What fentanyl looks like from a Washington hospital

As Washington state faces an ongoing fentanyl overdose crisis, state lawmakers have proposed many fixes to the problem, from making simple possession a felony again to cracking down on pill-production machines.

But what does the crisis look like at the local level, out of the halls of Olympia?

To get a measure of this, The Center Square interviewed by email Dr. Raul Garcia. He is the medical director of Astria Toppenish Hospital in Toppenish, Wash., as well as the executive director of the nonprofit Opportunity for Washington, a group that weighs in on drug addiction and homelessness, among other issues.

TCS: From the perspective of an emergency physician in Washington state, how bad is the fentanyl problem?

Garcia: Throughout my 25 years serving as an emergency physician, 16 in Central Washington, I have never seen a crisis develop and then multiply as drastically as fentanyl overdoses have. According to the Centers for Disease Control, 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022, with 67 percent of those deaths involving synthetic opioids like fentanyl. Here in Washington State, overdose deaths involving synthetic opioids, mostly fentanyl, have increased 10-fold just over the past year — and I’ve seen it firsthand.

Why is fentanyl so deadly?

Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine, leading to high dependency and addiction. Only 2 milligrams of fentanyl is needed to kill most people, which is equivalent to just a few grains of salt. The death rate from this synthetic opioid has been increasing at alarming rates in the past few years, and emergency rooms like mine are being flooded with these overdose cases.

Is the fentanyl problem a normal drug addiction issue, or is it something different?

The fentanyl crisis is not just a drug-addiction issue — it’s a multi-pronged public health crisis that stops at no lines or victims. Healthcare professionals have been buffeted from crisis to crisis over the last few years, but this one is entirely preventable. It’s past time we take substantive action to address this crisis that is killing off thousands of our children every year. We need common-sense legislation to help our frontline workers and victims while holding the drug dealers and manufacturers accountable.

What should be done at a legislative level?

First, our healthcare professionals who are battling this crisis on the frontlines need more resources. The COVID-19 pandemic swept through medical staffing and resources, leaving us overwhelmed and inadequately prepared to not only handle the influx of patients from the pandemic, but also the increased rates of overdoses from this lethal drug. Supporting our healthcare workers is the first step to successfully maneuvering through this crisis.

What else needs to happen?

Much like our healthcare workers who are fighting this crisis in the emergency rooms, our law enforcement officers are fighting this crisis on the streets. Right now, fentanyl-related substances are classified as Schedule II drugs, meaning that medical-grade fentanyl does have a use in some cases. However, bad actors are creating different variants of fentanyl that are extremely lethal. By exploiting loopholes, this drug is sold on the streets without being classified as Schedule I drugs by law enforcement.

Classifying fentanyl as a Schedule I substance, meaning that it would have no acceptable medical use, would help ensure that law enforcement can keep them off the streets. Congressman Dan Newhouse, who represents us here in Central Washington, introduced the bipartisan Save Americans from the Fentanyl Emergency Act earlier this year to permanently schedule all fentanyl-related substances as Schedule I drugs. It’s a great first step. I commend Rep. Newhouse for his unwavering dedication to help curb this crisis and hope he recognizes we can’t stop there.

What should be done for hospital patients who currently rely on microdoses of fentanyl to treat their pain? 

Our regular treatment of pain with fentanyl directed by our medical providers should continue. These treatments are professionally regulated, properly dosed by pharmacist, and continuously monitored to effectively treat our patients.

You said that Rep. Newhouse shouldn’t stop there. What would be a further step?

Fentanyl primarily enters the United States through our southern border. Open-border policies have allowed fentanyl, amongst other drugs, to flow freely over the border with little to no prevention. Securing our southern border and enforcing the laws of the land will go a long way in preventing fentanyl from plaguing our communities in the first place.