It is highly likely that a person’s skin color will undergo a change in the event of an overdose. This could manifest as an ashy tone or a blue coloration. Additionally, if excessive fluid accumulates in their mouth or lungs and mixes with air, foam may appear at their lips. Another symptom that may be present is light snoring. These are the main indicators of an overdose, regardless of the specific drug involved. “An overdose is an overdose,” emphasized Soma Snakeoil, one of the co-founders of the Sidewalk Project, an organization focused on harm reduction.
While the symptoms of overdose have remained consistent, the approach to treatment has evolved, largely due to the availability of naloxone. This medication has the ability to rapidly reverse the effects of an overdose and was recently approved for over-the-counter sales under the name Narcan. This shift in policy is indicative of the changing landscape surrounding overdoses in the United States. We are currently experiencing the fourth wave of the opioid crisis, and the number of fatalities has reached unprecedented levels. “What makes this current crisis so unique is the volume,” explained John Pamplin II, an epidemiologist at Columbia’s school of public health. The drugs themselves have also become more potent, increasing the risk of overdose. “It’s not necessarily that more people are using drugs,” clarified Emilie Bruzelius, an epidemiology researcher at Columbia’s school of public health. “The opioids that people are using now are incredibly strong, and they’re more likely to cause an overdose.”
These factors have contributed to a higher likelihood of overdosing among drug users across all demographics. “There’s no population segment that is insulated,” noted Bruzelius. “It’s really affecting everybody now.”
The origins of the opioid crisis can be traced back to 1999, when the prescription of opioids became more prevalent. This led to a sharp rise in related deaths, with the number of fatalities increasing by almost 30 percent to nearly 9,000 by 2002. Initially, the first wave of the crisis primarily affected white individuals, as the mortality rate for opioids was more than two times higher for white people than for Black people by 2010.
A second wave began in 2010, characterized by a significant increase in heroin-related deaths. By 2015, heroin overdoses surpassed deaths caused by opioid pills. During this period, illicitly manufactured fentanyl, a synthetic opioid, started to be mixed with other drugs unknowingly. This gave rise to a third wave of overdoses, resulting in a surge in mortality rates. In 2017, synthetic opioids were responsible for over 28,000 deaths, surpassing the combined death toll of opioid pills and heroin. The demographic impact of the crisis also shifted, with the death rate of Black and Indigenous Americans surpassing that of white Americans in 2020.
The current fourth wave of the crisis is characterized by the mixing of different drugs. For example, individuals are overdosing from combinations of cocaine and fentanyl or methamphetamines and fentanyl or a combination of methamphetamines, fentanyl, and heroin. The infiltration of xylazine, a non-opiate sedative, into the fentanyl supply has further intensified the danger, with the DEA identifying it as the deadliest threat thus far.
This is the context in which the FDA approved the sale of Narcan over the counter. Marketed as a nasal spray, Narcan contains naloxone, which binds to opioid receptors and blocks the effects of opiates, thus reversing the overdose and restoring normal breathing. The FDA argues that this approval will improve access to naloxone, expand its availability, and ultimately help reduce overdose deaths nationwide.
Drug policies in America tend to fluctuate between extremes, shifting from a focus on care for drug users to a more punitive approach. Some critics have already advocated for restrictions on Narcan’s use, claiming that an effective overdose treatment might encourage drug use. However, as Bruzelius pointed out, there is no scientific or empirical evidence to support such arguments. It is logically sound to ensure accessible treatment for overdoses in every community, particularly given that overdoses now impact all segments of society.
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