"They die too quickly:" Reversing a fentanyl overdose with naloxone
This week on 60 Minutes, Bill Whitaker reported on fentanyl, the deadly synthetic opioid that has created the worst drug crisis the United States has ever faced.
Last year, more than 70,000 Americans died from a fentanyl overdose, according to the Centers for Disease Control and Prevention. That's a higher death toll than U.S. military casualties in the wars in Vietnam, Iraq, and Afghanistan combined.
Drug cartels in Mexico have flooded the United States with fentanyl, often hiding it in counterfeit pills designed to look like authentic prescription pills, including OxyContin, Percocet, Xanax, and Adderall. And fentanyl is also showing up as an additive in street drugs, like cocaine, heroin, and methamphetamine.
This has led to an increased risk of accidental overdoses, cases where someone has unwittingly ingested fentanyl without knowing it was present.
Parents Mike O'Kelley and Angela King know this all too well. Last year, they lost their 20-year-old son, Jack O'Kelley, to an accidental fentanyl overdose.
"You hear about it, but you think 'Oh that's just affecting people on the streets, homeless people, drug addicts.' No. It is so insidious," King told Whitaker in an interview.
After their son's death, they found text messages between Jack and a drug dealer. Jack had bought what he thought was Xanax, OxyCodone, and a gram of cocaine. But the death certificate states that fentanyl was the cause of death.
"He made a really bad decision," King said. "Not one that should have taken his life."
Fentanyl has devastated the community of San Diego, California. The legal port of entry in nearby San Ysidro has been used by Mexican drug cartels to smuggle fentanyl into the United States.
Whitaker and a 60 Minutes team met with San Diego County medical examiner Dr. Steven Campman to better understand the impact fentanyl has had on the city in the last decade.
"For years…we saw five, or 10, or maybe up to 20 deaths from fentanyl in a year," Dr. Campman told Whitaker in an interview.
"But then, around 2016, the number of deaths started increasing, above just 20, to 30, and 80, and 150. And then, made it up to 800 in just a few years."
Dr. Campman told 60 Minutes that on any given day, including the day the 60 Minutes team was there, one in five bodies in the morgue was a person who had died from a fentanyl overdose.
Signs of a fentanyl overdose
60 Minutes asked Dr. Campman what a fentanyl overdose looks like, and what happens to the body during an overdose.
"As a central nervous system depressant, it causes people to sleep… lose consciousness. It causes their respirations to slow and their heart rate to slow," he explained.
Dr. Campman said the typical fentanyl death is "a sleepy, slow death" and that the victim could go into a coma, anywhere from a "short time" to a few hours.
The CDC says other signs of a fentanyl overdose are an inability to awaken the person; constricted "pinpoint" pupils that don't react to light; shallow breathing or difficulty breathing, such as choking sounds, gurgling, or snoring from someone who cannot be awakened; and discolored skin, especially in the nails or lips.
Dr. Campman added that a rare subset of fentanyl overdose victims die a more rapid death due to "wooden chest syndrome," where they suddenly can't breathe.
"That causes a more rapid respiratory paralysis. So, people die quickly. Either way people lose consciousness pretty quickly."
But Dr. Campman also noted that a person overdosing on fentanyl can look deceivingly "healthy," even long after they have died.
Reversing a fentanyl overdose
Dr. Campman attributes a recent decrease of fentanyl overdose deaths in San Diego County to the increased availability and accessibility of naloxone.
Narcan is a nasal spray that delivers the life-saving drug naloxone. When delivered in time, naloxone can reverse an overdose, from fentanyl or other opioids, that would otherwise be fatal, and save someone's life.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), if a person shows signs of an opioid overdose, you need to administer naloxone immediately and then call 911.
To administer naloxone using Narcan, you insert the spray nozzle up one nostril, spray the contents of the single-use device, and wait two to three minutes, to monitor the person and see if they begin to breathe normally or become responsive.
If they are still unresponsive or normal breathing has not been restored, the overdosed person may require another, or even multiple, doses of Narcan.
Multiple doses are especially common in cases where the person has intentionally or unintentionally consumed fentanyl.
One complicating factor in all of this, according to Dr. Campman: a box of Narcan only contains two doses, and some fentanyl cases require much more.
"Even if someone were there and were able to get them one or two doses of Narcan, if they had a box… a lot of times, people need four, six, or eight, or ten doses of naloxone to reverse their effects," he told Whitaker.
Dr. Campman said several bodies that have come into his medical examining room were found with naloxone in their hand or nearby at the scene of their death.
"We see them dead with the… naloxone near their hand, or even in their hand, thinking that they would be able to save themselves. But they die too quickly. They lose consciousness too quickly."
The CDC recommends that people who use opioids and are at an increased risk of an overdose should carry naloxone, keep it at home, and let others know they have it. "Because you can't use naloxone on yourself, let others know you have it in case you experience an opioid overdose."
A warning for parents
Mike O' Kelley and Angela King, parents of Jack O'Kelley, told Whitaker that their experience has been a crash course on the dangers of fentanyl. They advise other parents to educate themselves.
"It's in every street drug right now, small amounts. Unless it's prescribed by a doctor, you can't, you can't take it. You're playing Russian roulette."
If you or a loved one are struggling with opioid use, or you would like to find additional information and resources, like free Narcan in some states, visit the CDC Stop Overdose webpage.
The video above was produced by Will Croxton. It was edited by Sarah Shafer Prediger.