Fentanyl deaths can be prevented with education, intervention

LIHU‘E — As Kaua‘i, like the rest of the U.S., continues to reckon with an opioid-abuse crisis that has claimed hundreds of thousands of lives, a new challenge is spreading on the island: fentanyl.

“It changes the whole landscape of drug addiction,” said Aaron Hoff of the Keala Foundation, a Kaua‘i nonprofit that seeks to prevent youth drug abuse. “It’s catastrophic. You think COVID’s bad. This is on a whole ‘nother level.”

The synthetic opioid fentanyl is some 100 times more powerful than morphine, a drug commonly used to dull pain at the end of life, officials contend.

Kaua‘i Police Department Chief Todd Raybuck urged the public to learn about the dangers of the drug, which he told the Kaua‘i County Council last week was a “poison” that had claimed at least four lives in the last two years as it began to appear with growing prevalence on the island.

“It only takes about two milligrams of fentanyl to cause a fatal overdose,” Raybuck said. “To put that in perspective, there are 2,300 milligrams in a teaspoon of salt.”

According to Raybuck, fentanyl is being used across the gamut of drug users and abusers. That includes those who are trying to supplement an existing opioid addiction, those trying to offset the effects of methamphetamine use, and some who may not even know they are ingesting fentanyl, which is often consumed in a powdered form and can be mistaken for other illicit drugs like cocaine.

Raybuck said the fentanyl supply chain — like those of most illicit drugs — has proven difficult to cut off. Drugs arrive on Kaua‘i via means that law enforcement simply cannot practically or legally control. For example, KPD doesn’t have the capacity to screen every passenger disembarking a plane or go through everyone’s mail to check for contraband.

“It’s pouring into the island,” said Hoff. “Pretty much everything that’s coming into the island now has live fentanyl in it. They put it in everything.”

Hoff, who regularly works with those impacted by drug abuse, said that everything from marijuana to methamphetamines are increasingly likely to be laced with fentanyl. He said that the casual drug user who, for example, occasionally uses cocaine, was bound to have a run-in with fentanyl sooner or later, and would almost certainly overdose or die as a result.

“You won’t know you’re taking it until it’s too late,” Hoff said.

Addressing the rise of fentanyl is a challenge being faced across the United States, and solutions have been few and far between, even as the stakes in the opioid crisis grow increasingly dire. In 2019, for example, the National Institute on Drug Abuse reported that more than 70,000 people died of drug overdoses.

In fighting the opioid crisis on Kaua‘i, Raybuck told the County Council last week that “we can’t arrest our way out of this.” When asked to elaborate, he said that enforcement of drug laws and arresting people was just one part of what is needed in a multi-pronged approach.

Other elements in the approach Raybuck described included coordination with medical providers like the Hawai‘i Opioid initiative and Malama Pono Health Services, which operates a free clinic in Lihu‘e and has helped Kaua‘i’s police force with training in the use of the life-saving drug naloxone.

The public also has a role to play, Raybuck said.

“The public’s role, number one, is becoming educated about what the threat is in our community,” Raybuck said.

“The second thing is for everyone to have these conversations with their keiki and with their family members, with those that they love, especially those they know are susceptible to substance abuse or are engaging in illicit substance use, and then talking about the dangers and trying to find them the help and assistance they need through treatment and therapy.”

Hoff stressed the importance of preventing people, especially Kaua‘i’s youth, from getting involved in drugs in the first place. He cautioned parents against assuming that their kids were immune from the pitfall of drugs, saying that the modern culture of normalized drug and alcohol use make everyone susceptible.

“It’s not like you’re going down a dark alley and picking up drugs from some shady people,” Hoff said. “It’s our family members — uncles, aunties, surfers at the beach. They’re all getting loaded. Prevention is 100 times more effective (than treatment).”

Hoff and Raybuck both urged people to familiarize themselves with the drug naloxone, commonly referred to by its commercial name Narcan, which can be used as an emergency measure to reverse the immediate effects of an overdose and keep a person breathing, potentially saving them from death.

“That’s really what this is all about, is saving lives,” Raybuck said.

First responders, including police, often bear the brunt of crises like the opioid epidemic. They are the members of a community who most-often see firsthand the pain and loss of a drug epidemic which has claimed hundreds of thousands of lives, which has endured for years, and which will almost certainly endure for many more.

Nonetheless, Raybuck said that he and his officers will endure.

“I wouldn’t be telling the truth if sometimes it didn’t feel like, you know, people weren’t listening or sometimes we weren’t making as much gain as we would want to,” he said.

“But you cannot give up on saving lives. And I think that’s what continues to keep our officers motivated. There’s no greater reinforcement of purpose in this job than when you have the opportunity to save a life.”

Details on the Keala Foundation can be found at kealafoundation.com. For more information on opioids in Hawai‘i and the overdose-reversing drug naloxone, including where it can be purchased, visit hawaiiopioid.org.

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Kaleb Lay, general-assignment reporter, can be reached at 808-647-0329 or klay@thegardenisland.com.​