Lori Townsend: The rapid increase in drug overdose deaths in Alaska is due in large part to fentanyl, an extremely powerful and often lethal opioid.

Unknown: It's believed the police said that he went down immediately and was not able to ask for help.

Lori Townsend: What do you need to know about this alarming trend and the work being done to stop it?

It's our discussion right now on Alaska Insight.

Alaska experienced a nearly 70% increase in the number of drug overdose deaths between 2020 and 2021, according to preliminary data from the state health department.

That means 245 Alaskans died from an overdose in 2021 including anchorage resident Bruce Snodgrass.

Alaska Public Media's Jeff Chen brings us a story of his mother who wants to make sure her son is more than a statistic.

Unknown: This boy shouldn't be dead.

It's been less than six months since Bruce Snodgrass overdosed and died after consuming a lethal dose of fentanyl.

Bruce was 22-years-old and an avid outdoorsman.

Out to the woods.

His mother Sandy Snodgrass says he finished a treatment program and moved home.

Then one day he went for a bike ride and he never came home.

When he had passed away he was in the woods, he was within shouting distance of help.

So that's part of the really seriousness of fentanyl is that he, it's believed, the police said that he went down immediately and was not able to ask for help.

Sandy works as a licensed therapist fentanyl.

In her off hours, and she has a new calling: raising awareness about the dangers of fentanyl, a particularly strong and addictive opioid on the street.

Fentanyl is used as a cheap way to enhance drugs like heroin, cocaine or meth to make them more addictive.

She doesn't think her son knew what he took that day, but says it was 100% and fentanyl and she thinks Bruce's first dose of an opioid was likely a legal one during high school.

I took him to get his wisdom teeth out, like so many parents, almost all parents do.

And I think that triggered an addiction.

Fentanyl, along with other synthetic opioids, was responsible for more than 60% of overdoses in the US in the 12 month period ending in October 2021, killing roughly 70,000 people according to the Centers for Disease Control.

Without acknowledging any wrongdoing, four large pharmaceutical companies recently agreed to pay more than $26 billion to the vast majority of states, local governments and Alaska Native and American Indian tribes to fund health care and drug treatment programs to help ease the opioid crisis.

Accountability is just one piece of the solution though.

Michael Troster, a retired Drug Enforcement Agency agent, says there are three legs to the stool of drugs: There's enforcement, there's treatment, and then there's demand reduction.

And unless you're looking at all three of them, then you're just -- the stool's, you're just gonna tip over one way or another.

You have to do all three or it's gonna fail.

Sandy agrees.

She knew how to navigate the system to get her son into detox and treatment because of her profession.

I was able to do that for my son.

But most addicts, alcoholics unfortunately are separated from family and loved ones so they don't have anyone to help them navigate the intake process.

So that's one of the barriers to treatment that is, in fact killing people.

Sandy says she and other families are working with elected officials at the local and national level to propose curriculum about opioids for middle and high school students.

A lesson she thinks might help save the lives of kids like her son.

Young people are, you know, experiment with things.

He was a risk taker, he was a free solo climber.

So that kind of explains a little bit about his personality.

You know, so many boys are bulletproof.

And he believed that he was.

Troster said Sandy is one of 105,000 mothers across the country that lost a child last year to an overdose death.

That's enough to fill up, you know, a large football stadium.

That's one year.

happening all over the country But despite losing her son so recently, Sandy says her advocacy is helping her heal.

I've been taking care of him his whole life.

And this is how I'm taking care of him now, still.

So I'm compelled to take care, to continue to care for him, continue to tell people what killed him and hope that someone doesn't die from fentanyl because of what I'm doing.

In Anchorage, I'm Jeff Chen.

Lori Townsend: Such a powerful and tragic story.

Joining me tonight to discuss the work being done to educate Alaskans about the dangers of opioids, stem the flow of these dangerous drugs to Alaskans and help lower the rate of overdose deaths is Jessica Filley, an epidemiology specialist with the State Department of Health and Social Services Office of Substance Misuse and Addiction Prevention.

And in the studio with me is John Kuhn, the U.S. Attorney for Alaska.

Welcome both of you.

Unknown: Glad to be here.

Lori Townsend: Thanks so much.

Great to have you.

So that story is just, really hit me so hard to hear the anguish in a mother's voice being a mother and a grandmother myself, it really resonated with me.

Jessica, I want to start with you.

The statistics in that story we just heard are so alarming.

Can you start by just describing the scope of this problem in Alaska right now?

Unknown: Yeah, sure.

So the United States started experiencing a rise in synthetic opioid overdose deaths from 2013.

And we really didn't see an increase until just a few years ago.

And you'd mentioned that 68% increase in drug overdose deaths.

And that was primarily driven by fentanyl.

So from 2020 to 2021, we saw a 141% increase in overdose deaths involving fentanyl.

So it's a huge problem.

And it's, it's just getting worse.

And in Alaska, we've found fentanyl in counterfeit pills, so those fake blue oxycontin pills that people were talking a lot about.

We've also found it in black tar heroin.

It's, it comes in the form of a gray or white powder.

And as you guys mentioned, also it it can be found in stimulants contaminated meth or cocaine as well.

So it's a really scary drug.

Lori Townsend: Certainly, as John.

I know that you haven't been in Alaska for very long, but certainly have a lot of experience in this area.

What would you add, from your perspective about the scope of the problem here?

Unknown: Well, I'd like to say a couple of things.

First of all, as you've mentioned, I've been involved with this for quite some time, I've been the National Heroin and Opioid Coordinator for all U.S. attorney's offices.

And that means I have led and helped U.S. attorney's offices with their policies on on a district level or statewide level.

One of the things we've seen is that every state is different.

And so nationally, we've directed all U.S. attorneys to lead a department opioid strategy that involves what Mr. Troster mentioned: enforcement, prevention and treatment.

And when I look at Alaska's problems, I see a state that is lagging behind the rest of the country, to some extent, but it's catching up quickly.

Right now, the major opioid in Alaska remains heroin.

That's somewhat unusual.

Most states are already gobbled up by the fentanyl problem.

But the way fentanyl is manifesting itself now, it's looking like every other place, and it's immensely dangerous, because as Jennifer mentioned, it's mixed with heroin.

It's mixed with methamphetamine.

It's mixed with cocaine.

No one has any idea what they're getting when they consume these substances, nor do they know how potent any particular pill or mixture of powder might be.

And then they don't know how lethal it is.

Lori Townsend: Well, and I want to talk about that a little bit.

Jessica, you mentioned the 245 overdose deaths, and 140 of them were due to fentanyl.

Why is it so much more lethal than other opioids?

Unknown: Yeah, so when someone overdoses on an opioid they that slows their breathing and it stops their breathing, and lack of oxygen can cause brain damage or death.

So, and fentanyl is just like it's so much more potent, it's 50 times stronger than heroin, 100 times stronger than morphine.

And so the margin for error when using fentanyl is much smaller.

So just a few milligrams can cause an overdose.

So if you don't know what's in your, in the substances you're using, it's very easily going to cause an overdose and even if you do know that you're using it, as some, some people do, or they suspect that it's in their drugs.

Like I said, the margin of error is just so small.

So just a little bit extra can throw you in an overdose.

And you just, you just wouldn't even know.

Lori Townsend: John, you were talking about your previous work as the national heroin and opioid coordinator.

And you talked about the fact that Alaska has a higher rate of use for heroin than other states.

Any idea why that is?

I really can't explain it.

All of our opioids are coming from Mexico these days, for a time.

A lot of this synthetic opioids came from China, but that production has now moved to Mexico.

It gets into Alaska, with by people carrying it here, it gets here, through parcels.

It gets here on boats, and then it's distributed throughout the state in the same way.

I should mention, since we've talked about the fake pills, the pills that look like legitimate prescription pills, typically Oxycontin, DEA has seized massive numbers of these pills.

And they estimate that 40% of the pills contain lethal amounts of fentanyl.

Frankly, fentanyl is not the only problem.

We're seeing a number of other synthetic opioids.

We've talked about fentanyl being as high as 50 times more powerful than heroin.

But there's a substance out there called the carfentanyl, only one of the many types of other synthetic opioids, that is 100 times again more powerful than fentanyl.

A miniscule amount can kill people.

And this is found occasionally throughout the United States mixed in heroin, mixed in meth, cocaine.

How how you mentioned that, you know it's coming in, people are carrying it, it's coming in on vessels.

Alaska has more coastline than any other state vessels moving in out of state waters all the time.

How porous is our border?

And I certainly don't mean to just blame this problem on, you know, vessels traffic, but I imagine that's part of of some of how it's getting here, isn't it?

Absolutely.

There are many enforcement programs that try to screen for this.

There are interdiction programs at airports.

The Coast Guard does boardings of vessels and inspects those Homeland Security does a lot of work.

To attempt to interdict substances like fentanyl, meth and cocaine coming in.

The Postal Service has programs.

And in addition, we rely quite a bit on tips from the public on investigations that lead to information where we have reason to inspect particular packages or shipments or boats.

And that can be incredibly helpful, helpful.

And I would say that, it this time when our drugs are just so deadly, and so dangerous.

I think it's more important forever for the public.

To inform law enforcement when they have concerns when they see activities that might look like drug trafficking or overhear people talking about that sort of thing.

Let us know.

It couls save lives!

Unknown: Absolutely.

Lori Townsend: Yeah, absolutely.

The, we've been talking about how fentanyl is in nearly all all of the illicit illegal drugs that are being sold now.

Why is such a lethal compound being so frequently used, it seems very counterproductive for a dealer to sell drugs that will kill their clients.

And that's not very good PR for your business if you're trying to sell drugs to people.

Jessica, do you want to start there?

And I think it does seem counterintuitive, but you know, it's because it's more potent.

It's it's easier to carry.

It's easier to get into the you know, the country.

So I think that remotes Yeah, a big a big part of why these drugs are being adulterated and some of it is just contamination.

So I think cross contamination.

We see that a lot with meth where maybe someone was packaging, fentanyl and then at the same place where they're putting together meth.

So that's also what's happening.

I don't know if John might have some more insight into the intentions Well, before I move back to John, I want to stay with you for a moment.

Jessica.

We heard in the story that started us off today.

Sandy Snodgrass.

In Jeff Chen's report.

She mentioned that she believes her son became addicted to opioids after first being exposed to them legally.

After wisdom teeth surgery, how common is that?

And how is it being addressed?

I mean, that's, that's definitely a very common story that we hear.

So people often start with prescription opioids, if they're prescribed it legally, or maybe they're misusing a friend's prescription or a family member's prescription that happens as well.

But addiction happens so quickly, it can happen within a couple of days, and you really can't predict who it's going to happen to.

So then once the supply is cut off, or their prescription runs out, they might still seek the drug, and they'll look for the drug on the illicit marketplace.

So that's when they start looking for counterfeit pills.

Sometimes they go for heroin, and then it can even transition to if they develop tolerance over time, they might look into fentanyl as well.

So yeah, it's a common story that we hear.

And is it being addressed?

How are doctors and dentists and Now, there's definitely initiatives that people are others thinking about these things?

taking to reduce either the, the number of pills, they're prescribing, or maybe giving alternatives to pain management.

And so there's a lot of discussion around how to reduce the amount of opioid prescriptions that are out there, in general.

And I think the public is starting to get a little bit more aware of it as well.

And so there's a lot more discussions around how to deal with pain in an alternative way.

John, you as we talked earlier, you have a very long tenure in National Law Enforcement and very high profile settings.

You said there's not a more pressing important issue to be talking about.

That's really striking to me.

How big do you see this problem both for people who suffer from addiction, but in how it ripples out and affects families and entire communities?

Unknown: Substance use disorder of any claim, whether it's alcohol, or opioid use disorder is just a terrible disease.

And that's how we need to think of this, we don't need to think of this as a moral failing on somebody's part.

It can happen to anyone.

It happens to families at every stratum of society.

And it's, it's very important for us to destigmatize this idea of addiction, so that people can feel more comfortable seeking treatment.

The effects on a family when they're going through addiction is it tears them apart.

It tears apart the life, lives of the individuals who suffer from addiction.

It leads to drug related violence.

As you know, we've got a terrible problem with violent crime here in Alaska.

And a lot of the gun violence we see is drug related.

And so the the consequences and impacts here are just absolutely.

Lori Townsend: Is, is your background in this very work, part of the reason that you were appointed to Alaska?

Unknown: I think so.

The Attorney General appointed me in December.

And I'm hoping that we can do more.

I think it's time for us to bring together all of the stakeholders that work in this area and talk about resources, talk about improving our response, identify gaps in in the services that are available.

And I'm hopeful that we can do that soon.

Lori Townsend: You fought the opioid crisis in Kentucky nearly a decade ago.

How do you see this today, both in Alaska and the nation?

Is there hope in some areas where progress in this fight is being made?

Or is it generally getting worse?

The numbers are certainly bleak.

Unknown: It is, the numbers are bleak.

And I am very concerned that the situation in Alaska may worsen before it gets better.

What we have to do is work on disrupting the supply.

That's the job of law enforcement.

But we also need to work on demand.

Lori Townsend: It seems like a much more difficult area to wrap your mind around how to how to back up enough to prevent that demand so that you don't have to get to the point where it's arrest and treatment.

Unknown: Well, prevention is a big part of that.

And we need to educate families and parents so they understand the risk that their children can face, so they encourage their children not to experiment.

You can't do it these days, it's too dangerous.

But treatment options are expanding rapidly.

We now have multiple medication assisted therapies that are available.

It makes it much more humane for a person suffering from addiction when they go through withdrawals because those can be managed medically now, pretty effectively.

And long term treatment options with buprenorphine with methadone are are very effective ways of, of going into recovery.

It used to be the abstinence programs, basically 12 Step programs were our only choice, but now we've got medications that really help with a very high level of success.

Lori Townsend: Jessica, tell us about fentanyl test strips, how do they work?

And are they available to the public as Narcan is?

Yeah, so we offer, through our Project Hope through DHSS, we offer free Naloxone and free fentanyl test strips through the organizations we partner with.

So you can actually just check out our website Project HOPE.

If you just Google Project Hope Alaska, it pops up where you can email projecthope@alaska.gov But the fentanyl test strips are free.

You can use them at home to test to see if your drugs contain any presence of fentanyl.

And actually we have for setting up a webinar and some other trainings so that people can learn how to use it.

But if you do use them, they do come with instructions as well that tell you how to use them.

Unknown: I'm very pleased to see the availability of fentanyl test strips.

I think it's a great program.

But just one cautionary note, these test strips won't detect the presence of other dangerous opioids.

So for example, if a substance like acetyl fentanyl or furo fentanyl, carfentanyl that I mentioned earlier that's so potent that we see occasionally, that won't be detected by these test strips.

So fentanyl is the primary driver here.

It's the primary risk.

It's terrific that we have something that can detect that.

But it's not a failsafe by any stretch of the imagination.

Lori Townsend: The story that we heard at the beginning of the show, $26 billion paid by drug companies to settle opioid lawsuits.

The North Carolina Attorney General said the settlement represented real accountability.

Is it, when not one admitted any any culpability in this?

Would that have sent a message if the drug companies would have said something about we should have realized sooner that this was creating some of the problem?

What do you think that they should have admitted something?

Unknown: Well, the amount of those settlements tells a story all by itself, the size of those.

This was however, civil litigation, and it's very common, almost a standard practice for parties not to mention to admit liability.

So I'm really not surprised at the results here.

Lori Townsend: Jessica, talk a little bit in our final minutes here about what's being done for treatment here, we know that more treatment options are needed.

But there's a system that you referenced called Open Bed Platform to help people find help.

Tell us how that works.

Yeah, so the we've we've partnered with Open Beds, Open Beds Platform to create the website treatmentconnection.com.

And that's a website that you can go to that has a list of providers that have available beds and spaces.

So if somebody is needing treatment, it's a great resource when you need to get into treatment right away.

So you can see what's available, contact the provider directly and get started in the treatment.

I often carry bear spray on on the trails.

Should I be carrying Naloxone or Narcan also?

I, In the past, when I would see people in the woods laying down, I would usually walk over and check on them.

If they were breathing okay, and didn't seem to be in distress.

I would just walk away and leave them alone.

But now I'm more concerned when I see folks out along the trails and what should we be looking for?

Yeah, I think that's probably step one is understanding what the signs of an overdose are an opioid overdose.

There's we hear stories about people who overdosed in the same room as somebody and they just didn't realize what was going on so.

So, failure to respond when you're spoken to or shaken, slow breathing, no breathing, they might have tiny pupils.

So once you recognize those signs, then yeah, I think we've been trying to, you know, push out Naloxone as a tool, just like CPR and first aid kits.

You don't expect to use them, but they're life saving when you have them available.

So you can put them in your purse in your car somewhere nearby and handy, but yeah, recognizing the signs of an overdose and knowing that if, if they, if you administer it, and it's not an opioid overdose, it's okay.

It won't hurt them.

It's benine.

Yes.

Thank you.

Thank you.

Thank you, John.

Thank you, Jessica.

If you are using these dangerous and illegal drugs, we're not here to judge but please get help and until you do carry Narcan and don't use alone.

If you know someone who is using please encourage them to seek help, and also carry Narcan or naloxone.

You very well may save a life.

That's it for this edition of Alaska Insight.

Be sure to tune in daily to your local public radio station for Alaska Morning News and Alaska News Nightly every week night.

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We'll be back next week.

Thanks for joining us.

I'm Lori Townsend.

Good night.