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This Is What Neuroscientists and Philosophers Understand About Addiction

By Maia Szalavitz

Ms. Szalavitz is a contributing Opinion writer who covers addiction and public policy.

When I was arrested and charged with possession with intent to sell cocaine in 1986, I was addicted to both coke and heroin. Although I was facing a 15 years-to-life sentence, the first thing I did after my parents bailed me out and held a family meeting was to find and secretly inject some prescription opioids that I knew the police hadn’t confiscated.

I knew that doing this further jeopardized my life prospects and my relationships with everyone I cared about. I knew it made no sense. But I didn’t believe that I could cope in any other way. Until I finally recognized that I needed treatment and began recovery in 1988 — with the prospect of that lengthy sentence under New York’s draconian Rockefeller laws still occluding my future — I didn’t think I had any real choice.

Was my brain hijacked by drugs — or was I willfully choosing to risk it all for a few hours of selfish pleasure? What makes people continue taking drugs like street fentanyl, which put them at daily risk of death?

These questions are at the heart of drug policy and the way we view and treat addiction. But simplistic answers have stymied efforts to ameliorate drug use disorders and reduce stigma.

Research now shows that addiction doesn’t ‌‌mean either being completely subject to irresistible impulses, or making totally free choices. Addiction’s effects on decision-making are complex. Understanding them can help policymakers, treatment providers and family members aid recovery.

Claims that people with addiction are unable to control themselves are belied by basic facts. Few of us inject drugs in front of the police, which means that most are capable of delaying use. ‌‌Addicted people often make complicated plans over days and months to obtain drugs and hide use from others, again indicating purposeful activity. Those given the option will use clean needles. Moreover, small rewards for drug-free urine tests — used in a treatment called contingency management — are quite successful at helping people quit, which couldn’t be possible if addiction obliterated choice.

However, those who contend that substance use disorder is just a series of self-centered decisions face conflicting evidence, too. The most obvious ‌is the persistence of addiction despite dire losses like being cut off by family members or friends, getting fired, becoming homeless, contracting infectious diseases or being repeatedly ‌incarcerated‌‌.

‌Most people who try drugs don’t get addicted, even to opioids or methamphetamine, which suggests that ‌factors other than simply being exposed to a drug can contribute to addiction. ‌The majority of people who do get hooked have other psychiatric disorders, traumatic childhoods or both — only ‌7 percent report no history of mental illness . ‌‌Nearly 75 percent of women with heroin addiction‌‌ were sexually abused as children — and most people with any type of addiction have suffered at least one and often many forms of childhood trauma‌‌. ‌‌This data implies that ‌‌genetic and environmental vulnerabilities influence risk.

So how does addiction affect choice? Neuroscientists and philosophers are beginning to converge on answers, which could help make policy more humane and more effective.

Brains can be seen as prediction engines, constantly calculating what is most likely to happen next and whether it will be beneficial or harmful. As children grow up, their emotions and desires get calibrated to guide them toward‌ what their brains predict will ‌meet their social and physical needs. Ideally, as we develop, we gain more control and optimize the ability to choose.

‌But there are many ways that these varied processes can ‌go awry in addiction and alter how a person makes choices and responds to consequences.

Traditionally, researchers focused on how the drug experience changes during addiction. At first, using is fun, perhaps exciting, perhaps soothing. It solves a problem like social anxiety or an absence of pleasure. Then, however, it becomes less effective: More is needed to get the desired effects, and coping without it begins to seem impossible. As addiction becomes ingrained, the craving for drugs intensifies even as they become less enjoyable.‌

In my own experience with cocaine, this disconnect was pronounced. At first, I found it euphoric. Toward‌ the end of my addiction, I was injecting dozens of times a day, desperately wanting coke but ‌also knowing it would make me feel hideous. The ‌‌ incentive salience‌ theory suggests that addiction is a problem of outsized “wanting” despite reduced “liking,” which becomes less amenable to cognitive control over time.

‌‌During addiction, people also tend to prioritize short-term rewards over long-term gains, which means that they postpone the pain associated with quitting, often indefinitely. This idea, which is known as “ delay discounting ” further helps explain why people with chaotic childhoods and precarious incomes are at higher risk: When a better future seems unlikely, it is rational to get whatever joy you can in the present.

Chandra Sripada, professor of psychiatry and philosophy at the University of Michigan, argues that distorted thinking is more important in addictive behavior than overwhelming desire, leading to what he calls “unreliable” control over use. He focuses on how addiction affects our stream of consciousness.

During addiction, he contends, despairing thoughts about oneself and the future — not just thoughts about how good the drug is — predominate. At the same time, thoughts about negative consequences of use are minimized, as are those about alternative ways of coping. Drugs are overvalued as a way to mitigate distress; everything else is undervalued. The result is an unstable balance, which, more often than not, tips toward getting high.

This theory ‌is helpful for explaining who is most likely to get addicted and what is most likely to generate recovery. Risk factors like poverty, a traumatic childhood and mental illness generate excess stress while tending to produce negative thoughts about oneself. In my case, I was depressed and isolated because of what I later learned was undiagnosed autism spectrum disorder — and hated myself for my inability to connect. The result was a mental climate conducive to relying on drugs, even when they no longer ‌provided relief.

Factors linked to recovery — like social support and employment — can offset distorted thoughts and inflated valuation of drug use. Essentially, people make better choices when they recognize and have access to better options‌. If you are locked in a room with an escape route unknown to you hidden under the carpet, you are just as trapped as if that exit didn’t exist. My recovery began when I saw that there was a bearable way out.

This is why punitive approaches so often backfire : Causing more pain for people who view drugs as their only way to cope drives desire to use even more. Punishment doesn’t teach new skills that can allow better decisions. I was just lucky that I got help before it was too late.

But if addicted people are making choices that are harmful to themselves or others, shouldn’t they be held responsible for their behavior? Hanna Pickard, distinguished professor of philosophy and bioethics at Johns Hopkins University, calls for a framework she labels “ responsibility without blame .” In this view, addicted people do have some control over their decisions. However, that doesn’t mean they deserve blame or that shaming and punishing them will improve matters.

Instead, providing people with both the skills and the resources they need to change, and compassionately holding them accountable as they learn to make different choices, can promote recovery. (This approach is a therapeutic one, not aimed at adjudicating addiction-related crimes, although the idea could potentially be extended into the legal realm.)

Research finds that framing addictive behavior as an involuntary brain disease reduces the tendency to blame people for it. But this perspective does not necessarily alleviate stigma or the desire to punish. This is probably because viewing individuals as having no autonomy dehumanizes them and makes others want to lock them up in an attempt to protect society.

The “responsibility without blame” concept offers a way around this: ‌People with addiction have agency, but it is compromised. And this is not unique to addiction.

“I will have less control, if I’m exhausted and tired and upset, than if I’m well-slept in a stable happy place in my life,” said Professor Pickard, noting that being “hangry” is a classic example of ‌diminishe‌‌d emotional control.

To recover, people with addiction need both new skills and an environment that provides better alternatives. This doesn’t mean rewarding people for bad behavior. Instead, we must recognize that compulsive drug use is far more often a response to a life where meaning and comfort appear out of reach than it is a selfish quest for excess pleasure.

Maia Szalavitz ( @maiasz ) is a contributing Opinion writer and the author, most recently, of “ Undoing Drugs : How Harm Reduction Is Changing the Future of Drugs and Addiction.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Essay on Drug Abuse

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Essay on Drug Abuse in 150 words

Essay on drug abuse in 250-300 words, essay on drug abuse in 500-1000 words.

Drug abuse is a global issue that poses serious risks to individuals and society. It involves the harmful and excessive use of drugs, leading to physical and mental health problems. Drug abuse can result in addiction, organ damage, cognitive impairment, and social and economic difficulties. Prevention efforts should focus on education, raising awareness about the dangers of drug abuse, and promoting healthy lifestyles. Access to quality healthcare and addiction treatment services is crucial for recovery. Strengthening law enforcement measures against drug trafficking is necessary to address the supply side of the problem. Creating supportive environments and opportunities for positive engagement can help prevent drug abuse. By taking collective action, we can combat drug abuse and build healthier communities.

Drug abuse is a growing global concern that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have negative effects on physical and mental health.

Drug abuse has severe consequences for individuals and society. Physically, drug abuse can lead to addiction, damage vital organs, and increase the risk of overdose. Mentally, it can cause cognitive impairment, and psychological disorders, and deteriorate overall well-being. Additionally, drug abuse often leads to social and economic problems, such as strained relationships, loss of employment, and criminal activities.

Preventing drug abuse requires a multi-faceted approach. Education and awareness programs play a crucial role in informing individuals about the dangers of drug abuse and promoting healthy lifestyle choices. Access to quality healthcare and addiction treatment services is vital to help individuals recover from substance abuse. Strengthening law enforcement efforts to curb drug trafficking and promoting international cooperation is also essential to address the supply side of the issue.

Community support and a nurturing environment are critical in preventing drug abuse. Creating opportunities for individuals, especially young people, to engage in positive activities and providing social support systems can serve as protective factors against drug abuse.

In conclusion, drug abuse is a significant societal problem with detrimental effects on individuals and communities. It requires a comprehensive approach involving education, prevention, treatment, and enforcement. By addressing the root causes, raising awareness, and providing support to those affected, we can combat drug abuse and create a healthier and safer society for all.

Title: Drug Abuse – A Global Crisis Demanding Urgent Action

Introduction :

Drug abuse is a pressing global issue that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have detrimental effects on physical and mental health. This essay explores the causes and consequences of drug abuse, the social and economic impact, prevention and treatment strategies, and the importance of raising awareness and fostering supportive communities in addressing this crisis.

Causes and Factors Contributing to Drug Abuse

Several factors contribute to drug abuse. Genetic predisposition, peer pressure, stress, trauma, and environmental influences play a role in initiating substance use. The availability and accessibility of drugs, as well as societal norms and cultural acceptance, also influence drug abuse patterns. Additionally, underlying mental health issues and co-occurring disorders can drive individuals to self-medicate with drugs.

Consequences of Drug Abuse

Drug abuse has devastating consequences on individuals and society. Physically, drug abuse can lead to addiction, tolerance, and withdrawal symptoms. Substance abuse affects vital organs, impairs cognitive function, and increases the risk of accidents and injuries. Mental health disorders, such as depression, anxiety, and psychosis, are often associated with drug abuse. Substance abuse also takes a toll on relationships, leading to strained family dynamics, social isolation, and financial instability. The social and economic costs of drug abuse include increased healthcare expenses, decreased productivity, and the burden on criminal justice systems.

Prevention and Education

Preventing drug abuse requires a comprehensive and multi-faceted approach. Education and awareness programs are essential in schools, communities, and the media to inform individuals about the risks and consequences of drug abuse. Promoting healthy coping mechanisms, stress management skills, and decision-making abilities can empower individuals to resist peer pressure and make informed choices. Early intervention programs that identify at-risk individuals and provide support and resources are crucial in preventing substance abuse.

Treatment and Recovery

Access to quality healthcare and evidence-based addiction treatment is vital in addressing drug abuse. Treatment options include detoxification, counseling, behavioral therapies, and medication-assisted treatments. Rehabilitation centers, support groups, and outpatient programs provide a continuum of care for individuals seeking recovery. Holistic approaches, such as addressing co-occurring mental health disorders and promoting healthy lifestyles, contribute to successful long-term recovery. Support from family, friends, and communities plays a significant role in sustaining recovery and preventing relapse.

Law Enforcement and Drug Policies

Effective law enforcement efforts are necessary to disrupt drug trafficking and dismantle illicit drug networks. International cooperation and collaboration are crucial in combating the global drug trade. Additionally, drug policies should focus on a balanced approach that combines law enforcement with prevention, treatment, and harm reduction strategies. Shifting the emphasis from punitive measures toward prevention and rehabilitation can lead to more effective outcomes.

Creating Supportive Communities:

Fostering supportive communities is vital in addressing drug abuse. Communities should provide resources, social support networks, and opportunities for positive engagement. This includes promoting healthy recreational activities, providing vocational training, and creating safe spaces for individuals in recovery. Reducing the stigma associated with drug abuse and encouraging empathy and understanding are crucial to building a compassionate and supportive environment.

Conclusion :

Drug abuse remains a complex and multifaceted issue with far-reaching consequences. By addressing the causes, raising awareness, implementing preventive measures, providing quality treatment and support services, and fostering supportive communities, we can combat drug abuse and alleviate its impact. It requires collaboration and a collective effort from individuals, communities, governments, and organizations to build a society that is resilient against the scourge of drug abuse. Through education, prevention, treatment, and compassion, we can pave the way toward a healthier and drug-free future.

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We Need to Stop Trying to Raise “Drug-Free” Kids

The important shift away from abstinence to addiction resistance..

Posted May 13, 2024 | Reviewed by Michelle Quirk

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• Kids and teens lack basic knowledge about what alcohol and drugs actually do in their brains and bodies.
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• Addiction resistance is a more realistic goal than abstinence.

“Beer then liquor, never sicker… Liquor then beer, never fear .” This was a common refrain when I was a Gen X teenager. Besides “Don’t drink and drive,” this was the extent of how I was taught to drink responsibly. Like most kids, most of my knowledge about alcohol and drugs didn’t come from my parents or my school’s alcohol and drug education programs.

Now I am a clinical psychologist, professor of psychology, and mother to three young kids who have a genetic vulnerability to addiction . I’ve spent the past 20 years studying addiction and providing evidence-based addiction treatment. I’ve helped thousands of people better understand the risk and protective factors that influence why one person develops addiction when another doesn’t. I’ve heard countless “If only I had...” stories from parents, students, and people in addiction recovery.

Problems With School Alcohol/Drug Prevention Programs

Each semester that I taught college courses on addiction, I was dismayed by students' lack of basic knowledge about what psychoactive substances actually do in their brains and bodies. They shared their personal experiences with “alcohol/drug education” programs they encountered in their school settings, and these accounts typically share a common refrain—these “prevention” initiatives become jokes, trigger rebellious substance use, or have little to no impact on their substance use decisions.

At worst, prevention programs create shame for people struggling with their substance use and actually impede help-seeking by shutting down communication with adults. Abstinence-only and anti-drug programs cause people to internalize stigmatizing messages like “Users Are Losers,” “Just Say No” (like it’s just that simple and easy for everyone), and “Good Kids Don’t Get High.” Yet they also recognize the disparity between the way that alcohol is discussed compared to other drugs, and that inconsistency leads to confusion.

To receive federal funding, schools must check a box on the annual paperwork stating they deliver alcohol/drug education programming to their students. But there is no metric for what that education includes. So, many schools are able to check that box (and retain their funding) with “Red Ribbon Week” activities like “On Wednesday, wear neon to show you’re too bright for drugs!”

When we talk about addiction prevention, we typically focus on school-based curricula. But that misses two key elements that are critical for helping kids develop the resilience and protective factors they need to combat addiction and other mental health struggles—school policies and parent training. At home, many parents assume their kids are either too young to talk about alcohol and drugs or that the school will provide the essential knowledge their kids need to be “drug-free.”

My parenting tactics are different, and definitely the minority (for now). My 9-year-old knows how to recognize the signs of alcohol intoxication and knows that drugs like methamphetamine can alter one’s perception of reality. I am purposely raising my kids to know that it’s not the substance (alcohol or drugs) that is the problem, but that other factors make some people more vulnerable to substance use becoming dysfunctional. My kids will all know at a young age that since genetic predisposition accounts for 50 percent of the chance of developing addiction, they are 10 times more likely to develop addiction than their friends without a family history of addiction.

Building Addiction Resistance

Why does my 9-year-old know more about the risk factors for addiction than most college students? Because I’m not trying to raise “drug-free” kids . As a clinical psychologist specializing in evidence-based addiction treatment, I’m trying to raise addiction-resistant kids. I fully accept the likelihood that they will use alcohol or other drugs at some point. Instead of trying to scare them out of that choice or build shame and stigma around the addiction history in our family, I am choosing to provide them with the essential knowledge and skills they need to make informed decisions about substance use. Building their addiction resistance gives them the best chance to navigate the hellscape of adolescence with healthy coping skills instead of turning to alcohol and drugs to self-medicate, tolerate distressing thoughts or feelings, or foster a sense of belonging with their peers.

My approach definitely isn’t popular (yet), but I am developing the Raising Resilient and Addiction-Resistant Kids program to provide a viable alternative to abstinence-only messaging. Many parents have trouble stepping outside of the narrative that trained them to think that providing honest education about alcohol and drugs somehow condones their use and leads to a higher risk of addiction, but many others are ready for a different approach.

In a feel-good-all-the-time society like the United States, how can we expect kids and teens to make informed choices about alcohol and drugs if we don’t provide them with the foundational knowledge and skills they need to do so? How can we tell them to “Just Say No" when that message is overly simplistic and fuels stigma against substance users that perpetuates innumerable social injustices in the pursuit of “drug-free communities”?

The “Users Are Losers” message shuts down communication lines between students and educators, and children and parents. We’ve made so much progress destigmatizing mental health struggles like depression , anxiety , autism , and posttraumatic stress disorder, yet we continue to perpetuate the Us vs. Them mentality when it comes to substance use and addiction. Where does that leave kids whose risk factors for addiction outweigh their protective factors?

If we truly want to reduce addiction… If we truly want to reduce drug overdose deaths… If we truly want to “save our kids” from drugs, then we need to stop trying to raise “drug-free” kids and focus on raising addiction-resistant kids instead.

Copyright 2024 Kelly E. Green and Grind Wellness, LLC

Kelly E. Green, Ph.D. , is a psychologist specializing in evidence-based addiction treatment, the author of Relationships in Recovery , and an Associate Professor of Psychology at St. Edward’s University in Austin, Texas.

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Argument Drug Addiction

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Words: 651 |

Published: Mar 19, 2024

Words: 651 | Page: 1 | 4 min read

Table of contents

Introduction, causes of drug addiction, impact on individuals, families, and communities, prevention and treatment strategies, a comprehensive approach.

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Substance Abuse: Case Study Analysis Essay

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Introduction

Andrew, a Hispanic man of 26, lives with his mother and elder sister. He works part-time since he is currently enrolled at a nearby community college. Andrew was suspended from school and placed on academic probation for his involvement with marijuana. In addition, he was doing a number of part-time gigs, all of which ended in his dismissal after a few months of bad performance. One of Andrew’s four siblings, a brother, lost his life in a terrible childhood drowning. He has not sought either therapy or a solid support network. Andrew, though, has admitted to consuming marijuana and drinking alcohol and has sought professional help.

A decade of fighting Major Depression, it is finally revealed after he attends many therapy sessions. Andrew says he can drink heavily without becoming drunk. He freely admits to having tried and failed on several occasions to kick his weed and alcohol habits. Andrew has a higher chance of being fired again since he keeps skipping work. Multiple prescriptions for antidepressants were written for Andrew’s mum by her Physician. In addition, her sister gives off a gloomy vibe but insists she is well. To this end, the self-medication model will be applied to Andrew’s case to establish the root of her addiction and the best means of treating it.

Treatment Model and Conceptualization

Under the self-medication theory, drug use is a symptom of a deeper problem. For some people, drug abuse is a means of coping with difficult feelings, mental health issues, and stressful situations. Drug use is a coping mechanism for the distress of mental illness (Parvinro et al., 2022, p.20). Individuals may feel better in the short term, but the underlying substance misuse problem remains. Substance addiction problems are strongly linked to self-medication, suggesting that people engage in this approach because they believe it would cure their underlying disease. The use of substances provides a means for those who have suffered trauma to divert their focus away from their feelings and toward something else, which is why addiction and trauma occur together. In addition, drug use is perpetuated because it provides users with temporary relief from unpleasant experiences.

Pain, whether mental or physical, that persists over a long period of time is a major factor in the development of drug misuse disorders. Self-medication is a coping mechanism used to alleviate both emotional and physical suffering (Hawn et al., 2020, p.5). Relaxation and pain reduction from any source are two of the many benefits of using marijuana or opioids. The paradigm of self-medication is crucial to understand because it may lead to improved methods of treating substance abuse problems(Hawn et al., 2020, p.8). Substance misuse typically manifests as a symptom of a more severe problem. Substance addiction treatment often ends in relapse since so many things might trigger an individual to start abusing drugs or alcohol in the first place.

Andrew’s been using marijuana and alcohol as a kind of self-medication for his mental health issues. Over the past decade, Andrew has been medicating his significant depressive disorder using it. This suggests that Andrew’s decision to self-medicate in order to deal with his grief is a symptom of a deeper mental health issue. Since Andrew’s mom used antidepressants and her sister seems down in the dumps, it is possible that Andrew has a family history of depression. Andrew’s mental difficulties run in the family; both his sister and her mother suffer from depression. Even more importantly, Andrew is hiding his feelings of despair by consuming drugs. From Andrews’s case, it is evident that people turn to drugs as a means of relieving tension and gaining security against the unknown.

DSM5 Diagnosis

Andrew suffers from significant depression and addiction. A person with symptoms consistent with DSM-F33, IV’s major depressive disorder, recurrent episode, typically has recurring episodes of depression without a concurrent history of periods of increased activity or improved mood (Jongsma, 2022, p.6). A recurrence after two months should have been expected, and the last episode ought to have been two weeks. A lack of previous mania or hypomania is a common feature of this condition. Andrew has admitted to having serious depression for the past decade but insists he does not require treatment. The relationship he shares with his brothers is strained, but he is happy with his fiancée.

Andrew has been allowed a number of part-time positions owing to subpar performance. His lack of focus shows in his inconsistent performance at work and subsequent terminations. Despite his lack of a pre-existing depressive disorder, Andrew satisfies the diagnostic criteria for severe depression. He admits he does not need aid since Andrew thinks he is OK on his own. Andrew claims he has tried and failed to give up both alcohol and marijuana. Andrew’s drinking has been worse recently, and he brags about being able to consume large quantities of alcohol without seeing any effects.

It is clear that Andrew has a drug use disorder according to the DSM-IV criteria. Due of his dependency and abuse, he describes the experience of cravings. Andrew has a severe craving for both weed and alcohol. He freely admits to having tried and failed to kick his nicotine and alcohol habits. Because he does not seem to cut down on his drinking, Andrew also satisfies the requirements for dependency. Fearing he may fail in his job as a result of his absences, he is unable to take any significant action. He fits the abuse criteria since he has been using drugs and alcohol to cope with his major depressive disorder for a decade.

Treatment Plan

Problem presentation.

Andrew suffers from significant depression and addiction, he opens out about his heavy use of both marijuana and alcohol. His girlfriend had been encouraging him to see a counselor, and he finally did. A decade of significant depression and alcohol abuse were revealed after he attended numerous sessions. Recently, Andrew has been bragging about drinking excessively without becoming drunk. Andrew’s drinking has gotten out of hand, and he is tried several times to cut back without success.

Treatment Goal

Long-term planning for Andrew should focus on improving both the quality and the duration of his life. Goals include relieving Andrew’s severe depressive symptoms and helping him give up drinking. Andrew is depressed and uses marijuana and liquor to self-medicate. Evidence of extreme reliance and misuse is his recent pattern of drinking heavily without becoming intoxicated. Andrew has tried several times to cut back on his drinking but to no avail. Short-term targets for Andrew include cutting back on drinking and consuming marijuana and increasing his attendance at work.

Therapeutic Intervention

In order to alleviate Andrew’s substantial depressive symptoms, cognitive-behavioral therapy (CBT) should be suggested. Zayfert & Becker (2019, p.5) found that clients suffering from both depression and substance misuse responded positively to CBT. In comparison to other types of psychiatric drugs or psychological therapy, the therapy has proven to be more effective. That is why CBT is the best option for helping Andrew overcome his significant depression since he will have access to new and healthier coping mechanisms. The reduction of his depressive symptoms should help him become more productive. Andrew will be better able to handle difficult situations after doing CBT since he will have acquired the necessary problem-solving abilities. Behavioral modifications are the focus of treatment in CBT.

The second strategy is connecting Andrew with abuse support groups. The support group will assist him in giving up alcohol and drugs as coping mechanisms. In these gatherings, Andrew may hear from others and gain insight into how they have dealt with similar situations. Those who take part in support groups have less cause for worry, anxiety, and despair (Shaari, & Waller, 2022, p.10). A common theme in the group’s communication is honesty and openness about members’ internal experiences. Therefore, Andrew will be able to stick with the different treatment options that have been proposed to him and maintain his motivation to quit drinking and smoking.

Andrew suffers from serious depression, which has led him down the path of substance misuse. Andrew’s drinking and smoking habit is best explained by the self-medication theory. Upon participating in therapy, he said that he had suffered from serious depression for the previous decade, which had led him to turn to alcohol and marijuana for relief. Andrew will be able to overcome his alcohol and drug addiction with the aid of cognitive behavior therapy and connection to substance abuse support groups.

Abu Hassan Shaari, A., & Waller, B. (2022). Self-help group experiences among members recovering from substance use disorder in Kuantan, Malaysia . Social Work with Groups , 1-17. Web.

Hawn, S. E., Bountress, K. E., Sheerin, C. M., Dick, D. M., & Amstadter, A. B. (2020). Trauma-related drinking to cope: A novel approach to the self-medication model . Psychology of addictive behaviors , 34 (3), 465. Web.

Jongsma Jr, A. E. (2022). The addiction treatment planner . John Wiley & Sons.

Parvinroo, S., Rouhi Khalkhali Pargam, H., Hosseinzadeh Asli, R., Rafiei, E., & Nemati, S. (2022). Frequency and causes of self-medication in patients with chronic rhinosinusitis, North of Iran, 2018–2019. European Archives of Oto-Rhino-Laryngology , 279 (8), 3973-3980.

Zayfert, C., & Becker, C. B. (2019). Cognitive-behavioral therapy for PTSD: A case formulation approach . Guilford Publications.

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Fentanyl is fueling a record number of youth drug deaths

The new trend has shocked many pediatricians, who say they feel unprepared to provide counseling on opioid addiction.

Fentanyl, a pervasive killer in America’s illicit drug supply, is increasingly landing in the hands of teens across the region and nation, worrying providers who say treatment options for youths are limited.

Across the country, fentanyl has largely fueled a more than doubling of overdose deaths among children ages 12 to 17 since the start of the pandemic, according to a Washington Post analysis of Centers for Disease Control and Prevention data released this month.

Fatal overdoses in D.C., Maryland and Virginia are in keeping with the national increase in opioid fatalities, which until recently primarily claimed the lives of adults. In 2022, 45 teens succumbed to opioids locally, a number roughly equal to the previous three years combined, data show. And incomplete data for 2023 show no sign of the crisis abating in young people.

Physicians at area hospitals report a rise in young people who took opioids arriving to emergency rooms and local addiction specialists say the number of teens seeking help for opioid use is spiking — especially among Latinos.

The surge, experts said, reflects a collision between adolescents’ natural drive to experiment, a decline in teen mental health and an increase in the availability and potency of counterfeit pills that mimic the appearance of prescription medications, making the experimentation that is a hallmark of adolescence more dangerous. A single pill containing fentanyl can be lethal, and those who survive often need comprehensive addiction care that clinicians say isn’t widely available.

“You had this really, really disastrous combination of a dangerous drug supply with teens who were increasingly struggling,” said Scott Hadland, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School.

Many pediatricians surveyed nationwide report feeling underprepared to counsel patients on opioid use, Hadland and his co-authors found in an analysis of survey results . As providers try to catch up and government agencies weigh how best to respond, many schools are stocking overdose reversal medication as recently recommended by the Biden administration and are working to teach students and families about the dangers.

Easy to get from friends or through social media, potent pills masquerading as prescription Percocet or oxycodone cost a few dollars each and seemed to flood the market as students reeling from the isolation and the trauma of the pandemic returned to school, treatment providers said in interviews.

Frequently sold online at $2 to $10 a piece, addiction specialists say, pills laced with fentanyl are hard to spot, easy to hide and can quickly lead to powerful dependencies — or worse.

“It’s not easy to stay away from drugs once your body has a substance abuse disorder. The pump is primed. The brain wiring has been rewired,” said Daniel Smith, director of addiction services at Mary’s Center, a community health center that predominantly serves Spanish-speaking patients in D.C. and Maryland.

Smith and Sivabalaji Kaliamurthy, a pediatric addictions specialist who runs the Children’s National Hospital addictions clinic, have spent years treating young people addicted to marijuana or alcohol. In the summer of 2022, they saw a change that shocked them both: teens were seeking treatment for opioid dependency. Now they almost exclusively treat opioid use disorder.

“We did not anticipate this happening with teens. It kind of fell in our lap,” Smith said, adding: “Before 2022, we had no kids ever [for that].”

“All of this has come together when kids were coming back to school post covid,” Kaliamurthy said.

Opioid-related visits to the emergency department at Children’s National in Northwest D.C. from 12-to-21-year-olds doubled from 2022 to 2023, while visits for other drugs remained flat, said Anisha Abraham, the hospital’s chief of the Division of Adolescent and Young Adult Medicine.

A dozen young people ages 16 to 19 died in the District last year, surpassing the previous high of six in 2021 and echoing the precipitous rise in adult overdose deaths which hit a record 522 last year, according to a recent medical examiner’s report.

Montgomery County emergency rooms tracked a spike in opioid-related visits last year among young people ages 10 to 21, according to state surveillance data . Hispanic youths made up 4 in 10 visits; Black youths a quarter and White youths about 20 percent, data show.

While White teens make up the largest share of adolescent opioid deaths nationally and locally, Black and Hispanic adolescents are now dying at a faster rate, CDC data show.

Liseth’s mother knew something was wrong in summer of 2022 when her teenage daughter stopped cleaning her room and started smoking marijuana. Within months, Liseth lost weight, ate less, came home late and vomited often. Even while raising two other children and working, her mother could tell Liseth wasn’t herself. The first doctor the Maryland family saw dismissed her concerns but when they ended up at the Children’s National Hospital emergency department in Northwest Washington last year, Liseth admitted she was using fentanyl.

The mother shared her daughter’s story with her permission, speaking Spanish through an interpreter on the condition of anonymity to protect the family’s privacy and identifying Liseth, now 17, by her middle name.

While data shows the profile of a fatal overdose victim in D.C. is a middle-aged Black man who snorts or injects heroin, treatment providers say adolescents like Liseth almost exclusively use pills, known as M30s, perks or blues, by inhaling the fumes off a foil. Teens tell providers they have easy access to the pills at school and once their friend group begins using, it’s hard to say no.

Experimentation and pushing boundaries is part of being an adolescent, Smith said, “but you can die from using a perk one time and that is terrifying.” As of 2020, drug overdoses and poisonings rank as the third-leading cause of pediatric deaths in America, after firearm-related injuries and motor vehicle crashes. Fentanyl is present in at least three-quarters of teen overdose deaths, CDC data show.

Treatment has been tough on Liseth, who was born in Virginia to Guatemalan parents and lives in a tidy suburban home in Maryland filled with flowers and symbols of her family’s Catholic faith. There were relapses, disappearances, a 911 call and a stay at the Psychiatric Institute of Washington. Her mom considered moving the family back to Guatemala.

Kaliamurthy, Liseth’s doctor, advised them to stay in the U.S. and started the girl on monthly injections of extended-release buprenorphine , a medication commonly used to treat opioid use disorder that blunts withdrawal symptoms and cravings. Finally, things are turning around. She is eating again, looking healthy and — unable to go to school where drugs are ubiquitous — ready to start a GED program.

How families can approach youth opioid use

• Talk to your teen about your concerns. Ask about use by friends and classmates as well
• Remind your child that you love them and will be there to support them
• Consider involving a health professional or counselor soon as possible
• Remind your teen to have Narcan available and to never use alone
• Look out for small, constricted “pinpoint pupils”
• Choking or gurgling sounds
• Slow, shallow breathing
• Limp body; loss of consciousness
• Having pale, blue or cold skin
• Call 911 for emergency medical help.
• Give naloxone (if available) which can reverse the effects of an opioid overdose
• Keep your child or teen awake and breathing by rubbing their chest with your knuckles
• Lay them on their side to prevent choking if they vomit
• Stay with your child or teen until professional help arrives
• Pick it up free at participating pharmacies in each ward
• Text LiveLongDC to 888-811 and an outreach worker will deliver it within two business days
• Fill out a form online to have it mailed to your home in discrete packaging
• Contact a Public Overdose Response Program to pick up free naloxone or have it delivered to your home
• Naloxone may also be found in your local pharmacy and billed to insurance and Medicaid.​​
• For more information or if you need help finding naloxone, contact [email protected]
• Ask about free naloxone at your local Community Service Board or health department
• Most pharmacies sell a two-pack of naloxone nasal sprays over the counter for about $45

Provisional data released in May by the CDC showed a slight decrease in overdose deaths among all ages across the country last year — heralded by some public health leaders as a glimmer of progress.

The contrasting increase among youths is especially troubling, experts say, because when and where counterfeit pills can trigger a spate of overdoses is unpredictable. Teens are especially vulnerable to the consequences of hidden fentanyl as many are experimenting and have no tolerance to opioids, Hadland said.

A spate of nonfatal overdoses in Loudoun and a suspected overdose in Arlington last year prompted schools to institute drug-sniffing dogs and embrace the overdose antidote naloxone, adding it to first aid kits and allowing students to carry it.

As prevention techniques ramp up, officials are seeking more ways to expand intensive treatment options for adolescents who need inpatient and outpatient care, using medication and individual, group and family therapy. The District this year sought a teen residential treatment provider and awarded the Children’s National clinic an $830,000 contract to expand outpatient substance use services.

For adolescents on public insurance, there are no residential treatment options in D.C. and only a few spots in Maryland, leaving youths to navigate the challenges of outpatient care while surrounded by triggers.

“If you live with people who are using drugs, if you go to school with people who are using drugs, if you encounter people between home and school using drugs … It’s very hard to stay sober,” Smith said.

The mother of a 16-year-old from Silver Spring, who spoke on the condition of anonymity to protect her daughter’s privacy with the teen’s permission, said it never occurred to her that any of her daughter’s friends would be using fentanyl or that her child could become addicted.

Then her daughter’s girlfriend died, and she noticed the teen was spending more time alone. The family smelled the telltale odor of fentanyl fumes, like burnt tires, emanating from the basement.

They turned to Children’s National, where she was already receiving mental health care, and entered an intensive outpatient treatment program. After bristling at the daily reminder of her struggle when taking daily buprenorphine as a tablet, she switched to a longer-acting injection form of the drug and started to feel better.

There are hard days, but the family feels lucky to be able to navigate insurance hurdles and afford the out-of-pocket costs associated with her treatment.

The spike is driving public health experts to rethink preventive drug education for young people. Guidance should present not using drugs as the safest choice but also include information about reducing risk for those who choose to experiment, Mass General’s Hadland and a co-author said in a New England Journal of Medicine article earlier this year.

“We always say to teenagers, ‘Don’t use drugs,’” said Abraham, the Children’s National adolescent medicine specialist. “But I will also say that the nature of being a young person, is that they’re going to try things — especially when you tell them not to.”

David Ovalle contributed to this report.

The Origin and Impact of Crack Cocaine in the United States

This essay about crack cocaine’s rise in the 1980s examines its devastating impact on American society. It explores the origins of cocaine, the creation of crack, and its widespread appeal, especially in economically disadvantaged communities. The social consequences, including addiction, crime, and the racial bias in law enforcement responses, are highlighted. The essay emphasizes the ongoing legacy of the crack epidemic and advocates for a compassionate, comprehensive approach to addressing drug addiction.

How it works

In the turbulent realm of American drug culture, few substances have left as significant and destructive a legacy as crack cocaine. Its rise in the 1980s signaled a new era of addiction, crime, and social decay, leaving behind a path of destruction that still echoes through U.S. communities today.

To understand the origins of crack cocaine, one must first consider the broader context of cocaine itself. Sourced from the coca plant native to South America, cocaine has long been used by indigenous peoples for its stimulating effects.

However, it wasn’t until the late 19th century that it became popular in the Western world, praised as a wonder drug with medicinal benefits and even used in early versions of Coca-Cola.

Throughout the 20th century, cocaine remained present in various forms, from powder to paste. However, the landscape began to shift in the 1970s with increased cocaine trafficking from South America to the United States. This surge led to a burgeoning cocaine market, especially in urban areas like Miami and Los Angeles, where the drug became popular among wealthy individuals and celebrities.

The development of crack cocaine in the early 1980s profoundly altered America’s drug landscape. Crack, a smokable and crystalline form of cocaine, provided a cheaper, more potent alternative to powdered cocaine. Its creation was made possible by using baking soda to “freebase” cocaine, a process that made it more accessible to a wider audience.

The impact of crack cocaine on American society was immediate and devastating. Its low price and intense high made it particularly attractive to economically disadvantaged communities, resulting in widespread addiction. Crack houses, where the drug was bought, sold, and consumed, became symbols of the urban decay that afflicted many inner-city neighborhoods.

The social consequences of crack addiction were severe. Families were torn apart as parents fell into addiction, leaving children to fend for themselves or enter the foster care system. Crime rates surged as addicts turned to theft, robbery, and other illicit activities to support their habits. The crack epidemic worsened existing socioeconomic disparities, disproportionately affecting communities of color and perpetuating cycles of poverty and disenfranchisement.

The response to the crack epidemic was marked by severe law enforcement measures, most notably the Anti-Drug Abuse Act of 1986. This legislation imposed harsh mandatory minimum sentences for crack-related offenses, leading to mass incarceration, especially among African American and Latino populations. The sentencing disparity between crack and powdered cocaine offenses, with the former carrying significantly harsher penalties, underscored the racial bias in the criminal justice system.

Although the crack epidemic subsided by the mid-1990s, its legacy continues to profoundly shape American society. The scars of addiction, violence, and incarceration from those dark years persist, contributing to ongoing issues of poverty, crime, and racial inequality. Additionally, the stigmatization of crack addiction continues, further marginalizing those struggling with substance abuse and hindering efforts at rehabilitation and recovery.

In recent years, there has been a growing recognition of the need for a more compassionate and comprehensive approach to addressing drug addiction. Efforts to shift the focus from punitive measures to treatment and harm reduction have gained momentum, with initiatives such as drug courts and needle exchange programs aimed at reducing the societal impact of substance abuse.

However, the specter of crack cocaine remains a cautionary tale about the dangers of unchecked drug proliferation and the consequences of punitive drug policies. Its legacy serves as a stark reminder of the need for vigilance in addressing the complex interplay of social, economic, and political factors underlying substance abuse and addiction in America. Only through a holistic approach that tackles root causes and prioritizes compassion and equity can we hope to break the cycle of addiction and build a healthier, more resilient society for future generations.

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Fentanyl users get free smoking gear in some cities. Now there’s pushback.

MORGANTOWN, W.Va. — For years at this downtown public health clinic, staffers have given drug users small glass pipes along with sterile needles and other supplies. The strategy: Users might choose to smoke street drugs — limiting infected wounds and the spread of diseases that come with injecting.

Some public health advocates and drug users believe smoking fentanyl — the street opioid fueling thousands of deaths — may also lessen chances of a fatal overdose compared with injecting the drug. Scott, a user picking up supplies on a recent weeknight, now smokes fentanyl more than he uses needles because injections caused his hands to swell and damaged his veins. He said he overdosed twice when injecting fentanyl but never while smoking.

“I understand why people think it’s enabling users,” said Scott, 38, a former coal miner who spoke on the condition of being identified by first name only to openly discuss his addiction. “It’s actually helping more than people think.”

But starting June 2, it will be illegal for state-authorized syringe exchange groups to supply Scott and other users with smoking paraphernalia. Under a law passed by West Virginia lawmakers, the Milan Puskar Health Right clinic will be banned from giving away pipes, tin foil and other supplies used to consume illicit drugs, even as researchers say more drug users nationwide are turning to smoking. The law is part of broader resistance in communities where critics assert that distributing “safer smoking” supplies encourages substance abuse and could make fentanyl more appealing to new users.

The pushback underscores long-standing tensions over strategies aimed at reducing the harmful effects of illicit drugs as the nation grapples with an overdose death toll that has topped 100,000 for three straight years.

In Idaho, police raided a Boise harm reduction organization in February on suspicion that it distributed drug paraphernalia. In Oregon, the county health department in Portland scrapped a pilot program to hand out smoking supplies last summer amid criticism. In New York City, vending machines stocked with pipes and the overdose reversal medication naloxone prompted conservative media headlines about free “crack pipes.”

South of Baltimore, in Anne Arundel County, the health department halted giveaways of smoking supplies in 2021 after Black leaders protested, saying pipes might enable drug use in communities devastated by crack cocaine decades ago.

“The crack pipe represents the worst of that era,” said Carl Snowden, a civil rights activist and member of the Caucus of African American Leaders of Anne Arundel County.

‘Hard to leave the needle’

Four decades ago, when heroin was the opioid of choice on America’s streets, smoking the drug wasn’t prevalent. For users, the high wasn’t sufficiently robust, said Daniel Ciccarone, a professor of family medicine at the University of California at San Francisco who studies drug use trends.

That changed with illicit fentanyl, which has largely replaced heroin in the United States and is up to 50 times more potent. Particularly on the West Coast, users who smoked fentanyl found its vapors hit the brain with speed and potency. They often use tin foil to heat fentanyl, then inhale through straws, foil tubes and skinny glass tubes known as stems.

“It’s one person teaching another, and it’s spreading like wildfire,” said Ciccarone, who recently published a study on San Francisco’s fentanyl smoking culture.

Research suggests fentanyl smoking is catching on beyond the West Coast, although it remains unclear whether smoking poses less of an overdose risk than injecting.

Fentanyl is a powerful sedative and generally wears off quickly. Constant injections can damage veins and create pus-filled skin abscesses. Smoking allows users to titrate doses, said Alex H. Kral, an epidemiologist at the nonprofit research institute RTI International. He suspects that “means you are less at risk of an overdose because you’re not taking as strong a dose.”

In a study published in December, Kral and fellow RTI researchers in San Francisco tracked nearly 1,000 drug users and found those who injected were 40 percent more likely to have experienced a nonfatal overdose in the previous three months than those who only smoked.

Still, no conclusive evidence exists that smoking fentanyl is less likely to result in overdoses, said Andrew Kolodny, an addiction doctor and opioids researcher at Brandeis University.

“If it were the case, as smoking has increased, perhaps we would have seen a significant decrease in overdose deaths — and we haven’t,” said Kolodny, who says the debate detracts from emphasizing addiction treatment.

In February, the Centers for Disease Control and Prevention released a study that suggested smoking fentanyl was increasingly linked to overdose deaths in 27 states and D.C. The study drew on mortality data from medical examiners and coroners and witness reports. Comparing six-month periods in 2020 and 2022, researchers found overdose deaths with evidence of smoking increased nearly 74 percent, while cases linked to injections plummeted.

Some researchers say the increase in deaths reflected in the CDC study might be misleading. They caution against attributing overdose deaths to the discovery of smoking equipment. Smoking supplies found at the scene of overdoses might have been used for other drugs, belonged to other people or been used on previous days, said Jon E. Zibbell, an RTI senior public health analyst studying drug-smoking trends in North Carolina and West Virginia. The shift to smoking isn’t widespread enough to significantly lower overdoses, he believes.

“People are smoking, but they’re also injecting,” Zibbell said. “It’s hard to leave the needle. ”

The picture is complicated by users who increasingly use the stimulant meth with fentanyl and often switch back and forth between smoking and injecting both drugs.

In Washington state, an April survey of participants in programs that exchange used needles for sterile ones showed 89 percent of users had smoked drugs such as meth or fentanyl within the past week, with 36 percent smoking and injecting and 10 percent injecting. The survey reported “high interest” in getting smoking supplies from harm-reduction programs that don’t already distribute them.

Reducing harm

Some communities and public health agencies have embraced harm reduction, which focuses on lessening the deleterious effects of drug use. Using clean needles reduces HIV and hepatitis C rates, studies show. Workers also hand out naloxone and condoms and connect people with wound care, disease testing and other medical services.

The Biden administration has embraced the approach, although it took a hit in 2022 when conservative media claimed $30 million in federal funds would be used to hand out “crack pipes.” Even as the White House denied the claim, Republican lawmakers proposed banning federal funding for pipes.

Safer smoking supplies often include rubber, plastic or silicon mouthpieces to prevent cuts and burns, brass screens to filter contaminants, and disinfectant wipes. That’s safer than items improvised from aluminum cans, lightbulbs or plastic tubes that can break easily or release dangerous fumes, advocates say. Giveaways may also prevent users of other drugs — who may not have a tolerance for opioids — from sharing pipes that contain fentanyl residue.

Because many states ban paraphernalia, harm reduction groups that provide smoking supplies tread lightly.

Four years ago in Boston, Jim Duffy and Nathaniel Micklos created the group Smoke Works after encountering drug smokers who were not engaging with services offered by harm reduction groups. Today, Smoke Works distributes free or low-cost supplies for smoking or snorting to more than 300 groups nationally. Many don’t want their participation made public because of potential scrutiny, Duffy said.

“There’s absolutely no end in sight for hostile enforcement,” he said.

Those concerns were underscored in February in Idaho, where police raided offices of the state-funded Idaho Harm Reduction Project five months after employees in a panel discussion suggested program workers had been skirting the law in handing out pipes and supplies for snorting drugs. Boise police said it involved distribution of drug paraphernalia, including items related to the use of meth, opioids and crack cocaine. Syringes were not seized, and no arrests have been made, police said.

The program has shut down. And that wasn’t the only development that led to the curtailing of harm reduction programs. Idaho’s Republican-dominated legislature has since repealed a law that authorized syringe-exchange programs, which have come under increasing restriction in some states.

States with more liberal politics have also resisted free smoking supplies.

In Oregon, the Multnomah County Health Department launched a pilot safe-smoking program because fewer users were getting services at its needle-exchange program in Portland. The department knew it might generate controversy, spokeswoman Sarah Dean said, but proceeded because of surging overdoses. Within a week, the program was halted amid public outcry.

This year, Oregon lawmakers rolled back decriminalization of minor drug possession amid concerns about crime and rampant open-air drug use. “The issue around smoking is that while it’s likely to have a public health benefit, it’s very visible,” said Ciccarone, of UCSF. “People don’t like the fact that drug use, which was once hidden, is now very public.”

In West Virginia, the Health Right clinic began handing out pipes, stems and foil in 2020 to minimize the spread of the coronavirus through shared equipment. Donations and private grants paid for the supplies.

“I’m the director of a medical clinic. I would be the last person to say, go smoke drugs, smoke cigarettes or smoke anything,” Health Right Executive Director Laura Jones said. “But when you’re talking about a harm reduction, it’s a different philosophy.”

But the clinic’s harm reduction program came under scrutiny in 2022 when state delegate candidate Geno Chiarelli posted a Facebook video showing a “free meth pipe” and other equipment he said he obtained at the clinic. “These are the kinds of things that are unacceptable in a civilized society,” he said in the video.

Chiarelli (R) won election and sponsored the bill this year that prohibited needle exchange groups from giving away smoking equipment. Chiarelli declined to comment.

On a recent weeknight, most clients — their arms and veins dotted with reddish puncture marks — exchanged needles at the health clinic. Their stories rang tragically familiar: Pain pill use led to heroin and fentanyl, jails and rehabs. Outreach workers preparing plastic bags filled with supplies and food included pipes from their dwindling cache.

“She gave me a pipe and said it would probably be best to try and get off needles,” said A.J., a 28-year-old roofer who uses fentanyl and spoke on the condition that his full name not be used because of his addiction. “I’ll give it a try.”

Fire truck pull raises awareness for addiction recovery at Toyota Field

MADISON, Ala. ( WAFF ) - On Thursday evening, several agencies and organizations will team up for addiction recovery at Toyota Field.

Partnership for a Drug-Free Community is hosting its fourth annual fire truck pull at the ballpark to raise money for recovery resources in the community.

Huntsville Police Department, Madison Police Department SWAT, Madison County Sheriff’s Office SWAT, COLSA, His Way, Cross Fit Impulse and Partnership for a Drug-Free Community will all compete for bragging rights. They all will attempt to pull a 46,000-pound fire truck 100 feet, with all the money raised supporting youth and community programs in recovery.

The event has raised nearly $21,000. To donate to the cause, click here .

For more information on Partnership for a Drug-Free Community, click here .

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Fentanyl test strips are being used by drug dealers to advertise 'clean pills'

Fentanyl test strips are sold online and easily obtained free from many public health departments. They’re touted as a harm reduction tool to help drug users determine whether fentanyl is present in a pill or powder.

But Sheriff’s Deputy Patrick Craven, the lead detective of the newly formed opioid response team in rural Placer County, California, warns that the test strips are now being used by drug dealers who post photos on social media showing “negative” test results to advertise that their drugs are “clean.”

Asked if users can trust that information, Craven said, “Absolutely not.”

Fentanyl test strips can’t offer accurate results unless an entire pill or batch of powder is tested, something most users don’t know how to do — or don’t want to do.

“Most people are not going to go and spend money on drugs only to test them and then find out, ‘I can’t use this,’” Craven said.

Last year the Drug Enforcement Administration seized more than 77 million fentanyl pills and nearly 12,000 pounds of fentanyl powder, the most fentanyl seized by the DEA in a single year. According to the agency, that’s more than 386 million deadly doses of fentanyl — enough to kill every American.

The DEA also says that fentanyl pills are only growing more potent. In 2023, laboratory tests showed that 7 out of 10 pills tested contained a potentially deadly dose of fentanyl, a steady increase from 4 out of 10 pills in 2021 and 6 out of 10 in 2022. Just two milligrams is considered a deadly dose — an amount that fits on the tip of a pencil.

Craven said the danger to users is made still worse by a lack of quality control. Counterfeit versions of Xanax, Oxycontin and Percocet that contain fentanyl have flooded the market, and the level of the deadly synthetic opioid can vary widely from pill to pill.

“No pill is processed and made in the same way, and therefore they don’t contain even amounts of fentanyl,” Craven said.

Fentanyl test strips were intended as a public health measure to address the recent surge in overdoses , which has finally started to subside. Health departments nationwide have spent millions of dollars to provide free test strips. In New York, the state health department website walks users through how to test their drugs. Chicago has vending machines to dispense the strips.

“Our hope is that using the fentanyl strip will have prevented people from overdose,” Chicago Public Health Commissioner Simbo Ige said.

But they are hardly a failsafe. If a user cuts up a pill and tests just one part of it, said Craven, it could come back negative for fentanyl, while the rest of the pill or the batch contained a deadly amount.

And, said Craven, they can also be used by dealers to give customers a false sense of security.

In 2022, Craven led the investigation into the fatal fentanyl poisoning of 15-year-old Jewels Wolf.  

Investigators found that Nathaniel Cabacungan, 20, met Wolf on social media, and then provided the counterfeit Percocet pill that killed her. Cabacungan became the first dealer in California to be convicted of murder for providing fentanyl-laced pills.

Cabacungan had a history of ensuring customers that his pills did not contain fentanyl, according to investigators and to text exchanges reviewed by NBC News. 

“Nathaniel Cabacungan put out there that his pills did not contain fentanyl, and that was not the case,” Craven said.

Two years later, Craven said that he now sees posts on social media sites and messaging apps in which dealers use test strips to advertise to potential drug buyers that what they’re selling is fentanyl free.

Wolf’s mother Regina Chavez said parents and young people need to understand that test strips can provide “a false sense of security” because of the way they’re being used. Chavez believes her daughter’s death was an accident.

“She wouldn’t have intentionally done this,” Chavez said. “She was planning on getting her first job. She was about to start studying to get her driving permit. She was thinking about what she wanted to do for career.”

Chavez wants people to know test strip results can be trusted only if a user is testing the entire pill or batch themselves. She said talking about her daughter Jewels is how she can keep her memory alive, and try to help others.

“The solace that I take from her death is ... my baby is still doing amazing things, even after she’s gone, to help save our communities, to help save our children.”

Vicky Nguyen is the senior consumer investigative correspondent for NBC News. See her reports on "TODAY," "Nightly News with Lester Holt," MSNBC and NBC News Now.

Andrew Blankstein is an investigative reporter for NBC News. He covers the Western U.S., specializing in crime, courts and homeland security. 

Lisa Cavazuti is a producer and reporter for the NBC News Investigative Unit.