In 2017, nearly 70% of the 70,237 documented overdose deaths in the United States involved an opioid—that's roughly 47,600 deaths from opioid overdose in one year. To put that number in perspective, that is slightly less than the 58,220 total service members who died throughout the nearly 20 years of the Vietnam War.

And, while those numbers had been steadily rising since 2010, the years during the COVID-19 pandemic unfortunately saw significant increases in reported opioid overdose deaths. By 2021 the number of documented opioid overdose deaths had nearly doubled to 80,411. Last year, provisional data suggested that number had risen to 82,998.

However, we have to remember that statistics and numbers are more than just abstract information and data. Every one of those numbers represents a person with family and friends—with people who loved them and who were greatly affected by their loss.

August 31st is International Overdose Awareness Day. It's a day to remember those we've lost to overdose, to acknowledge the grief of the family and friends they left behind, and to renew our commitment to end overdose and its related harms. This year, Door County Medical Center (DCMC) spoke with Holly Weber, a Registered Nurse in the DCMC Clinic about her daughter Katherine, who passed away in 2021 from an opioid overdose. Note: excerpts from our interview with Holly appear in italics, and portions of the interview have been edited for length and clarity.

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As a child, Katherine was a sweet, kind girl. She was intelligent and talked clearly from an early age—perfect diction. And, she was really funny, talking constantly, a chatterbox. She loved the water and being in the sun. She had a lovely childhood and I was lucky to have been able to stay home with our girls for 7 years. We went to The Farm, the beach, to the pool at Horseshoe Bay and the pool at my sister-in-law's house. And, she was involved in sports—skiing, sailing, golfing, tennis lessons—you name it.

Around age 5, when she became self conscious, she also developed a lot of anxiety and the shyness kicked in. It was tough because her anxiety would be so bad that we couldn't go places. And, as she got older, those anxieties became worse.

In high school, Katherine never drank and never used drugs. However, when she started college, she started drinking alcohol, and within a year and a half it became obvious that she had a problem. She later told me, "When I first drank alcohol, it was the first time I felt normal." You know, it made her feel better. But, the problem was, she'd go from 0 to 100 just like that—she wanted to have a glass of wine with her friends like everyone else, but once she started, she couldn't stop.

Initially, she went to a residential inpatient 30-day treatment program, followed by a 6-month aftercare program. After those 2 programs, she stayed sober for 2 years, but when COVID hit, and her best friend died, she relapsed. At that point, she was being offered pills. She would be so anxious she couldn't sleep, and people would say, "Here, take this, it's just a percocet—it will help you sleep." But really, she was just trying to numb all of her pain and anxiety. It was around then that her addiction to opioids began.

Throughout this period, Katherine struggled with a tremendous amount of guilt—about what she was going through, and what she was putting us through. That being said, she tried with all her might to stay sober—in fact, she was sober far more often than she wasn't. And, while it was a horrific time for all of us—I would describe it as an emotional rollercoaster combined with a state of constant fear—Katherine was always grateful for our help and never turned away from us. Rather, she was remorseful and would often apologize for, "being the way I am." That, in particular, broke my heart.

The thing is, while drugs and alcohol are external stimuli, they are not necessarily the problem—they are the solution for the person involved. It may be a temporary solution, but that's what it is, a solution—self medication for someone trying to numb their pain. Unfortunately for my daughter, it came on suddenly. A sweet girl, who had to that point abstained from using drugs or alcohol, started using and came down hard over a short period of time.

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What drugs are classified as opioids?

Opioids are a class of potent pain-relieving drugs that work by binding to specific neuronal receptors in the brain, spinal cord, and other parts of the body. These receptors are part of the body's natural pain-regulating system, and by binding to these receptors, opioids block pain signals from reaching the brain, thereby reducing the perception of pain.

Common opioids include (brand names in parentheses): opium, heroin, morphine, codeine, hydrocodone (brand names: Vicodin and Lortab), Oxycodone (OxyContin and Percocet), Tramadol (Ultram), Hydromorphone (Dilaudid), Fentanyl (Duragesic and Actiq).

Opioids can be administered in various forms, such as pills, patches, or injections. They are often prescribed for managing severe pain after surgery or injury, and for certain medical conditions that cause chronic pain.

The difficulty surrounding the administration of opioids is that, while they are highly effective for managing pain, opioids also activate the brain's reward system, leading to feelings of euphoria and pleasure. This dual effect on pain relief and pleasure is what makes opioids highly addictive. Additionally, the long-term use of opioids can result in tolerance, meaning higher doses are required to achieve the same pain relief. This can lead to physical dependence, wherein sudden cessation of the drug can cause withdrawal symptoms, and an increasing likelihood that the person using opioids will overdose.

What happens when a person overdoses on an opioid?

When a person overdoses on an opioid, it means they have consumed a toxic amount of the drug, leading to potentially life-threatening effects. Opioid overdose can cause severe respiratory depression, where breathing slows down significantly or even stops altogether. This lack of oxygen can lead to unconsciousness, coma, and, in the worst cases, death.

Additional signs a person may have overdosed on an opioid include:

• Pinpoint pupils
• Pale or clammy skin
• Limpness
• A bluish tint around the lips and nails (due to inadequate oxygen circulation)

Why is the synthetic opioid fentanyl so dangerous?

Chances are you've likely heard about fentanyl over the course of the past few years. The truth is it's possible to overdose on just about any medication—even too much water can be life-threatening. That being said, it is far easier to overdose on some drugs than others, with opioids perhaps being the most common type of drug to cause an overdose. For instance, a 2018 study, published by the National Library of Medicine found that among overdose deaths, "Oxycodone ranked first in 2011, heroin during 2012-2015, and fentanyl in 2016." Each of those drugs is an opioid, and the problem has only gotten worse.

When it comes to fentanyl, the danger lies primarily in its potency—according to the Centers for Disease Control and Prevention (CDC), "Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine."¹ In fact, depending on a person's body size, an amount of fentanyl as small as 2 milligrams—small enough to fit on the tip of a pencil—can be lethal.

As a white powder, fentanyl looks like many other drugs, and as a result is often cut (mixed in) with drugs like heroin, cocaine and methamphetamine. Again, potency is the part of the issue. Because fentanyl is so potent, cutting it into other drugs means those drugs can be stretched—a finite amount can make more doses, and that in turn means more profits. Additionally, fentanyl is extremely addictive, meaning people will become hooked quickly, which in turn means—again—more profits.

Over the course of the past few years, fentanyl has been found in drugs that were not commonly associated with the opioid, like marijuana. And, as the CDC notes, "Drugs may contain deadly levels of fentanyl, and you wouldn't be able to see it, taste it, or smell it. It is nearly impossible to tell if drugs have been laced with fentanyl unless you test your drugs with fentanyl test strips." This means, even with recreational drugs like marijuana, fentanyl overdoses are now possible.

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Katherine died of an accidental fentanyl overdose—known as fentanyl poisoning. The toxicology report showed that it was straight fentanyl. From texts, we know that she was not aware this was the substance she was using. However, regardless of the fact that it had been cut, it was still obviously enough to kill her.

Losing a child is absolutely the worst thing that can happen to a person. When you lose parents, it is hard, but it is the natural circle of life. When you lose a child, it violates your very sense of being. That natural cycle of life—it's suddenly in the wrong order, and seeing your child's name on a headstone—there's no way to describe that feeling.

When this happens, all of the emotions are present: anger, confusion, guilt. There are no "stages" of grief—all of those emotions, all of those "stages," come at once. And, so far for me personally, those emotions are all there permanently. It's not something one gets over. Instead, it's more like a severe disability. One must simply learn to live with it—to make accommodations for it.

Looking back on everything we went through with Katherine, I realize we did not know how to navigate or process the situation—for us, and for her, it was just a living hell. Nevertheless, while acknowledging that hindsight is 20/20, there are a couple different pieces of advice I would give parents, siblings, relatives or friends of people struggling with substance use disorder.

When someone you know and love is battling this disease, try to be supportive and work to get them quality help. Moreover, the opposite of addiction is not abstinence, it is engagement. Nurture their sense of purpose and self-worth. In other words, the more someone is engaged in his or her life, the better the chance that they can embrace life, rather than attempt to avoid it. You cannot "fix" their problem—they must do it themselves, but with your support.

This disease is innate to the person struggling with it, and the signs—the personality traits—are usually there from an early age, as they were with Katherine. In her case, there was alcoholism on both sides of her family, which makes the chances of developing an addiction much greater. And so, if you're a parent, be conscious of those personality traits like anxiety and the desire to isolate—to avoid social situations. This doesn't mean being a helicopter parent because that won't solve the problem. Curiously, it will make it worse. Instead, and as previously mentioned, nurture a sense of purpose and engagement from an early age.

Additionally, be aware of how fast addiction can happen and how fast it can spiral out of control—in other words, it can happen way faster than you can ever imagine. In particular, the drugs today are much more serious than they were even 10 years ago, and with drugs like fentanyl, addiction can occur almost instantaneously.

Finally, to parents of young children, you cannot keep them from being exposed to these drugs. As they grow up, it will inevitably (and unfortunately) happen. When I think about what to say to kids, what could deter them, I think, "we all have free will—everybody's going to do what they want to do." So, what you can do is educate them. If you are able to have honest discussions with your kids about the incredible dangers surrounding drug use today—if they are aware taking drugs from someone other than a physician means there is a very good chance that those drugs are cut with fentanyl and could kill them—then hopefully they can make an educated choice not to go down that path when they are confronted with it.

I think every single person, at some point in their lives, is touched by somebody with an alcohol or an addiction problem. I know this is cliche, but if telling Katherine's story help's one family not have to go through what my family has been through, then it's worth telling.

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What is Naloxone/Narcan and how is it used to reverse an opioid overdose?

While there are many steps that can be taken to prevent the use of opioids and other drugs before it begins, one important step that can be taken on the other side of addiction is to have Naloxone (brand name: Narcan) readily available in public spaces to stop overdoses once they've begun.

So, what is Naloxone? Per the National Institutes of Health (NIH), "Naloxone is a medicine that rapidly reverses an opioid overdose. It is an opioid antagonist. This means that it attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose." And, administering Naloxone is fairly easy, as it is a fast-acting nasal spray that begins to take effect within 2 minutes.

Naloxone availability in Wisconsin schools

Nationwide, fatal overdoses in teens ages 14 to 18 jumped 123% from 2019 to 2021, according to data from the CDC. The vast majority of those deaths involved fentanyl. Now, some teachers in the U.S. are being educated on the use of Naloxone in order to prevent opioid overdose deaths when they happen at school.

In Wisconsin, there is currently a bill being proposed that requires public and private schools to maintain a usable supply of an opioid antagonist, like Narcan. The estimated cost is $31 to $100 per box, which contains two doses of generic naloxone (in some cases, two doses are required to save a person's life), and while the bill is not yet approved, as teenagers across the country are bearing the brunt of the opioid epidemic, there's no denying the need for easily accessible opioid antagonists in our schools.

Recently, in collaboration with Door County Public Health, Door County Medical Center has been working with area schools to take matters into their own hands by sponsoring the procurement of Narcan and training teachers and staff to administer the life-saving drug. Already, the Sevastopol School District has trained over 25 staff in the administration of Narcan, and plans are underway to distribute Narcan to all remaining Door County schools.

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If you, or someone you know, is struggling with addiction, there are resources available. Nationally, SAMHSA's Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. To reach the SAMHSA Helpline call 1-800-622-HELP (4357). To visit the SAMHSA website, go to: https://www.samhsa.gov/find-help/national-helpline. Locally, Door County's Health and Human Services Department offers mental health and substance abuse services. For more information, call 920-746-2439 or visit: https://www.co.door.wi.gov/360/Behavioral-Health.

¹ Opioids are naturally derived from opium, which comes from opium poppies. Synthetic opioids, however, "are substances that are synthesized in a laboratory and that act on the same targets in the brain as natural opioids (e.g.,morphine and codeine) to produce analgesic (pain relief) effects."