Within the last 10 years, the number of fentanyl related deaths has quadrupled within the unhoused population in the United States, and these types of deaths are tragically rising here in Washoe County as well.
Mikayla Willden, a REMSA Care Flight critical care technician, shared that substance use is most commonly seen at the extremes of our society, in wealthy families and within the unhoused community.
In Reno, the number of homeless deaths from October 2022 to the beginning of April 2024 reached above 190. Sixty-six of these 192 homeless deaths recorded by the Washoe County Medical Examiner’s Office have a cause of death listed with fentanyl included.
Since the start of 2024 to the beginning of April, there were 14 homeless deaths, five of which are still awaiting toxicology reports. Intoxication by fentanyl is labeled under different titles, such as ‘Acute Ethanol, Fentanyl, And Methamphetamine Toxicity’, ‘Morphine, Methamphetamine, and Fentanyl Toxicity’, or ‘Acute Fentanyl Intoxication.’ Toxicology examinations indicate that fentanyl was frequently a factor in deaths involving multiple substances, including but not limited to ethanol, morphine, methamphetamine, methorphan, and cocaine.
With laced drugs, Willden said that, “Narcan tends to not work as well due to the fact that [these are] mixtures of opioid versus non-opioids together.” This makes even common, less detrimental drugs like marijuana and LSD dangerous not only because Narcan wouldn’t work on them as well, but because they are often found to be laced with fentanyl and other highly addictive and dangerous opioids.
It is also worth mentioning that 25 of the toxicity causes of deaths mentioned previously are titled with the beginning words ‘Acute Fentanyl.’ Acute intoxication does not refer to the amount of substance taken being small, as many people initially assume. It means intoxication on the functioning side, where it is too much for your body to continue operating normally. “Acute intoxication is more so if you have a dosage or an amount of a substance that’s technically lethal,” Claire Coutts, a certified alcohol and drug counselor intern at Quest Counseling said. This dosage amount changes based on the tolerance of an individual as well.
According to Coutts, substances are classified fittingly as ‘uppers’, ‘downers’, and ‘all-arounders’. Downers are those that have a depressing affect (heroin, fentanyl, alcohol) while uppers are stimulants (cocaine, nicotine, amphetamines). All-arounders are those that often, but not always, have both affects (cannabis, ecstasy).
Fentanyl is a depressant and a schedule II controlled drug, meaning it has “a high potential for abuse, with use potentially leading to severe psychological or physical dependence” (according to the DEA). Other examples of schedule II drugs are oxycodone (OxyContin), Adderall, and methamphetamine. These drugs are also typically classified as dangerous.
Something especially dangerous about fentanyl is its extremely high potency, where just “two milligrams can cause overdose or death” (according to a study from UCDavis).
While recognizing the dangers of fentanyl is important, recognizing the stigma surrounding substance usage within the homeless population is necessary, especially when considering the welfare of healthcare workers. Most calls from the homeless population regarding overdoses go to ground care of REMSA.
Different types of vigils have been been held in northern Nevada in recent years for the unhoused, from alongside the Truckee River, to the Believe statue to churches.
“Unfortunately, especially in the Reno area, it does consist of 911 abuse of ambulances by the homeless population,” Willden said. REMSA workers receive calls from the homeless community where an individual simply wants a bed for the night and purposefully does something in a shelter, such as violent acts or drug use, to get sent to the hospital. A lot of these calls are from CARES Campus, Wells Avenue, Fourth Street, and other areas downtown.
Lack of access to resources for this community is a huge factor in the rising number of overdoses. The rate Naloxone (Narcan) was dispensed in 2022 in Nevada was .5 per 100 people, and while there are free Narcan kits in public spaces around Reno, actual help is limited for these individuals. The waitlist for counseling is also long and requires more counselors than Washoe County has at its disposal.
While there are resources for addiction, many do not seek help for multiple reasons. Four common reasons are they are unwilling to admit they have addiction, do not want help because they want to continue in their actions, fear legal consequences if seeking help, and/or their surroundings and community do not provide a space where these drugs are seen as a hazard and potentially harmful and deadly. One of the main things people need to possess in order to want to seek treatment is internal motivation (according to the NIH).
Many who are experiencing homelessness are in an environment where the consequences are not seen as dire as they truly are. The negative connotation surrounding fentanyl can also be downplayed when surrounded by the substance more often. With the drug becoming more and more prevalent, both inside and outside the homeless community, Willden said the lack of stigma surrounding fentanyl becomes a serious issue.
Exploring the stigma and knowing the dangers with substance use is important to understand when evaluating the rapidly increasing number of fentanyl deaths in the past three years. Understanding the mindset behind substance use is key to helping unhoused individuals not only in improving their lifestyle, but also their future and overall state of mind.