LINN  —  Osage County Anti-Drug Community Action Team (OC-ADCAT) board and coalition members will host a Town Hall meeting on March 23 titled “Let’s Talk About Drugs in Osage County,” and free event open to the public from 5:30-7:30 p.m. at the State Tech Vehicle & Power Center. A free dinner will be held from 5-6 p.m. The program focused on drug use, vaping, and underage drinking will begin following the meal.

“Fentanyl is real, and we have been affected in Osage County,” said OC-ADCAT Executive Director Lorie Winslow. “We often think we are in an isolated bubble in rural Missouri but two deaths in the last year from this show a real problem.

“I do not want any drug-related deaths in Osage County, ever,” Winslow continued. “We can change this statistic with knowledge. We have to talk about this in our community and talk about it with our youth! We are not going to passively let this continue without learning how to make a change. My hope is that sharing this information at our Town Hall event will make a difference in our community. We can turn this around. Our knowledge is power and the more we know, the more we can help stop this from hurting our loved ones.”  

OC-ADCAT, which is sponsoring the Town Hall event, also provides the “Too Good for Drugs” program, with Linn Elementary, Middle and High School, Chamois Elementary, Middle and High School, St. George, Immaculate Conception in Loose Creek, and St. Joseph in Westphalia participating. “Our goal through OC-ADCAT is for all students in Osage County to see this program each year,” said Winslow. “The more we can share with our youth on making positive choices, the better their futures will be.”

Sheriff Mike Bonham will address the dangers of drug use, including fentanyl, and how law enforcement is dealing with the problem.

There were 1,349 deaths attributed to fentanyl in 2022 in Missouri, with two in Osage County confirmed by Coroner AJ Probst.

“It’s on the uptick, that’s for sure,” said Sheriff Mike Bonham. “One of the overdose deaths is still under investigation. “If they had called 911 as soon as the person had trouble breathing, there’s a high likelihood that he would have lived. It’s very challenging as a rural sheriff because I knew them. It becomes personal.”

What exactly is fentanyl?

According to the Community Anti-Drug Coalitions of America’s (CADCA) Practical Theorist 13, “Fentanyl: Why Fentanyl/Why Now,” there are two types of fentanyl – pharmaceutical fentanyl and illicitly-manufactured fentanyl (IMF). 

Pharmaceutical fentanyl has been used for decades for medicinal purposes. It is prescribed by healthcare providers to treat severe pain, particularly after surgery and for advanced-stage cancer. Illicitly-manufactured fentanyl is produced in clandestine laboratories and distributed through illicit drug markets. IMF is easier and less costly to make, distribute, and sell than heroin and is often mixed or co-used with other drugs because of its extreme potency. Both pharmaceutical fentanyl and IMF are synthetic opioids, meaning that they are man-made substances that are created to act on the same targets in the brain as natural opioids (e.g., morphine and codeine) to manage pain.

Fentanyl is one of the most dangerous substances circulating in communities across America, up to 50 times stronger than heroin and 100 times stronger than morphine, according to the Drug Enforcement Agency Fentanyl Factsheet (2020). 

Significant increases in overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl, began in 2013. From 2013 to 2019, the mortality rate from fentanyl and other synthetic opioids jumped from 1.0 to 11.4 per 100,000 people – a 1,040% increase, according to CADCA. It is estimated that by 2029, over 1.2 million people will die from fentanyl and other opioids if no action is taken.

Closer to home, 1,581 Missourians died from an opioid overdose in 2021. That means that 1 out of 47 deaths statewide was attributed to an opioid-involved overdose. While prescription opioids and heroin once drove this epidemic, potent non-heroin opioids such as fentanyl have increasingly taken over as the primary killer.

According to the Missouri Department of Health and Human Services, drug overdoses — both fatal and non-fatal — have become an epidemic in Missouri over the past decade. The Show-Me State ranked 32nd among all states and Washington, D.C., for drug overdose death rates in 2020 and is the leading cause of death among adults aged 18-44 in Missouri.

Worse than fentanyl is carfentanil, a very potent opioid analgesic used in veterinary medicine to anesthetize large animals such as elephants and rhinoceroses.

“People think they can handle it, but they can’t,” said Bonham.

It’s one thing to ingest a drug willingly. It’s quite another to take something else that has been infused with fentanyl.

Bonham recalls a time in the 1980s when cocaine was cut to dilute the strength of the drug. “You had to know what you were doing, or you’d give someone a ‘hot shot,’ and it would kill them,” he said. “We’re dealing with the same thing now with fentanyl. They’re putting it in marijuana and meth, and a big part of the problem is that it doesn’t take very much fentanyl to kill you. Remember that drug dealers are in this to make a profit, and they don’t care about the harm they cause.”

As little as 2mg of fentanyl – the equivalent of 10-15 grains of salt – is almost certainly lethal, particularly for youth, young adults, or others who have not previously used fentanyl or other opioids, CADCA warns.

Manufacturers are also offering what appears to be candy that is actually fentanyl.

Since August 2022, DEA and its law enforcement partners have seized brightly-colored fentanyl and fentanyl pills in 26 states.   

Dubbed “rainbow fentanyl” in the media, this trend appears to be a new method used by drug cartels to sell highly-addictive and potentially deadly fentanyl made to look like candy to children and young people.

“Rainbow fentanyl — fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes — is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults,” said DEA Administrator Anne Milgram. “The men and women of the DEA are relentlessly working to stop the trafficking of rainbow fentanyl and defeat the Mexican drug cartels that are responsible for the vast majority of the fentanyl that is being trafficked in the United States.”

Brightly-colored fentanyl is being seized in multiple forms, including pills, powder, and blocks that resembles sidewalk chalk. Despite claims that certain colors may be more potent than others, there is no indication through DEA’s laboratory testing that this is the case. Every color, shape, and size of fentanyl should be considered extremely dangerous.

Osage County Health Department Administrator Kim Sallin noted that in 2019, the US Surgeon General said there was a greater chance that people would need to be revived from an opioid overdose than they would need CPR. It was also noted that Narcan should not be administered to anyone under 18, but Sallin said she has standing orders from the state to make the nasal spray an option for people of all ages.

“Drug dealers are targeting teens and pre-teens, and access to Narcan could very well save lives,” she said. “The Surgeon General also said the public has an important role in addressing the opioid epidemic because this a public health crisis.”

Milgram noted that fentanyl remains the deadliest drug threat facing the country. According to the Centers for Disease Control (CDC), 107,622 Americans died of drug overdoses in 2021, with 66% of those deaths related to synthetic opioids like fentanyl. Drug poisonings are the leading killer of Americans between 18 and 45. Fentanyl in the U.S. is primarily supplied by two criminal drug networks, the Sinaloa Cartel and the Jalisco New Generation Cartel (CJNG), according to the DEA.

“Fentanyl is making its way into the U.S., primarily through Mexico,” said Bonham. “Once it’s here, it spreads quickly to the bigger cities and then finds its way to rural America. We are not insulated from this epidemic. To assume it’s not here would be a mistake.”

Winslow recently attended the CADCA National Leadership Conference in Washington, D.C., and Milgram, in her keynote address, talked about the two drug cartels. “She shared a map with the audience of the path that is often taken by the cartels through the United States,” Winslow noted. “It really hit home when I realized one of the paths led directly through Osage County. I was not prepared to see this slide in her presentation.”

Fentanyl’s effects come on quicker than morphine but don’t last as long, according to a fact sheet published by the National Center for Drug Abuse Statistics. The drug remains in the body for over a day, impacting different organs and systems. Fentanyl overdose rates are rising 2.5 times faster than heroin and outpace prescription opioid overdoses by 550.94%.

Physical impacts include drowsiness, nausea/vomiting, urinary retention, and pupillary constriction. Severe or prolonged reaction may require medical attention.

The DEA has classified fentanyl as a schedule II controlled substance, meaning it has a high potential for abuse and severe physiological and psychological dependence.

Because drug traffickers are targeting youth, several organizations, including OC-ADCAT, are taking steps to educate children on the dangers of drugs.

One resource is “The Tall Cop,” Officer Jermaine Galloway, who speaks to schools and organizations nationwide.

In a newsletter he wrote last month, schools are seeing an increase in the use of fentanyl — and, unfortunately, more drug overdoses as a result.

“Teens across the country are gaining more and more access to different substances, and we are seeing different strands of these drugs every day,” Galloway wrote. “Even more recently, marijuana-laced fentanyl in some high schools has been reported. But that doesn’t mean middle or even elementary schools will not see an increase. Every day, I am seeing stories pop up of kids being exposed to fentanyl.”

He noted that in addition to offering alternative forms such as powders, candy, etc., illicit manufacturers are making pills that are very similar in appearance to legitimate oxycodone tablets, known in schools as fake M30 tablets, Perc 30s, blues, dirty 30s, etc. “These are pills manufactured at a street level that are made to look like Oxy,” said Galloway. “Other forms to pay attention to are fake Xanax bars, aka ‘bars’ or ‘school buses,’ fake ecstasy pills, etc.”

Galloway will be at Linn R-2 on Aug. 9 to present to educators and all who work with youth from 1-4 p.m. and deliver a presentation for parents from 6-7:30 p.m. at the Linn Fieldhouse.  

According to the Practical Theorist, youth are at risk for a number of reasons, including, among others, a marketplace where drugs containing fentanyl are more available and accessible to youth and young adults via social media platforms. A lack of prior exposure to opioids makes drugs with even small amounts of fentanyl more likely to be lethal, and a lack of awareness about fentanyl and its presence in other substances also leads to overdoses. The heightened need to address youth connectedness, resilience, and other protective factors, given the negative impacts of the COVID-19 pandemic on youth mental health, is important to consider. “These factors make the need for primary prevention efforts more important than ever,” the Practical Theorist noted. “Given the urgency and magnitude of the opioid crisis, which is currently being driven by increases in the availability of highly lethal illicitly-manufactured fentanyl, it is critical to focus on primary prevention and to be informed on other work to save lives. Focusing on primary prevention strategies, such as increasing awareness and promoting protective factors in schools and communities, can help to enhance broader strategies being used to reverse increases in overdose deaths, such as collaborative partnerships with public health and public safety, safe prescribing practices; access to substance-use treatment and recovery programs; and promotion of services such as naloxone distribution, fentanyl test strips, and syringe services programs.”

Galloway encouraged communities, school districts in rural and large areas, and parents to increase their education on fentanyl and other dangerous drugs to prevent the rising number of students from using and experimenting with these various substances. 

“Local and state policy alone cannot curve the trend we are seeing today,” she added. “Educating people will only motivate the efforts for change in this chronic issue.”

Bonham agrees. “There’s only so much law enforcement can do,” he said. “We do our best to warn the public about the dangers of drug use, and we’ve seen success with the Junior Deputy Program. However, until a person decides they’ve had enough and choose to stop taking drugs, we’re going to be reactionary.”

“Saying it’s a choice is not really accurate,” said Sallin. “It’s not that black-and-white. Often, people can’t get stop without help, and there are limited resources — not just here in Osage County, but most counties — to help them stop. In places that have resources, it’s costly and people can’t afford it.”

Sallin also noted that while there is a problem on the streets with illicit fentanyl, some people become addicted to properly prescribed opioids following surgery or to lessen chronic pain. “That’s not their fault, and we need to find a way to help them instead of blaming them and making them feel shunned,” she added. “Maybe then they would ask for help. Until we get away from thinking it’s a choice, we won’t get anywhere, but again, that takes funding.”

Bonham added that he is working with the Mid-Missouri Drug Task Force, MUSTANG, and the Missouri State Highway Patrol to share intelligence and develop solutions.

“I want to thank Osage County residents,” he said. “They have done a great job providing information we can track.”

Prosecuting Attorney Amanda Grellner, Judge Sonya Brandt, and drug task force members will also speak at the town hall. 

Samantha Sherman from Meramec Regional Planning Commission will be there to explain how to use Narcan in an emergency, and OC-ADCAT will distribute the overdose-reversing nasal spray free.

Sallin obtained grant funding and provides Narcan to deputies. She also has given supplies of the spray to Osage Ambulance District and first responders with several emergency agencies.

She also wants to make it available to county residents in need. Sallin noted that while commissioners have reservations about that, but she has consulted with Prosecuting Attorney Amanda Grellner regarding the county’s liability. “After reviewing all the statutes and state orders, Amanda agrees it’s okay to provide Narcan to residents without documentation,” Sallin said. “That’s important because people who have a drug problem at home aren’t going to want their name out there, which means they likely won’t come in for Narcan.”

Sallin said she plans to administer the spray to the public once she is settled in the new building.

Narcan is safe and effective for nearly 30 years, Sallin said, though the spray has an expiration date of two years. “That’s only because the plastic component begins to break down after a couple of years, but the spray itself is potent for a long time,” she added. “It’s safe to use even after the expiration date and it’s important people realize that. Even if it loses some potency, it’s not going to cause any harm to use it, especially given the alternative, which is most likely death.”

Narcan has been distributed to law enforcement and emergency medical personnel due to the increased dangers associated with fentanyl. “This drug is very potent and can be absorbed through the skin,” said Bonham. “In the old days, we used a kit to determine whether the substance was illegal. We can’t physically handle fentanyl because its effects are so quick and deadly.”

Instead, the department uses TruNarc, an analyzer that easily and quickly tests for over 400 substances, including narcotics, stimulants, depressants, hallucinogens, and analgesics.

“TruNarc has already saved the lives of two deputies,” Bonham noted.