A roundtable discussion raises alarm about potentially deadly impact on young people who unwittingly take counterfeit pills. A surge of illicit fentanyl in the Pacific Northwest is supercharging an opioid epidemic with counterfeit pills that are 50 to 100 times more potent than heroin, cheap and readily available — often to young people who make the potentially deadly mistake of viewing them as no more dangerous than cigarettes.
Jennifer and Jon Epstein joined the panel, sharing their experience in losing their son, Cal, after he consumed a counterfeit pain pill in late 2020, while home on a break from college. It contained a lethal dose of illicit fentanyl.
The couple have turned their loss into advocacy, to reduce the number of similar tragedies for other families. “These pills are everywhere,” Jon Epstein said. “You need to recognize the youth in your life are at risk, even when they don’t fit a traditional at-risk profile.” The pills are particularly dangerous because they are often disguised to appear harmless.
Todd Korthuis, M.D., Ph.D
In fact, they’re often deadly: The number of poisoning deaths recorded over the past year for teenagers in Oregon and Washington has doubled, said Todd Korthuis, M.D., Ph.D., a professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine who heads addiction medicine at OHSU and moderated the panel discussion. Impulsivity and risk-taking are a normal part of adolescent development, which makes it imperative for parents, school counselors and trusted clinicians to communicate openly and clearly.
Ana Hilde, M.D., M.P.H.
“Young people really do not understand risk,” said Ana Hilde, M.D., M.P.H., a child and adolescent psychiatrist with the Native American Rehabilitation Association of the Northwest. “Their thinking about risk is very limited. [They think], ‘It’s not going to happen to me.’ We see this both in the idea of novel risk-taking, like, ‘I’m at a party and there’s alcohol and there’s some pills. Oh, I’ve never used it, I’m just going to take it one time. It’s not going to hurt me.’”
Tony Vezina
That’s a huge miscalculation, said Tony Vezina, executive director of 4D Recovery Center, which provides peer-based recovery with a focus on youth and young adults. Even tiny amounts of fentanyl can be extremely addictive, assuming a new user survives. The tablets, sometimes known as “blues,” are made to appear like various types of pain pills or sedatives prescribed by physicians. “We’re seeing the market just flooded with blues,” Vezina said. “In addition, the pushers of fentanyl are using all sorts of different pills to hide their fentanyl. People don’t necessarily know what they’re taking, but they know that it’s cheap and easily accessible.”
Olivia Rae Wright, M.D.
These pills are killing many people quickly, but they also kill people slowly as they become more and more dependent, said Olivia Rae Wright, M.D., an addiction medicine physician in Vancouver, Washington, who provides medical care at the Daybreak Youth Treatment Center, the only addiction treatment center for youth in the region. Until recently, Wright said she mainly saw kids affected by alcohol or marijuana use. “Before when kids were experimenting, not only was the risk low for accidental overdose, they were also less likely to become dependent,” Wright said, adding that two years ago she began to see many more young people hooked on fentanyl. “This is a potent drug, it acts on the brain quickly, and it starts to remodel it quickly. And it can happen before the parents realize their kids are just way in over their heads.” Worse, young people lack access to proven therapies for opioid use disorder in Oregon and Southwest Washington.
Bradley Buchheit, M.D.
Pediatricians and family medicine physicians need to improve their ability and willingness to care for these patients, said Bradley Buchheit, M.D., an assistant professor of family medicine in the OHSU School of Medicine who directs a low-barrier clinic that provides medication for treatment of substance use disorder. “We need to educate families, and we need to educate students, teachers, coaches, health care professionals so they can talk to and screen their patients,” Buchheit said.
Joni Busche, R.N.
Joni Busche, R.N., a staff nurse in the Beaverton School District, said the district is coordinating staff training in the use of naloxone to reverse overdoses among students as young as middle school. The district has also worked with the Epsteins to promote a “Fake and Fatal” awareness campaign among students and families. The surge in fentanyl is quite evident within teenagers’ social circles, she said.
“It’s a different landscape from years ago, when we had students bring in mom and dad’s vodka or pills from the cupboard,” she said. “Until I heard Cal’s story, even as a medical professional, I had no idea the amount of fentanyl and illicit drugs that were out there ready for the next unsuspecting individual.” Last year, the surge in fentanyl led to a 41% increase in overdose deaths in Oregon — compared with a 16% increase across the rest of the country.
Honora Englander, M.D.
The situation is challenging but not hopeless. The community can make a difference with increased awareness, harm reduction, treatment and leadership, said Honora Englander, M.D., professor of medicine (hospital medicine and general internal medicine) in the OHSU School of Medicine. Englander leads Project IMPACT, an innovative in-hospital addiction intervention program that has demonstrated success in engaging people with substance use disorder with treatment. “Every overdose death is preventable,” she said.
