In Alaska, said Dr. Zinc, fentanyl kills many overdose victims before bystanders or rescuers can resuscitate them with naloxone, a drug that can quickly reverse an opioid overdose.

“You don’t have a second chance if you don’t have naloxone available right away,” she said.

A recent investigation into illicit pills seized by drug enforcement authorities found that a significant portion of what’s marketed as OxyContin, Xanax or the Hyperactivity Disorder drug Adderall now contains fentanyl. The proliferation of these counterfeit pills may explain a recent surge in overdose deaths among teens, who are less likely to inject drugs than older people.

Pat Allen, the director of the Oregon Health Authority, said that, as was the case in other states with rising overdose deaths, the clear difference in 2021 was fentanyl’s ubiquity. Children over the age of 12 are at high risk of being given counterfeit pills containing fentanyl, and high school students overdose thinking they are opioid pain relievers or anti-anxiety drugs. The state was in the process of sending naloxone toolkits to schools, similar to a program it has used in fast-food restaurants, where people overdosed in bathrooms.

mr. Allen said he’s seen an alarming phenomenon among those who overdose: they view fentanyl’s risk as low, even though the actual risk is “seriously higher.”

“We’ve had an addiction problem in Oregon that we’ve known about for a long time,” he said. “This takes away that existing addiction problem and makes it much more dangerous.”

By 2021, overdoses were one of the leading causes of death in the United States, comparable to the number of people who died from diabetes and Alzheimer’s disease, and about a quarter of the number of people who died from Covid-19, the third leading cause of death, according to the CDC

In Vermont, which had one of the largest increases in overdose deaths last year, 93 percent of opioid deaths were fentanyl-related, according to Kelly Dougherty, the state’s deputy health commissioner.

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