the key drug use or interaction points right really helps with validity and underpinning the realistic nature of the scene. People can relate to similar interactions and side effects, even if it isn't a real drug. Thanks for joining in on sharing this important information.

  3. Pat says:

    Thank you for educating us as writers and also as parents grandparents, neighbors...Worrisome, necessary information!

  4. Great post, Miffie! Very educational. In non-pandemic times, my husband and I work with a group, driving a drug education trailer. We give tours showing people signs of drug use in the home and places where teens and young adults hide drugs. Here’s a link with a virtual tour. You might find it interesting. We hope to get back on the road in the next few months. https://www.raliusa.org/virtual

    • Carrie- Thank you for that video link. It is all so unsettling. My mouth dropped open at the computer mouse weight scale. I would love to have this van come through Arizona when the world is again open. I may contact them to see if there is really a need to wait. The suicide and drug overdose rate has really escalated during covid. Now it the time to really help. I am going to show this video to others, if that is ok. I think every single parent should be made to watch it. How did you come to be involved with this awesome effort?

      • Of course, please share with everyone! My husband is retired law enforcement and involved with a group of officers on the west coast (we live in Central CA). A similar group on the east coast is one of the trailer sponsors and they were looking for a retired LE couple to drive one of the two trailers. We love doing it and can't wait to get back on the road. You can contact me at cpadgett59 at comcast dot net and I can give you more details.

  5. Thank you for writing this - lots of information here. I'll have to look down when I'm at a gas station now. The only thing I remembered was a friend who had to give up a boyfriend who abused drugs. I wish for courage for anyone and their family going through such hardship, but a certain hell for anyone selling street drugs.

  6. JL Nich Author SFF says:

    I write science fiction and have introduced fictional drugs used and sold on my planets by alien species. Even fictional prostitution and other addictive behaviors with the galactic spin. I even have a dragon drink called Soffa juice. Soffa juice in moderation, was often a favorite since it came from the soffa root found only in the depths of the crust fields of sulfur rock, which Draconia ate before flaming.

    Drugs/addictions are a reality of concern in all my work

  7. dholcomb1 says:

    Fentanyl is a real problem in the area where I live, hitting all levels of society. Narcan is hard to get because of supply issues.

    I don't use drug and alcohol addiction in my stories. One of my brothers just celebrated 26 years of sobriety. I'm not sure my other brother celebrates his sobriety. My father is a recovering alcoholic. It's all just too close to home to write about.

    denise

    • Hi Denise- I totally get it being too close to home. 26 years sober is an amazing celebration and struggle. I do worry about the Narcan supplies being low. That is a real concern. I'll have to check and see what our area is like here, just so I know. All my best in your writing endeavors.

  8. Thank you so much for writing this! A lot of good information here. There have been many fentanyl-related deaths where I live and understanding the process has really opened my eyes.

  9. Jenny Hansen says:

    As the mom of an incoming 6th grader, this article scared me down to the bone. It's sobering to think of such a tiny amount of something so readily available being so lethal, and to see how many "everyday" drugs it is getting mixed with. Yikes.

    Thanks for taking the time to educate us about this - I've been in my elementary school bubble and I had no idea fentanyl was such a growing problem.

    • Thanks, Jenny. It is sobering. It's such an extremely brazen industry focused only on money. The Adderall one got to me- so many see that as a safe medical treatment, not realizing there are counterfeit meth/fentanyl versions floating around. But this is the one I can see more kids not thinking bad to bum off a friend. You're kiddo will be ok- you have a great open relationship with her. It's that upbringing, expectation, knowledge share that will make her secure.

  10. Writing aside, this is very valuable information you've shared, Miffie, and could save lives. I can't thank you enough for taking the time to give us this very comprehensive rundown on these horrible drugs. And the explanation of safe dosages of fentanyl is comforting to know when we need it during surgical procedures. Thank you so much! -- Christine Samuelson

    • Thank you, Christine! I so wish this hadn't needed to be written, but was glad to have a group that so whole-heartily supported it. The doses given of fentanyl are at the lethal end of dosing for an adult (2-3 milligrams). Treatment doses are in micrograms- so much, much smaller than milligrams. Doses are often at about 50-100 micrograms for an adult. I know at my ER trip I ended up getting a total of 200 micrograms to kill the pain (so 1/5th of a milligram). I hope that clarifies dosing.

  11. One of the characters in my novel is in recovery from an oxycodone addiction, caused when he was prescribed pain pills after an accident. For so many years, physicians prescribed so many pain pills when people were recovering, it created all kinds of dependencies that weren't intentional. The current issues with Fentanyl are terrifying. A friend of mine lost her son to an overdose this summer. He had bought a pain pill from someone because he had a migraine. He died that night sitting on his sofa. The same dealer sold a pill to a 16 year old girl, who also died. The dealer was arrested but he is only one minuscule part of the problem. My friend had no idea that fentanyl was an issue until this happened. My heart aches for all the people losing their loved ones.

    • Hi Liz! Sorry to respond so late- I just saw this. My heart definitely hurts for those that have gone through just what you described with your friend and her son. Same thing happening here. Just last week, another 200,000 fentanyl laced tablets and 4 pounds of fentanyl powder were confiscated in a house 30 minutes from me. It is hard to keep up with the reports at this point. Thank you for sharing that story. The more word we get out about the reality, the more people we can inform and help protect.

    • Jenny Hansen says:

      Liz, your story is heartbreaking. I'm so sorry for your friend. I have a tween daughter and this article, which scared the hell out of me, has prompted me to do a lot of reading and open some discussion with her.

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