Fentanyl – Opiate Nation

Making Use of Wastewater Surveillance

(Translation into most languages at tab to the right.)

Wastewater monitoring is an effective tool in detecting emerging opioid threats, predicting overdoses, and tailoring treatments, according to new research from Biobot Analytics, Mathematica, and the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA) program. (1)

My husband and I live in Melbourne, Australia part of the year so we can be close to our daughter and family. We love Australians and their friendly and balanced way of approaching life and politics. It is a federal parliamentary democracy similar to England.

One area where they are ahead of the USA is in their approach to illicit drugs. As a nation with comprehensive health care for all from cradle to grave, they have a more communal attitude than our American individualistic posture. They view caring for each other as part of being a healthy and functioning society.

This necessarily affects how they treat people who use illicit drugs. They aggressively pursue educational and preventative measures while also working to keep those who use drugs as safe as possible until they are ready to seek recovery. While they don’t have a fluid border with a drug-producing country like we do with Mexico, they still have a problem with illicit drugs arriving from China and Asia.

One area that they use as a public health strategy is wastewater surveillance such as was used during the Covid-19 pandemic. Samples are collected from wastewater treatment plants, sewer systems, or targeted populations such as college dorms or prisons. When pooled together, they provide a community view of drugs circulating in the population. The samples are analyzed and the data is calculated through very sophisticated methods. The data then give objective, community-wide information on drug use trends. This is of great benefit in tracking changes and identifying new drug use and outbreaks and as an early warning tool. In the US, Biobot Analytics and Mathematica are leading the way with the “Drug-Surge” algorithm. (1) In a study involving five counties across four states, the algorithm correctly flagged between 71% and 100% of drug overdoses.

The US Drug Enforcement Agency (DEA) uses this wastewater testing to detect trends in illicit substances well in advance of reported overdoses. Xylazine was detectable a month before suspected overdoses from it were reported. Geographic and socioeconomic trends can be tracked also. If put to use, a national alert system would give early warning of at least a week in order to alert the public to a new or more potent drug threat.

In the US, the National Wastewater Surveillance System (NWSS) that is run by the CDC began in response to the Covid-19 pandemic. The CDC coordinates a national system primarily for infectious disease monitoring. While drug consumption can also be targeted, a national program does not yet exist. (3,4) Meanwhile, the National Institute on Drug Abuse (NIDA) is working with Biobot and Mathematica and has regional programs focusing on illicit drug use as a response to the opioid crisis.

With the CDC in the midst of worrisome changes, let’s be vocal proponents for increased national coordinated surveillance of illicit drugs in our wastewater and the use of that information to help prevent overdoses and deaths.

Wastewater Data Offers Powerful Tool in Confronting Opioid Epidemic

https://www.mathematica.org/news/wastewater-data-offers-powerful-tool-in-confronting-opioid-epidemic#:~:text=Wastewater%20monitoring%20is%20an%20effective,early%20warning%20for%20new%20threats.

2. DEA Releases 2025 National Drug Threat Assessment

https://www.dea.gov/press-releases/2025/05/15/dea-releases-2025-national-drug-threat-assessment

3. Correlation between wastewater-based substance use prevalence and syringe distribution in a harm reduction program in the United States

https://www.sciencedirect.com/science/article/abs/pii/S0048969725018261#:~:text=In%20the%20U.S.%2C%20although%20the,2019;%20NFLIS%2C%202024).

4. Wastewater-based monitoring could help guide responses to the USA opioid epidemic

https://www.nature.com/articles/s44221-023-00082-9

Not the Time to Rest on Our Laurels

(Translation into most languages a tab to the right.)

Resting on your laurels is as dangerous as resting when you are walking in the snow. You doze off and die in your sleep.

― Ludwig Wittgenstein, Culture and Value

In ancient Greece, when athletes competed and won, they were given a laurel wreath as a crown to show off their success. The idiom “resting on one’s laurels” refers to being content with our past accomplishments and not working towards any further improvement. Not exerting any effort and becoming complacent.

I am concerned that we might become complacent after hearing the recent encouraging news from the CDC that drug-related deaths among young people under the age of 35 are finally declining. This after more than two decades of year after year grim news about young people dying from opioid overdoses. And especially from the last 10 years from fentanyl. “Provisional data from the CDC’s National Center for Health Statistics indicate there were an estimated 80,391 drug overdose deaths in the United States during 2024—a decrease of 26.9% from the 110,037 deaths estimated in 2023.Annual drug overdose deaths are projected to reach their lowest level since 2019.” (1)

NPR’s Morning Edition discussed the possible reasons for this decline. (2) In Gen Z young people, the fear of overdose has caused a change in what they experiment with as opposed to Millennials like my son. When he was at the age of experimentation in middle school, highly addictive prescription opioids were the drug of choice. Now, Gen Z experimentation is mostly with weed and psychoactive drugs which normally won’t cause death, although they can be laced with fentanyl which may lead to a new and more deadly addiction. But those age 35 and older who are still living desperate lives addicted to ever-stronger synthetic opioids and/or meth are still dying from overdoses.

And then there is Narcan, the opioid overdose reversal medication that is now widely available and is attributed with saving thousands of lives. Parents and advocates have been working for a decade to make it easy to obtain and administer. But it is not the silver bullet many people hail it as. For opioid addicted people, many have been brought back from overdose only to continue using drugs and thinking they have a quick solution to their long-term problem. But repeated overdoses are causing serious brain injuries from oxygen deprivation, as Sam Quinones writes (3).

Author of Dreamland: True Tales of America’s Opiate Epidemic (2015) and The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth (2022), Sam says, “By leaving people on the street to suffer more overdoses, believing that with Narcan they’ll be revived and return to ‘normal,’ we are creating a population of people less able to make rational decisions, more given to erratic behavior, and more at the mercy of the street and its trauma…(Narcan) has great benefits, but also serious limits, particularly in a time of fentanyl and meth, and particularly when it is used virtually without any other tool.”

What’s the answer to this blight that was unleashed on our young people?

Sam continues, “After reporting on this for more than a decade, I believe the solution must start with getting people off those lethal streets and — crucially — into places they cannot leave when the drugs insist that they must. That way, their brains will have a fighting chance to heal. When that happens, readiness for treatment is far more likely to emerge than it will on those streets, where drugs and brain injury so easily conspire and lead to death.”

I encourage you to read Sam’s article for other great insights and pass it along to others. We need to be informed with a perspective gained from all the facts and then work for comprehensive reforms in policies and health care.

U.S. Overdose Deaths Decrease Almost 27% in 2024. May 14, 2025

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250514.htm

2. Drug deaths plummet among young Americans as fentanyl carnage eases.

Morning Edition June 10, 2025

https://www.npr.org/2025/06/10/nx-s1-5414476/fentanyl-gen-z-drug-overdose-deaths?utm_source=npr_newsletter&utm_medium=email&utm_content=20250610&utm_term=10186449&utm_campaign=news&utm_id=6355467&orgid=201&uniquet=CYeV6IcF5gy8kS5Vlimppw&utm_att1=

3. Sam Quinones. The Limits of Narcan Alone. June 04, 2025.

https://samquinones.substack.com/p/the-limits-of-narcan-alone

Frankenstein Opioids

(Translation into most languages at tab to right)

Just when we thought everyone was aware of the fatal danger of fentanyl and it being mixed into every drug of abuse available on the street, a new threat arises. Nitazene or Isotonitazene (ISO) or Protonitazene, new lab-made opioids, are showing up at hospitals and morgues around the world in the bodies of people thinking they were taking their drug-of-choice only to find it was laced with one more deadly drug. It is being mixed in with cocaine, or formulated into fake Oxy’s and other pills. In the US, it first showed up in 2019 in the Midwest and spread rapidly.

Nitazenes were developed in the 1950’s by pharmaceutical companies as an alternative to morphine but shelved due to the risks of overdose. There is still no approved medical use for nitazenes today. Another ‘Designer Drug’ being made in illicit labs around the world, Nitazenes are up to 40 times stronger than fentanyl. Fentanyl is already 50 times more powerful than heroin and up to 800 times more powerful than morphine.

No wonder these drugs are referred to as ‘Frankenstein Opioids’ – only an insane, evil intentioned scientist would work to create such a drug. But in reality, the motivation is greed more than insanity because synthetic drugs are cheap to make and easy to ship and deliver – and highly profitable. But evil is the correct description for the immoral heads of the drug syndicates and cartels around the world whose entire life and business is dealing death.

What can be done?

For parents with children still at home, community connection and education are the best preventative measures. As I have said before, my husband and I were totally unaware of what substances were readily available to our middle school son in the early 2000’s. Our concern was smoking and marijuana. Little did we know. General discussions about drug abuse were the extent of our educational conversations. But we would have been much better prepared and had much more information if we had been involved with our kids’ school community. Instead, we were insulated from vital resources because we spent so much time with our church community. But make no mistake. Many of the families at church with kids in youth group were just like us – unaware and ill prepared and sadly many of them suffered the same loss as we did.

There are other important aspects in raising self-reliant kids who are not subject to the lures of the “cool” kids or “in” crowd. Below is a link to a previous blog dedicated to the perils modern teens and their parents face with important resources. I hope it will be helpful to you and those you love.

Teenage Perils

https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dc-emerging-tri-state-area

The Least of Us, Part One: Julian

(Translation into most languages at tab to right)

As I was driving home in 105-degree heat last week, I noticed a young man carrying a plastic bag stumble to a bus stop bench and sit down. It was clear he was homeless and it was equally clear that he was on drugs. I felt compelled to pull over. I rolled down the window and asked, “Are you ok?” He said, “No.” I asked if he needed help, and he wept and said “Yes.” When he came over to the truck, I asked if he was on drugs, and he said “No.” I said “I think you are on drugs and you don’t need to be ashamed.” He said he was, so I asked if I could sit with him and talk.

As we sat on the bench in the heat I asked what drug Julian (not his real name) was using. Fentanyl in the form of street Oxy’s that sell for $2 and come from Mexico. He is homeless, has never known his father, his mother is out of state and done with him. He is 23 years old and has been struggling with alcohol and addiction for 5 years – fentanyl for the past 1½ years. I told him about my son and said Julian was on the same path to the morgue unless he could get clean. He had gone to rehab in March with a predictably miserable 5-day detox and then was supposed to go to a sober home, but said they never got him there – probably not true. I offered to take Julian for something to eat and to try to connect him with a program to help him. While I drove and he nodded off, I called a few of the directors I knew from programs our son went to, but had to leave messages. I decided to take him home for a shower and a rest as we tried to find him a place.

My husband John prayed with this sweet and troubled young man and encouraged him to know there was hope and that he wasn’t a bad person, or less-than, but had a powerful war waging in his brain that needed medical help and emotional support. We drove him to the public behavioral health service, where he had gone in March, and got him signed in. It was an hour wait for him to go through intake again, so we left him with our names and phone numbers to give as his contacts for help so that we could follow up on how he was doing.

When we tried to follow up the next day, we found he had done a runner and never went through the intake. I would guess the fear of excruciating withdrawal was stronger than the fear of a potential or eventual death. This is so common, especially for those who have tried many times to get clean. Addiction specialist, Dr. Richard Whitney said, “Once people get addicted, they really lose the power of choice.” (1) Even with medication, the drugs need to be out of your system first. On average, it takes 4-5 recovery attempts and 8 years to achieve one year of sobriety. After another 5 years in recovery, the relapse rate drops to 15%.(2)That is 13 years to try to undo what most commonly started as trying something fun as a young person. The chemistry in our brains needs more time to recover than a few weeks or months from the damage done by opiates.

In 2015, Sam Quinones released his award-winning book Dreamland: The True Tale of America’s Opiate Epidemic documenting how Purdue Pharma – with a monopoly on the market on pain in the 1990’s with its new highly addictive drug, Oxycontin – deceptively promoted it as a non-addictive solution for every ache and pain. Then, with the lure of easy money, young men in Mexico, independent of the drug cartels, trafficked black-tar heroin to neighborhoods in America as a cheap alternative to Oxy’s. Its powerful long-lasting high then became the go-to drug for millions of young people who could heat and smoke it – our son included. Quinones states that the perfect storm was created when the pursuit of prosperity, pain avoidance, and the breakdown of close-knit family and community life, beginning in the 1960’s, created the void that those easily available opiates filled.

Quinones has recently released The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. It is the second most important book written on addiction and American society. In my next blog, I will delve into this new book and discuss where we are in the drug epidemic and where we can go from here. I personally need some hope as I see the thousands of homeless young people on the streets of my city and struggle with the tension of wanting to help prevent one more life from a literal “dead end” and feeling frustrated with the lack of effective programs to help these addicted individuals get the long-term recovery care they need. This – in a country where the majority of people seem to think that health care is a privilege for those who can afford it instead of a basic service for all Americans, including the least of us.

Dreamland, pg 328
John Kelly, PhD – https://www.recoveryanswers.org/

Australian Real Drug Talk

Translation into most languages at tab to the right.

One of the things I have come to appreciate about the Australian way is their straightforward approach to life. They are easy-going yet they say what they mean and you know where you stand. A lack of pretense – with a large dose of slightly off-color humor added in.

I think that is why they are more advanced in their drug policies and treatments than America – they are more honest and have less taboos. They benefit from having had comprehensive public health for decades which has facilitated progressive drug policies such as clean needle exchanges, safe-injecting sites, and medication assisted treatment.

John and I had an interesting conversation a few weeks ago here in Australia with Jack Nagel. Jack does the “Real Drug Talk” podcast from Melbourne and also runs the Connection Based Living Recovery Programs. We were preparing to record a podcast with Jack – see links below – and were asking about his experiences and what the current trends are here with drugs of abuse.

https://podcasts.apple.com/us/podcast/saying-goodbye-to-my-son-in-a-body-bag/id1507177011?i=1000533422150

About

In discussing opioids, I wondered why methamphetamines seems to be the main drug of choice and why heroin is not as common here as it is in the States. Jack said that in the 1990’s there was a big problem with heroin coming in from the Golden Triangle of SE Asia and lots of overdose deaths. And the heroin use was IV, not smoking. So, there is a collective memory of street people using heroin and dying which created a lot of stigma and fear associated with IV use.

After that trend slowed, people began using meth – young people like Jack –because smoking or snorting meth seems more innocuous and a less intrusive way to take a powerful drug than IV. Jack said that there is a huge cohort of people who don’t live on the streets and who smoke meth for years. Sadly, they don’t seek help because the public messaging that portrays meth addicts as homeless people with sores and missing teeth doesn’t apply to them. But meth addiction will eventually burst that bubble and ruin their lives too.

There is also a growing problem with cocaine. While once considered the drug of the wealthy city dweller with some high-flying users in Australia spending $10-$20K per week, statistics reveal cocaine usage has now spread much further. Consumption has grown in other areas and demographics where prosperity has increased such as middle-class teachers, tradesmen, etc. Australia is now the highest per capita user of the drug in the world. And the rise in use is being driven by men aged in their 20’s, with Sydney leading the country in use. The most recent stats reveal that there are nearly 1 million weekly cocaine users in Australia out of a population of 26 million. (1,2,3)

We also talked with Jack about what the entry drugs are for kids here in Australia. After alcohol and pot, they usually begin with hard “party” drugs used at house parties and concerts like ecstasy/MDMA, benzodiazepines, GHB/GBL. All mood-altering drugs that create different types of euphoria, but which are dangerous because many times they are mixed with alcohol and other drugs, sometimes without the user’s knowledge.

Even though heroin is in the background in Australia, it is still available and becoming more dangerous due to fentanyl being mixed in to the supply of much of the heroin, and all opioids, along with other drugs of abuse. (4)

When our son, JL, began using Oxy’s he never thought he would even try heroin. Then, as Oxy’s became more expensive and heroin was cheaper, he started smoking heroin. He then swore he would never stick a needle in his vein – the danger and stigma to him was clear. Eventually, just like 95% of heroin users, he did just that. He was living under the delusion that smoking opioids – or any drug – would never lead him to become a “junkie”, an IV drug user.

My concern for the young people and families of Australia is that, as The Age reported in 2020, pain management with opioids has increased here too, although not to the degree it had in the States. Opioid-related deaths have increased in the past decade and today at least three people die from opioid harm each day and 150 are hospitalized. (5) Fentanyl is showing up in wastewater testing and drug overdoses of cocaine and meth, drugs where the users are not expecting a potent narcotic. Because it is synthetic and cheaper to produce in China and India, it brings its criminal networks a greater profit margin.

As I’ve said before and will continue to say: We will not treat our way out of the opioid/drug epidemic. Prevention is key. Let’s continue to stay aware and educated about what we all can do to keep our children and their future safe and healthy.

http://www.RealDrugTalk.com.au

1. Why cocaine is most used drug in Australia behind cannabis

https://www.heraldsun.com.au/news/national/why-cocaine-is-most-used-drug-in-australia-behind-cannabis/news-story/0fa9bbcec60dfe0ecfb52a5cb58a38f5

2. Australia the highest per capita cocaine user in the world

https://www.news.com.au/national/australia-the-highest-per-capita-cocaine-user-in-the-world/news-story/c91869d4e2b2adeef266917d82f705e0

3. Sydney and cocaine: an illicit love affair for the ages

https://www.smh.com.au/national/nsw/sydney-and-cocaine-an-illicit-love-affair-for-the-ages-20210225-p575uz.html

4. Fentanyl in the Australian illicit drug market

https://adf.org.au/insights/fentanyl-australian-illicit-drug/

5. Australia’s opioid crisis: How pain management got out of control

https://www.theage.com.au/national/australia-s-opioid-crisis-how-pain-management-got-out-of-control-20200204-p53xrn.html?login_token=6k67UOPLwp5Xl2j0rc4YRnMBCQfFMYmi_oQ7Wy-FhUoshvJtqTVUQRQtnZMeXk9e6ZvG2rO1y9HCtcf1QfpRxw&expiry=1659821531

Lifespan of Heroin & Opioid Addicts

(Second in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right. If you feel this blog is important, please repost to your social media using the buttons below. Thank You!)

When our 25 yr old son died of a heroin overdose in 2014, the statistics for the average life-span of a heroin addict was 5 years. Five years. Not very long if you are 15 or 20 or even 30, the age when most young adults’ nowadays are just getting in gear with their career, a long-term relationship, and planning a family. To have your life swept away before you have a chance to experience some of the most wonderful years of living on this earth is painful to consider.

America’s Love Affair with Opioids

Andrew Sullivan’s 2018 article for the NY Magazine entitled “The Poison We Pick”, wrote: “…For millennia, the Opium Poppy has salved pain, suspended grief, and seduced humans with its intimations of the divine. It was a medicine before there was such a thing as medicine. Every attempt to banish it, destroy it, or prohibit it has failed…This nation pioneered modern life. Now epic numbers of Americans are killing themselves with opioids to escape it…According to the best estimates, opioids will kill up to half a million Americans in the next decade.

“Most of the ways we come to terms with this wave of mass death…miss a deeper American story. It is a story of pain and the search for an end to it. It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Continue reading “America’s Love Affair with Opioids”