John C. Hagan III, MD is a medical researcher and Editor of Missouri Medicine medical journal. He is a graduate of St. Brendan & Mexico High Schools.

Fentanyl, a powerful opioid pain medication 50 to 100 times more potent than morphine, is killing Missourians in record numbers. Drug overdose is the most common cause of death in Missourians ages 18-44. Of the 108,000 killed nationally by fake pills in 2021, the Show-Me state accounted for 1,581 deaths and 3,266 non-fatal emergency room cases. One in 47 deaths statewide was opioid related.

Mexico Missouri and Audrain County are in the Central Data Area that experienced 211 deaths, a 15% increase. Estimates for 2022 are not yet available but experts predict the highest number ever. Eighty percent of these deaths were due to fentanyl, the remainder heroin, cocaine, amphetamines (Speed), methadone and overdose of legally manufactured medications.

Poisoned pills are intentionally made to resemble authentic pills such as oxycodone. The fentanyl is manufactured in cartel-controlled areas of Mexico using chemicals from China. Enough fentanyl is smuggled across the US southern border monthly to kill everyone in the United States several times over.

Fentanyl is so easily and inexpensively made that it is often used to ‘cut’ or dilute other addictives such as heroin, cocaine and Speed. Fentanyl fillers increase the profits to dealers and make the product more addicting and deadly.

The fentanyl pills are sold illegally but blatantly on streets and easily purchased on the internet or dark web. In many parts of Missouri fake pills can be delivered to the users’ doorstep. With audaciously evil intent, the fentanyl criminal chemists are making the pills brightly colored resembling candy. Infants and children have died from ingesting what they thought was candy.

The users of fentanyl fake pills are often heroin addicts who daily use drugs or young people seeking a recreational ‘high’ or mistakenly to reduce anxiety or depression. The amount of fentanyl in these pills varies wildly. Incredibly deadly, 3 milligrams, the size of a grain of sand, can be fatal.

Individuals vary in their ability to tolerate fentanyl. In one instance in Missouri, three teenagers each took a single fentanyl pill from the same dealer. Two got high and the third died.

There is an antidote for fentanyl overdose, a nasal spray known as naloxone. All first responders and most Missouri medical facilities have naloxone immediately available. Naloxone is available without a doctor’s prescription in Missouri. Several organizations and agencies are working to distribute affordable or free naloxone among the addicted and non-addicted, improve overdose prevention and educate the public. Concerted efforts are being made to have naloxone as available as CPR and electronic defibrillators.

Public education, especially of children and young adults, is crucial and must be improved. Surveys show many young persons are not aware of the lethal effects of fake pills. Ed and Mary Ternan founded “Song for Charlie” after their son died from taking a single fentanyl fake pill. He took it and the urging of classmates to relax from college stress. The Ternan’s motto is “Just Say ‘Know’ and is centered on youth education. Real talk about fake pills. www.songforcharlie.com

There are no national strategies to abate the fake pill carnage. City, state, national legislative and law enforcement efforts have been ineffective. The media has not given these drug deaths proper coverage. Without effective abatement, a million total fentanyl deaths loom ahead.

America and Missouri are losing the war on fentanyl and fake pills. More Americans have died from fentanyl poisoning than in all US wars and military campaigns since World War 2. Fentanyl is a new paradigm in killing. This deadly drug war is one we must win.