By Jennifer Fernandez
LEXINGTON — On a recent Saturday, family members gathered in a circle at a church here to share stories of loved ones lost to fentanyl.
“Our whole world is turned upside down,” said Michelle, a Forsyth County mother who lost her 19-year-old son to fentanyl poisoning. She didn’t want to use her full name for this story or go into details about his death, as authorities are still investigating.
She doesn’t think her son knew he had taken fentanyl, which has become more common as drug dealers add it to everything from heroin to fake prescription medications.
Just a few grains of the highly potent opioid — about 2 milligrams, an amount that’s barely enough to cover the date on a penny — can be fatal. In 2021, fentanyl was involved in 83 percent of fatal medication or drug overdoses in the state, according to N.C. Department of Health and Human Services.
“If this can happen to him, this can happen to anybody,” said Michelle, who has made it her mission to help educate other parents about the dangers of fentanyl.
She’s not alone in her fight.
Barbara Walsh, whose Fentanyl Victims Network of North Carolina organized the recent Lexington meeting, is pushing for North Carolina to require that the opioid reversal drug naloxone be available in all schools. Her 24-year-old daughter died from fentanyl poisoning in 2021 after unknowingly drinking a bottle of water laced with the drug.
The North Carolina Child Fatality Task Force also is looking into the role fentanyl has played in the deaths of not only teens, but young children who likely are getting exposed through trash from illegal substance use left within reach.
“We were floored when we started seeing the deaths of the infants and the toddlers, and that’s really what started our prevention efforts,” said Sandra Bishop-Freeman, the state’s chief toxicologist who works in the Office of the Chief Medical Examiner.
The youngest victims
In North Carolina, fentanyl contributed to the deaths of 10 children age 5 or younger in 2022. Just seven years prior, the state recorded only one death in that age group.
For children ages 13 to 17, fentanyl deaths increased from four to 25 in that same time period, according to data shared with Child Fatality Task Force members.
“Having one child or infant death related to fentanyl or other drugs is …, is too much,” Michelle Aurelius, North Carolina’s chief medical examiner, told task force members in November.
During that meeting, Bishop-Freeman read from investigators’ notes about child deaths due to fentanyl poisoning.
The decedent’s mother reported seeing the deceased pick up a baggie and put it in her mouth.
During the autopsy, a small piece of folded paper was recovered from the baby’s stomach.
Law enforcement stated there was a plastic bag and loose pills on top of a 4-year-old brother’s bed.
Another report focused on 22 cases in 2021 where a single substance was linked to the child’s death. Pathologists determined that fentanyl was the single substance in 15 of the fatalities. Only one other single substance killed multiple children that year — carbon monoxide, which killed two children. Also that year, fentanyl was one of the substances attributed in six out of seven deaths where pathologists determined more than one substance caused the death.
“These are startling stories to hear. They’re awful stories to hear, but we need to talk about them so we can prevent them,” Aurelius said. “I don’t want to have to do another autopsy on an 8-year-old who … died of (a) fentanyl overdose with (a) fentanyl patch on her skin after she was left alone.”
Counterfeit pills
For older children, fake pills laced with fentanyl are a rising concern.
In 2021, authorities seized 77,000 counterfeit pills in North Carolina alone. Eight in 10 pills contained some fentanyl.
Data from the U.S. Drug Enforcement Administration shows that of the fake pills tested by the agency, seven out of 10 contained potentially lethal doses of fentanyl.
The fake pills have become easier to obtain, with sales taking place online and on social media.
Further evidence of the impact of these fake pills comes from a recent study by the North Carolina Office of the Chief Medical Examiner. Officials looked at a sample of 75 toxicology reports from deaths between 2020 and 2022 and compared results to what investigators learned about the deaths.
The study showed that 50.7 percent of those who died thought they were taking Xanax (an anxiety/depression medication), and 54.7 percent thought they were taking a form of oxycodone (a pain reliever). However, the toxicology reports were most often positive for fentanyl with no traceable amounts of the medications the victims thought they were getting.
Last year, the DEA seized more than 79.4 million fentanyl-laced fake pills in the country, according to a tracker on the agency’s homepage. So far this year, more than 19.8 million pills have been seized nationwide, which is on pace to be one and a half times last year’s number.
Finding solutions
Walsh says the opioid reversal medication naloxone, also known by the brand name Narcan, should be available in every school. It should be treated like any other emergency item that schools stock, like epinephrine pens for allergic reactions or automated external defibrillators to shock a heart back into rhythm.
Some North Carolina school systems are starting to do that.
Charlotte-Mecklenburg Schools is adding naloxone to its first aid kits at every school. Nurses and at least two first responders at each school are to be trained in how to use it.
Wake County Schools, which already allows school resource officers to carry naloxone, may soon follow Charlotte’s lead. District officials plan to recommend that naloxone be placed in every school and a policy be created for staff on training and using it, WRAL-TV reported last week.
Last school year, school nurses, staff or SROs administered naloxone 21 times on school grounds in the state, according to the annual School Health Services Report Brochure. The year before, it was used 14 times. According to the report, 84 school districts last school year reported having the opioid reversal drug available on school grounds through SROs and 22 through a districtwide program.
As of September last year, eight states have passed laws requiring all public high schools to keep naloxone on site in case of overdoses at the school or a school-sponsored event, according to data compiled by the Legislative Analysis and Public Policy Association.
Late last year, federal officials encouraged educators to add naloxone to every school building in a letter signed by Rahul Gupta, director for the White House Office of National Drug Control Policy, and U.S. Secretary of Education Miguel Cardona.
“Studies show that naloxone access can reduce overdose death rates, that its availability does not lead to increases in youth drug use, and that it causes no harm if used on a person who is not overdosing on opioids,” Gupta and Cardona said in the letter.
They also noted that most states have Good Samaritan Laws that protect bystanders who help someone who is overdosing. North Carolina passed a limited Good Samaritan law in 2013 that permits people who are “acting in good faith” to seek medical help for someone who is overdosing without fear of being prosecuted for possessing small amounts of drugs or drug paraphernalia.
“Our schools are on the frontlines of this epidemic, but our teachers and students can be equipped with tools to save lives,” Gupta and Cardona wrote.
Limited resources
One of the big frustrations that family members expressed at the Lexington meeting was how long it took for them to learn that fentanyl killed their loved one.
“We didn’t know for six months it was fentanyl,” said Michelle, the Forsyth County mother whose 19-year-old died. “They just said, ‘Your son is gone.’”
The Office of the State Medical Examiner has faced an increasing workload due to the rise in opioid-related deaths while struggling to retain new forensic pathologists who can make tens of thousands of dollars more for doing the same job in neighboring states.
Last year, legislators took steps to address that wage disparity in the budget by adding $2 million in recurring funds for each of the next two fiscal years to help increase the state’s autopsy capacity.
Lawmakers also added two toxicology positions, however, those jobs were in response to the expected increase in workload due to the new requirement of comprehensive toxicology on all child deaths investigated by a medical examiner. While those new positions will help address that expanded workload, they do not help with the existing work where the department still needs additional positions, the Office of the State Medical Examiner said in an email to NC Health News. The two new jobs have not yet been posted.
One strain on the office is that 45 percent of the workforce is made up of temporary or time-limited employees, “which creates a very unstable workforce,” according to the medical examiner’s office.
The toxicology lab performs more than 36,000 analytical tests each year, performing analysis on 90 percent of medical examiner cases, the office said. On average, the toxicology lab issues reports on about 15,000 cases every year.
‘Takes your breath away’
That work won’t let up any time soon, as the number of overdose deaths continues at a steady clip in the state.
In January, the medical examiner’s office identified 332 suspected overdose deaths, down from 368 in January 2023. While some will be classified as non-poisoning deaths after further investigation, most will end up being confirmed overdoses, the medical examiner’s office said.
At last week’s meeting of the Child Fatality Task Force, members talked about the difficulty of seeing so many child deaths from overdoses.
Pediatrician Martin McCaffrey told the task force that the child fatality review committee he is on just reviewed three infant/toddler fentanyl overdoses. Jill Scott, president and CEO of Communities in Schools North Carolina, shared that a 17-year-old had died not too long ago.
“He got a hold of something,” she said. “He didn’t know what it was.”
They are part of a much larger picture of the toll that the opioid crisis has had.
In Arlington, Va., pictures line the walls at the DEA’s offices as a memorial to those who have died from fentanyl. There are so many victims, they ran out of wall space for photos, Michelle, the Forsyth County mom said.
“It kind of takes your breath away,” she said, “when you see face after face after face.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.
