By John Sharp
Alabama officials are scrambling to find solutions to the latest drug crisis as overdoses linked to illicit fentanyl ingestion are rattling the state with plenty of horrific stories.
Recent examples played out in Alabama news outlets include:
- A 15-year-old in Semmes snorted opioids, not knowing it was laced with synthetic fentanyl. She died and her boyfriend, also unaware that the drugs had fentanyl in them, was arrested.
- A 26-year-old Foley woman ingested an opioid that is believed to have fentanyl in it. She also died, and authorities are investigating the source of the drug.
- A 26-year-old woman in Birmingham took a pill laced with 11 milligrams of fentanyl. She died on July 26, and her family is now sounding the alarms of deadly fentanyl.
The teenager in Semmes, Adrianna Taylor, was a student at Mary G. Montgomery High School. The victim in Birmingham, Jakari Givens, was employed with T-Mobile and ranked among the best job performers within the company.
The statistics are alarming, and are putting pressure on policy makers to reverse an alarming trend. Overdoses in 2022 could be a record-breaker, and fentanyl manufactured outside the U.S. and shipped through Mexico is largely to blame.
In Jefferson County alone, health officials are reporting a 118% jump in fentanyl-related deaths from 2019 to 2022, though this year still has more than three months remaining.
The potency of fentanyl, according to law enforcement, is unlike anything they have seen in modern-era drug enforcement. Health officials say it is 100 times stronger than morphine and 50 times more potent than heroin. The U.S. Drug Enforcement Agency has rolled out a public awareness campaign aptly called, “One Pill Can Kill.”
“Right now, every drug out there to me is at high risk of having lethal fentanyl,” said Virginia Guy, executive direct of the Drug Education Council in Mobile.
Alabama state lawmakers are beginning to roll out proposed solutions dealing with the fentanyl crisis months before they are set to return to Montgomery to begin the spring legislative session.
The initial bills mostly focus on harsh penalties directed at traffickers and distributors of illicit fentanyl that results in overdoses.
The proposals are sparking a debate in Alabama, and one which is also going on throughout the U.S.: Should politicians look to more punitive measures to strike back at the fentanyl crisis, or are there better approaches?
“We have to hit this from multiple sides,” said State Rep. Matt Simpson, R-Daphne, who is sponsoring legislation that would increase prison sentences for people convicted of trafficking synthetic fentanyl. “This is not the run-of-the-mill old-time drugs that there used to be. It’s not the pot of the 70s or the cocaine of the 80s. I hate to say it, but it’s not the meth of the early 2000s. It’s highly potent and deadly.”
Alabama Republicans are looking to increase punitive action against the drug traffickers, even if critics believe the efforts will fall short of capturing the real culprits of the current crisis.
Simpson and state Rep. Chris Pringle, R-Mobile, plan to sponsor legislation next year that focuses on adding penalties to people distributing the deadly drug that accounted for 66% of all U.S. overdose drug deaths in 2021.
Under Simpson’s proposal, unveiled during a news conference earlier this month, mandatory minimum sentencing guidelines that do not exist in Alabama for illicit fentanyl trafficking would apply to the weight of the drugs that are distributed in Alabama.
Similar laws exist in other states, but Simpson’s proposal would be among the harshest in the nation. Traffickers who are caught with more than 8 grams of fentanyl could face a life sentence under his proposal.
Pringle’s legislation, which he has pitched in previous sessions, assesses a felony manslaughter charge against someone who is not a licensed pharmacists and who sells an illicit pill that causes death.
“This stuff is incredibly lethal,” said Pringle. “It is killing people left and right and listening to a DEA agent about it, it will scare you to death.”
Democratic politicians could be supportive of the Republican efforts, though they will likely call on more comprehensive approaches that include increased funding for health services.
Alabama State House Minority Leader Anthony Daniels, D-Huntsville, said he agrees with Simpson that lawmakers, “must do everything possible” to stop the illegal sale of illicit fentanyl. But he added that lawmakers must also be “smart about how we design tough-as-nails sentencing guidelines that act as real deterrents to those who would traffic in these dangerous drugs.”
“I pledge to work with him and others across the aisle as well as members of our caucus to pass legislation that works to severely punish those guilty of pushing such dangerous drugs, helps those who are looking for a way out (of drug addiction), and provides mental health treatment for those in need,” Daniels said.
He added, “Such a comprehensive approach will give us the best chance of success.”
Critics, including the ACLU, believe lawmakers are setting up another tough-on-drugs punitive approach to the crisis that they worry will worsen the state’s overcrowded prison system that continues to face federal scrutiny and is believed to be at over 150% capacity.
“There is no evidence that mandatory minimums deter the illegal sale of fentanyl and other narcotics, and it will most certainly not prevent any new deaths from their use,” said JaTaune Bosby Gilchrist, the executive director of the ACLU of Alabama. “Our prisons are overcrowded and unsafe because of too many bills (like Simpson’s proposal). This will only make our prison challenges worse.”
A recent report by the Alabama Appleseed Center for Law and Justice showed that 75%-80% of people within state custody have a substance abuse disorder. Since March 2020, there have been 72 drug overdoses inside the state prison system.
Gilchrist said the better focus is for lawmakers to focus on “mitigating disparities in healthcare access and social support services for substance use disorders that lead so many people to turn to opioids in the first place.”
Timothy Dickinson, a professor in the Department of Criminology and Criminal Justice at the University of Alabama, said increased punitive measures that include mandatory minimum sentences will not “do much to stem the tide of fentanyl flowing into the state.”
Dickinson said people who ingest fentanyl often do so unintentionally and do not know the drugs they are taking are laced with something that could kill them in an instant.
“My primary concern is that many people who are ingesting fentanyl are doing so unintentionally when it has been cut into other drugs,” said Dickinson. “Following this line of thought, many of the people trafficking in these drugs laced with fentanyl probably don’t know it is in there either. If the users and sellers do not know fentanyl is in their drugs, then it stands to reason that harsher penalties for fentanyl trafficking will not impact their decisions to buy and sell the drug. After all, if we do not think we are doing something why would we be afraid of its consequences?”
One recent example illuminates Dickinson’s concern. Adrianna Taylor, the 15-year-old Mary G. Montgomery High School student who snorted crushed up pills, and her 17-year-old boyfriend were reportedly both unaware they were ingesting fentanyl. Taylor died from a drug overdose, and her boyfriend was charged with manslaughter.
“I fear what really might happen is that many young people who are making stupid decisions may get caught selling drugs that they do not know are laced with fentanyl,” said Dickinson. “They will then receive harsher punishment which will make it harder for them to turn their lives around for the better.”
Naloxone and test strips
Dickinson and others want to ensure that naloxone, under the brand name Narcan, is available to anyone who is “drug curious” so that when an overdose occurs, “there is a stronger chance they could survive.”
Naloxone is a medicine that rapidly reverses an opioid overdose, quickly restoring normal breathing to a person if it has slowed or stopped due to the drug use.
Its popularity has risen within the past year. During Spring Break in South Florida this year, drug outreach teams distributed samples of Narcan to visitors. The Sunshine State is now planning to distribute Narcan nasal sprays to all 67 Florida counties and allow them to be used without the oversight of a health provider.
Pringle, however, worries that Narcan does not reverse a fentanyl overdose like it does with other drugs. He said that a fentanyl overdose requires someone to “keep hitting them with Narcan” in multiple dosages.
Dr. Karen Marlowe, director of the Center of Opioid Outreach at Auburn University, said naloxone use to reverse opioid overdoses has only become more common over the past five years, but that it’s important to get it into the hands of people who are at-risk.
“We know anytime an opioid is in the house, there is always a risk of someone getting into it and misusing it,” Marlowe said. “Having naloxone is a good idea.”
Fentanyl test strips, long outlawed and considered drug paraphernalia, were decriminalized by Alabama lawmakers this spring. The strips, which only cost $1 each through the Jefferson County Health Department, can identify the presence of fentanyl in unregulated drugs. Proponents of the test strips believe they can allow a fentanyl user to implement so-called “harm reduction strategies” to reduce the risks of overdose.
The Jefferson County Health Department is offering test strips and naloxone to those who request it anywhere in Alabama. Their program, funded by the U.S. Centers for Disease Control and Prevention, is a partnership with the Jefferson County Health Department and the Alabama Departments of Public Health and Mental Health.
“We are just launching the fentanyl test strips (distribution) and we are hopeful it will be helpful for individuals who are using,” said Dr. F. Darlene Traffanstedt, medical director with the Jefferson County Health Department. “We are careful that folks are getting the proper education and will know how to use the fentanyl test strips.”
The county offers online training in how to use the test strips and naloxone. It’s also encouraging people with any substance abuse issue to contact a 24-hour hotline at 1-844-307-1760.
“Naloxone and test strips are available to anyone in the state of Alabama, and we will make it out for free,” said Traffandstedt.
Outreach and ‘harm reduction’
Outreach and education will be an ongoing issue for Alabama, as the state continues to come to grips with a crisis that is receiving more national media attention in recent months.
Guy, the director of the Drug Education Council in Mobile, said there is a lot of education still needed in how to properly use fentanyl test strips. The Mobile County Health Department, for instance, does not have test strips.
Guy said she’s leery that people using drugs will stop what they are doing and test to see if they are laced with fentanyl.
“Do you sit there with the dealer and say, ‘Let me test this. I don’t want fentanyl in it”? Guy said. “I don’t know what you do.”
Marlowe said that education on how to use the test strips and Narcan are crucial, as is providing basic information on where to obtain them.
“Honestly, they are not widely available right now,” she said, referring to fentanyl test strips. “Some of the drug outreach programs have them and we are trying to get them into pharmacies.”
Marlowe added, “Fentanyl is present in so many different drugs available on the street right now. It’s probably present in more drugs than it’s not present. But we won’t stop people from using it. But if they won’t stop using it, we have to get the strips out there so they can test.”
Liz Komer, sentencing reform counsel with the Washington, D.C.-based Sentencing Project, said that Alabama’s efforts in decriminalizing fentanyl test strips should be considered the “lowest bar” and argues the strips should be “widely available” throughout the state.
She argues that states throughout the U.S. should embrace more “harm reduction” approaches like the test strips toward reducing deaths and illness from illicit drug use by making the drugs safer for people who use them. Harm reduction, while controversial in the U.S., is more popular in other countries and some Canadian cities like Vancouver where supervised injection sites are prevalent and naloxone is available and is free in every pharmacy.
“It’s about decreasing the stigma so people can come forward and have a candid conversation about how to use drugs more safely and how I can save my life and the people around me,” said Komer. “One of the great harms of criminalization is that it rachets up the stigma. The trafficking laws in Alabama will criminalize the low-level folks who are selling in order to support addictions. They are not the kingpins.”
She added, “Instead of using around other people so they can intervene when you overdose, a more threatening criminal law is more likely going to see people using alone where no one is there to save a life.”
Marlowe said isolation is a concern in Alabama, where unique challenges continue to cloud the state’s rural health system. Rural areas also remain with spotty Internet coverage, which makes it a challenge to reach certain demographics for drug education purposes.
Marlowe is pointing Alabamians to the website https://findtreatment.gov/ to find out where they should go for assistance, but she is also advocating that lawmakers consider increasing funding for the Department of Mental Health to address shortcomings in addiction treatment.
“There are numerous counties where you cannot get treatment, and you have to go to a larger city and travel across half the state,” she said. “That’s where I see a real need. Something like education can be developed and distributed at the school level but treatment, if you think about it … how likely is it that someone will travel halfway across the state to get the treatment they need?”
She added, “Where state money is needed is to develop these treatment resources otherwise, we are going to end up with a lot more people in situations where (the mandatory minimum prison) bill is going to apply to them. They will end up in situations where they are arrested for possession or involved in some of these more serious crimes.”