Hopefully the title of this piece convinced you to read a few lines to get an idea what I am observing on our territories. Together we can sound an important alarm in our communities. Only if we understand the threat can we properly educate others to the danger at our doorstep.
As prescription drugs have become harder to obtain and harder to get a high from, opioid addicts have been turning to heroin, both in Indian Country and throughout the nation. This demand has inspired Mexican cartels and other drug traffickers to start cutting the heroin they distribute with fentanyl. Fentanyl is a legal, but very dangerous drug that has legitimate use as a painkilling analgesic and anesthetic. When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. It's 80-100 times more potent than morphine, and as little as 0.7 nanograms (one billionth of a gram) is enough to cause death in a user, especially combined with other drugs. The potency of the drug seems like a boon to manufacturers, but in reality, it's difficult to reduce pure fentanyl to levels safe for ingestion. The DEA, who recently issued an urgent warning about fentanyl and fentanyl analogues, estimated a single seizure of 5800 grams of fentanyl prevented some 46 million doses from hitting the street.
The upper threshold for lethal exposure is 2 milligrams, and can be absorbed by the skin, in the air, in food or in water. In general, only laboratory testing can establish the presence of fentanyl in heroin, making it even more dangerous for law enforcement, emergency medical technicians, social service staff, housing employees and children who might accidentally come into contact with fentanyl-laced heroin.
The CDC recommends a minimum of coveralls, boots and gloves when responding to an area where the concentration of fentanyl is known to be below the level of acceptable exposure, which is listed as "undetermined." The CDC additionally recommends that responders wear full protective gear, including respirators and suits rated for chemical exposure, if the level of fentanyl contamination is unknown.
Tribal law enforcement faces a difficult balance of continuing to respond to emergency calls involving heroin use, distribution, and overdoses, and maintaining a safe distance until officer safety can be established. Police departments should stay on top of trends and note spiking trends in overdoses, which may indicate the presence of fentanyl in the supply chain. If the presence of fentanyl is suspected at a crime scene, serious precautions should be taken in investigating the area, collecting and transporting the evidence, decontaminating officers, victims and remains, and in testing the evidence.
The remedy for exposure to a toxic level of fentanyl is intravenous administration of naloxone. Just as some police departments are making naloxone kits part of standard issue equipment, the Blood Tribe of Canada is training tribal members to administer naloxone, as part of an effort to stem an epidemic of overdoses from fentanyl-laced drugs.
How hard is it to visualize a grandmother frantically trying to inject naloxone into an overdosed and dying grandchild.
Walter Lamar, Blackfeet/Wichita, is a former FBI special agent, deputy director of BIA law enforcement and is currently president of Lamar Associates. Lamar Associates' Indian Country Training Division offers culturally appropriate training for Indian country law enforcement and service professionals with both on-site and online courses.