The Dangers of Fentanyl – PediaCast 531

Show Notes


  • Dr Beth Weinstock visits the studio as we consider the dangers of fentanyl. This opioid is often laced into street pills and powder. Fentanyl increases addiction potential and leads to many untimely deaths. Learn the dangers of this drug… and life-saving tips to share with teenagers. We hope you can join us!


  • Fentanyl
  • Substance Abuse
  • Addiction Disorders


  • Dr Beth Weinstock
    Family Medicine Physician
    Founder, BirdieLight



Announcer 1: This is PediaCast. 




Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.


Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.


It's Episode 531 for February 9th, 2023. We're calling this one "The Dangers of Fentanyl." I want to welcome all of you to the program.


So we have a very important topic for you this week, as we consider the opioid crisis and the role that fentanyl plays in facilitating addiction and death among teenagers and adults.




And I'm sure most of you are aware of the ongoing opioid crisis in America. And much of this is the result of fentanyl, especially when it is laced unknowingly to the user in other drugs, such as oxycodone, Xanax, Adderall, heroin, cocaine. In fact, fentanyl is actually the number one cause of death of all causes in all people 18 to 45 years of age.


So right now, fentanyl is actually killing more 18- to 45-year-olds than any other thing. So it truly lives at the forefront of the opioid crisis. So how is it that teenagers are exposed to fentanyl? Because most of the time, the exposure is unintentional.


So why is it that fentanyl is in other drugs? Why is it dangerous? Or how is it dangerous?




And what steps can parents, schools, medical providers, and communities take to increase awareness and lower the incidence of death among teenagers and adults from fentanyl?


What role do fentanyl test strips play in preventing an overdose and death? And what is the role of Narcan in all of this? It's probably something that you've heard of before.


How does it work? How is it given? Where can you get it? And is it possible to just have it on hand in case of an emergency?


We're going to have answers to these questions and lots more as we explore the dangers of fentanyl. To help us with the conversation, we have a special guest today, Dr. Beth Weinstock. She is a family medicine physician in Columbus and the founder of BirdieLight, which is a nonprofit organization that seeks to raise awareness, educate the public and medical providers, and distribute life-saving tools, which we will learn more about during the course of today's episode.




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Let's take a quick break. We'll get Dr. Beth Weinstock connected to the studio and then we will be back to talk about the dangers of fentanyl. It's coming up right after this.




Dr. Mike Patrick: Dr. Beth Weinstock is a family medicine physician and founder of BirdieLight, which is a nonprofit organization whose mission it is to educate the public and medical professionals about the dangers of fentanyl and to facilitate the distribution of life saving tools such as fentanyl test strips.




That's what she's here to talk about today, the dangers of fentanyl and practical tips for keeping our teenagers safe. Lots to cover as we consider fentanyl's role in the opioid crisis. But first, let's extend a warm PediaCast welcome to our guest, Dr. Beth Weinstock. Thank you so much for stopping by today.


Dr. Beth Weinstock: And thank you so much for having me. I really appreciate it.


Dr. Mike Patrick: Yeah, we appreciate you taking time out of your busy schedule to chat with us. I know this is a topic that really has impacted you personally and that you are very passionate about, and that is because of the story of your son, Eli.


And I just wondered if we could just start off with you just sharing with us why this is such an important topic for you.


Dr. Beth Weinstock: Of course. And it is a dark and heavy topic, of course, related to my own personal family story. My husband and I have four kids. Eli is our second oldest. And he was a sophomore at American University in Washington, DC.




And on March 3rd of 2021, he accidentally ingested fentanyl and died in his off-campus apartment. He was a thriving sophomore in college, doing all the things one would expect from a kid who's developing into a great adult. And he did not intend to die.


He was enjoying his new buddies that he'd made at his fraternity. He was taking marketing and communications classes. He had an internship lined up for the summer. So this, of course, was completely tragic and senseless.


Dr. Mike Patrick: Yeah, absolutely. And unfortunately, Eli is one of many teenagers and young adults who have had similar stories. Just how big is the fentanyl problem in the United States?




Dr. Beth Weinstock: The numbers are actually staggering when you really start to consider the data, as well as compare this crisis to other health crises. So last year alone in the US, they recorded over 108,000 drug-related fatalities and that is the highest number ever recorded on American soil. About 75% to 80% of those were due to fentanyl alone.


And if we compare that back to 2015, at that time, only 15% of all drug-related fatalities were due to fentanyl. So that has happened in a short seven to eight years and it doesn't really show much sign of slowing down as it relates to fentanyl fatalities.


Dr. Mike Patrick: And I just want to pause and think about those numbers for a moment. You mentioned more than 60,000 deaths per year from fentanyl alone. And that's when we consider other drugs on the street like cocaine and heroin, of course, prescription opioids, morphine, even methadone, the medicines that we call benzodiazepines, which is like Valium and Versed. All of those, fentanyl is by far and away the number one killer, right?




Dr. Beth Weinstock: Absolutely. The fastest rising age demographic for these deaths right now is age 15 to 24, which is quite scary, increasing very rapidly in communities of color. And the scary thing is a lot of the numbers aren't really clear. So some of those deaths that might be attributed to cocaine or methamphetamine often are actually due to fentanyl adulteration of those substances. So the data can be murky figuring out actual cause of death.


Dr. Mike Patrick: Yeah, but it's, it is by far and away the, the largest number, with fentanyl.

How does the opioid epidemic compare to other public health issues that we've had in the past? One that comes to mind is especially back in the 80s, HIV and AIDS kind of at the height of that epidemic. How does this one compare to others in the past?




Dr. Beth Weinstock: One big similarity is that both the HIV and AIDS crisis as well as this public health crisis affect primarily young people, young people who are otherwise free of health problems. And so, it's a comparison where you can consider the massive loss of young talent, young life, young potential that is affecting most of the fatalities here from fentanyl and also back in the 80s and 90s with complications of HIV. So those are very similar.


One difference that really stands out to me is the massive gap in the numbers. So one of the things I talk about frequently is comparing the HIV and AIDS crisis. When at the peak of that crisis, we were losing, in one year, about 42,000 individuals.




And right now, as I mentioned, last year alone, we lost 108,000 individuals to a drug-related fatality in this country. And 60,000 to 70,000 of those were due to fentanyl.


So when we compare absolute numbers, this crisis way surpasses loss of life when it comes to that public health crisis. But I think the biggest similarity is just this loss of young potential.


Dr. Mike Patrick: Yeah, absolutely. When we compare the opioid crisis today, even to the Vietnam War, which also is a large number of lives lost in young, healthy people, the Vietnam War, there were 58,000 American deaths. And again over 100,000 deaths due to drug overdoses just last year in the United States.


And in fact, fentanyl overdose is the number one cause of death in all people 18- to 45-year-old. So it's not just a teenage problem, of course, but really a very large problem of young adults as well.


What exactly is fentanyl?




Dr. Beth Weinstock: So fentanyl is an opioid, which, of course, opioids and opiates, those are used interchangeably. That's a family of drugs. And the opioid family includes and has always included some opioids that are considered legal, regulated, pharmaceutical opioids and some opioids that are illegal. The most common illegal one we think of is heroin.


So this family of opioids is most commonly grown in a field. A poppy plant is harvested and the resin is taken to a lab and made into an opioid. So for the vast majority of history of opioids, those have been agricultural products. But the difference with fentanyl is that it's synthetic.


So fentanyl is purely made in a lab from chemical ingredients, meaning you don't need that agricultural season or a growing field to make it. It was originally developed in the 1950s as a surgical anesthetic, and then it quickly became more of a pain control tool.




And we still use it so commonly in medicine, legally regulated to control pain in the hospital for procedures or for perhaps high level of pain that you might think of when it comes to cancer pain.


So it's around in the medical setting and it's highly regulated, often, of course, monitored with oxygen monitors when it's given, monitored with staff and Narcan nearby, which is the reversal agent for an opioid. So I always warn people when I talk to them, don't be afraid of fentanyl if you go to the hospital, because that's being given on the level of micrograms.


But then, there's this other realm of synthetic fentanyl that's being made illegally and being made in an unregulated fashion, marketed, sold, millions and millions of dollars being exchanged. And that is usually circulated on the level of milligrams, so a thousand times stronger.




Fentanyl, because it's an opioid, creates a euphoria, a very powerful euphoria. It's highly habit forming, very addictive opioid, just because it's so strong. And that high level of euphoria is sometimes sought out by people who use opioids on a regular basis. The problem is, because it's so powerful, there's a very thin margin between that euphoria and the loss of consciousness or, subsequently, the loss of the drive to breathe. So that's why fentanyl is both ubiquitous but also so dangerous.


Dr. Mike Patrick: One, I think, important concept for folks to understand as we think about opioids is that you can develop a tolerance over time. The opioid is a chemical that hooks up with a receptor, and then that causes something to happen in cells.




In this case, at low doses, it's going to cause that euphoria, just the pain control, happy thoughts, feeling good. But then in high doses, it begins to cause depression of the brain, depression of the respiratory center.


And so, the fact that you have tolerance means that you need higher and higher doses of the drug in order to get that same effect, including the euphoria. And then again, if you're on chronic opioids and you've developed a tolerance, that's why this high-dose opioid like fentanyl would be something to consider.


But obviously, if you take another person who doesn't have that tolerance and give them that same dose of fentanyl, again in milligrams instead of micrograms, like in the medical setting, then you're going to very quickly get to that respiratory depression and then they stop breathing. And that's what causes death, correct?


Dr. Beth Weinstock: Absolutely. And I always warn young people when I'm speaking to them, as a representative of BirdieLight, my nonprofit, is I tell them about that concept of a brain that has never seen an opioid before. Your brain is unaccustomed to an opioid, so any amount of fentanyl that you get mostly unintentionally or even intentionally in an illegal substance is highly likely to be lethal.




Dr. Mike Patrick: And we want to point out that it is also very addictive, meaning that after you've used it a few times, your body starts to need those opioid receptors to be stimulated. And so you begin to have symptoms that are unpleasant if you aren't getting the opioid. And so then you may go searching for it in ways apart from the medical system.


And that brings me to fentanyl that we find on the street. You had mentioned that it's measured often in milligrams instead of micrograms. In what other ways is street fentanyl different from medical fentanyl?


Dr. Beth Weinstock: The main difference between street fentanyl and medical fentanyl is often in the delivery method.




So, for example, now, fentanyl is being hidden or adulterated within so many other substances that nearly every illegal pill or powder on the street market now can potentially contain a lethal dose of fentanyl. So it may show up in powders such as cocaine, crystal type drugs such as methamphetamine. It can show up in counterfeit or fake pills, such as a fake Adderall, a fake Xanax, a fake oxycodone.


It's very commonly found in heroin. In fact, I've heard most heroin now has fentanyl in it. It can also be present in Molly, also known as Ecstasy, which a lot of young people use at music festivals or concerts. So nearly every street or illicit substance now can contain fentanyl. And so, it's a major different delivery system than what you would see with medical fentanyl.




Dr. Mike Patrick: And why is it that drugs on the street are being laced with fentanyl?


Dr. Beth Weinstock: That's the million-dollar question. I have struggled to come up with a really decent answer to that. Most of the time, I think it's because this is big business and this is big money being exchanged and millions of pills in circulation. So you do get that returning customer who is perhaps struggling with an opioid use disorder and wants to return to get more of that euphoria, or perhaps, like you mentioned, just need to take that higher dose of an opioid so they don't feel sick.


And so there is a returning market. I don't understand completely the ratio of those returning customers versus people dying from it and how a major level, high-level drug distributor could be okay with that collateral damage. But I guess this must be cold-hearted business.


And sometimes, also because it's synthetic and made in a lab that actually amateur chemists, people who don't really know what they're  doing, can make fentanyl substances and don't really get the ratios quite right. These are the two explanations I've been given, but I don't know if they're that satisfying.




Dr. Mike Patrick: Yeah, absolutely. You mentioned not only fentanyl and street drugs, things like heroin and cocaine. What about these pills that are normally medications that many teenagers would take, like Adderall, for example? How can a teenager identify if it's a real Adderall that came originally from drug manufacturer in the United States versus this is something made in a lab and is a fake Adderall? Is there a way to tell the difference between real pills and fake pills?


Dr. Beth Weinstock: There is not a way to tell the difference. When they use a pill press to stamp it to look exactly like the real thing. It is really challenging to look at a counterfeit pill and know for sure that it's counterfeit.




It doesn't have a different taste or smell. And the illegal pill manufacturer will stamp it and color it and dye it to look like the real pill.


So that is, of course, deadly and quite challenging, particularly for a young person who might just Google, what does oxycodone look like? And if it comes up on Google as a blue pill with an M on one side and 30 on the other side, they're going to say, "Oh, well then, the one I have looks like the real thing." So there's that.


You can test pills and powders to see if they have fentanyl in it by using a fentanyl test strip. Those test strips are used in a small amount of water where a pill or a powder has been dissolved. And then the water travels up this narrow strip and it lights up just like a COVID test or a pregnancy test. It will light up positive or negative for fentanyl.




So these strips are one major life-saving tool we have in this fight to keep young people safe. And when I speak to young audiences, I talk about these. Sometimes I distribute them.


It depends on the setting. Occasionally, in high schools, they might not want me to pass them out but at least I educate young people that this is what they are, this is where you can find them. And also, when we speak to college groups, we're much more likely there to pass them out to people.


And as I mentioned, you can test a pill or a powder. And I stress that, particularly to college-age students, because cocaine, sadly, is wildly popular on college campuses right now. And so I stress to them that they do need to check cocaine if they're going to use it. Right now, in Ohio, cocaine, about 18% of cocaine does contain fentanyl, and that's an extremely high number to gamble with.


Dr. Mike Patrick: Yeah, absolutely. The fentanyl test strips, until recently here in Ohio, they were banned, right? And it really took a concerted effort to get them… They were considered drug paraphernalia, but they are legal here in Ohio now, correct?




Dr. Beth Weinstock: They are. The governor signed that law early January. And I think the way it works is there's a three-month lag from his signature to the actual enactment, so they will be no longer considered drug paraphernalia, I think, like the 1st of April or coming up here shortly.


Dr. Mike Patrick: Yeah, that may not be the case in all states. And so, we have listeners throughout the entire United States. And you may want to check in your state what the status of fentanyl test strips are and if they are considered drug paraphernalia. And you can be arrested if you have them in your possession.


That may be sort of a grassroots effort that you might want to get involved in to get those legalized in your state. Because it really is a life-saving tool to make sure that fentanyl is not in a product that you are ingesting, correct?




Dr. Beth Weinstock: Absolutely. And it is a law still in many states, but what I'm seeing over the last year is this slow peeling back of those laws. They're very outdated. And in multiple states, some of which I've helped to testify for and write written letters, et cetera, a lot of states are starting to remove them.


And I actually have not heard of real prosecutions of this law. I'm not encouraging people to break the law, but sometimes in a state where they are considered drug paraphernalia, you will still see public health departments passing them out.


So it's on the books. But whether or not in each individual state, they're actually looking for people breaking that law or even prosecuting it, I think that's not common at all.


Dr. Mike Patrick: Yeah, I'm curious, and as a physician, if you could explain, how do teenagers go from being just sort of curious about drugs all the way down that path of a substance abuse disorder? I know we've talked about tolerance and addiction and needing more and more and then needing it to feel normal.




And then, we get to the substance abuse disorder. And really, that's what you're doing is getting the drugs just that you feel normal again, not necessarily even the euphoria.


How long does that process take? I mean, is this something that happens very quickly? Or do you have to be using the substance over a long period of time to get to that point of a substance abuse disorder? Is there any thoughts on that?


Dr. Beth Weinstock: Well, I've read some studies that really document changes in that dopamine pleasure center in the brain that can happen after consecutive days of opioid use that are shockingly small. I mean, 5 days, 7 days, 14 days of this sort of consecutive opioid use that the brain actually starts to become more plastic and change the way it is seeking out pleasure, you know, that return.


I'm no neuroscientist. I feel like we all took that in medical school. I forget a lot of it.




But that pleasure center that wants us to return for things that make our brains feel even a mild level of euphoria, it's really hard for our brains, once it's in that pathway, to fight that urge. And that can happen in a person taking opioids on consecutive days very quickly.


There are other factors, of course, sometimes it's a family history of substance use disorders. Sometimes, it's life stressors and it can also be somewhat inexplicable. I mean, you can take a family and have multiple siblings and just one of them will struggle with a substance use disorder. And why does that happen? I don't think anyone fully understands it.


But one of the things I stress to my kids and my patients is just that. It's just something, especially in 2023, not to mess around with, not to take that risk. Not just because of the specter of addiction that looms over everything you take, but this idea that fentanyl is so deadly that you might not even get to the point, you might not survive to the point where an addiction can even take place just because of the lethality of these substance.




Dr. Mike Patrick: I do want to point out, because I hear this when I work in the emergency department quite a bit, is we often do use fentanyl for a really bad pain. For example, a broken bone that is not lined up correctly can be extremely painful. And the benefit of fentanyl is that it can be given as a nasal spray and take effect almost immediately. And it is just remarkable how quickly it just takes that pain away.


But again, as you mentioned, this is in a medical setting with oxygen available, with Narcan available, which we'll talk more about here in a minute. And also in the microgram doses, so it's in a safe dose. But yeah, I still get pushback often from parents who say, "Oh no, I don't want my child to have fentanyl," because they hear of the fentanyl crisis and the opioid crisis.




But I just want to reassure folks that in the medical setting, fentanyl can be very effective and very safe and you're not going to become addicted with one or two doses of it. It does take more than that over time.


And so, we want kids to be comfortable and we can stop their pain much quicker than putting an IV in and getting them some morphine. So I just want to point that out.


So I do want to talk about Narcan. I think that's something, it's a medicine that everyone has probably heard of, but maybe don't exactly understand what it is or how it works. So can you kind of demystify Narcan for us?


Dr. Beth Weinstock: Absolutely. So Narcan is the brand name for a chemical called naloxone, which has been around for a long time. Naloxone as of late is more popular in the nasal spray form, as you mentioned, commonly used in hospital settings. Also used out in the community more and more frequently because it is what's called an opioid blocker.




So it will go in through the nasal passages with this nasal spray, which functions sort of like FLONASE. If you've ever used that for your allergies, you squirt it into the nose.


And a person who might have too much opioid in their brain, perhaps that person is unconscious struggling to breathe on the ground, this nasal spray opioid blocker goes into the brain and lands on a receptor in the brain where the opioid is sitting. And it kicks it off.


So that naloxone then will sit on the opioid receptor and not allow the opioid to cause its effect on the body, like loss of consciousness or difficulty breathing.


It's really fast acting. So that nasal spray, to the time someone starts to wake up, could be anywhere from one to three minutes, depending on dose. Occasionally, someone who's had a lot of opioid might need another dose of the nasal spray. But this chemical, this packaged naloxone, is available fairly widely in most states.




Nearly every state, I think, has a law that says you can get it at the pharmacy without a prescription. The problem with that only is that you can get it without a prescription, but you would need to pay for it. And most pricing I've seen is anywhere from $50 to $100 per package.


But at least in Ohio, and I think most states have this, there's a mail order situation in multiple counties and statewide where you can get naloxone, Narcan, mailed to your home for free. You can also get it from multiple health departments, harm reduction groups. It will come to you through the mail for free.


So there's a lot of different ways to get Narcan. Also, I think fairly soon, it's going to go over the counter, as what I've been hearing. I don't know exactly the exact date on that, but at least in Ohio.


Dr. Mike Patrick: It's basically over the counter now, you just have to go to the pharmacy counter to get it.


Dr. Beth Weinstock: But I've heard they're going to have it out on the shelves. So I don't know how they're going to package that or where it's going to be in the pharmacy. It's an interesting…




I mean, I sort of envision in our lifetime not too far from now, that we will have a section at CVS or Target that's just harm reduction. You'll be able to buy some strips and get the Narcan.


I want that to happen. I want this to become very normalized, very commonplace. So we're moving in that direction.


But anyways, the Narcan, when I talk to young people, I tell them, you're not going to hurt someone who is on the ground or struggling to breathe unconscious. You're not going to hurt them by giving them Narcan if they didn't take an opioid. Maybe they're on the ground for another reason.


Maybe they've had too much to drink or maybe they've fainted. And who knows? But if you have any doubts, particularly in a party setting at a high school or college, I tell them this is now a good citizen thing to do. To know where the Narcan is, to carry it with you, to make sure your dorm hall has it, to make sure your sorority or fraternity or wherever you're living post-high school life, to make sure that a group setting just has Narcan available. And you're just not going to hurt someone by giving it to them.




Dr. Mike Patrick: Yeah. And even if you yourself are not using drugs, a loved one, a friend, a college roommate, someone else on the floor, in the dorm or fraternity, a sorority, may be using drugs. And by having Narcan available, you yourself, that may be a life-saving for them.


And I also want to point out that someone who is having the effects of respiratory depression from an opioid, they're not going to be giving Narcan themselves. So the folks doing the drugs, sure, it's great to have Narcan nearby. But just remember, you're not going to be able to be the one to give it.


And so, you probably want to let people know around you, if you're taking something so that they know that you could have respiratory depression, here's where the Narcan is. That would probably be the safest way to go.




Dr. Beth Weinstock: Well, one thing we always stress when we educate young people and parents and health care providers is that there has to be a three-step process for anybody who wants to use a substance. I always tell them the best thing is not to do anything in 2023 and moving forward. But if you are going to take a pill or a powder, number one, you always have to test your substance. You always have to check with the test strips to see if there's fentanyl in it.


If it's positive, the test is positive, then throw those substances away. The second thing I stress to them is that you can never, ever ever use anything alone in this day and age.


You have to have what we're now calling the new designated driver. And when I talk about normalizing this conversation, that's part of it, is to make it so routine for young people, just like having a designated driver, that nobody ever uses substances alone. That's sort of a cultural shift that we're trying to create.




So number two, never use anything alone. And number three, that person always, always needs to know where the Narcan is. And if you do those steps, one, test everything you're taking. Two, never use alone. Three, always know where the Narcan is.


I tell young people, I can nearly guarantee there's not 100% guarantee in anything related to substance use, but I can nearly guarantee that you can survive a fentanyl ingestion if you do all those things.


Dr. Mike Patrick: So again, test what you're taking. Make sure there's not fentanyl. If fentanyl is in it, get rid of it. Always have folks around who know that you're taking a substance and make sure the Narcan is available. It's like the ABCs of safe sleep. These are the ABCs of safe drug taking so that you don't die.


Dr. Beth Weinstock: Absolutely. And we try to stress that. I repeat that several times when I talk to young people.


Dr. Mike Patrick: Yeah, very important. So what can parents do then to prevent fentanyl from impacting their family? How can we keep our teenagers safe as parents?




Dr. Beth Weinstock: Well, one thing that's so important is that this fentanyl crisis has skyrocketed so rapidly that your kids, I can almost guarantee you, are not getting fentanyl education in their high school. It's just not there yet.


And we're trying to change that at BirdieLight. But they will teach about opioids and substance use disorders generally in health class, which most kids in high school have to take for a semester, but they just don't have a robust fentanyl education system yet. So most kids don't know what they don't know.


So I would encourage any parent or caregiver listening to just bring up the conversation very openly and ask, what do you know about fentanyl? What have you heard about fentanyl? How much do you know about counterfeit pills?


And then, go from there because a lot of kids will say, I don't even know what that is. I've heard of it, but I don't know what it is. And to start the conversation like that and then to say, did you know there are life-saving tools if you ever decided to use a substance?




So these are just starters. But I think the conversation needs to happen because you would think if you're a parent seeing on the nightly news everything about the fentanyl crisis, I think you would logically assume that they're telling your kids about it in high school. But really what I've found is there's no standardized curriculum about this.


Dr. Mike Patrick: If you don't know what your school is doing, as a parent, you have the right to ask, correct?


Dr. Beth Weinstock: Sure, absolutely. Or you have the right to say, "Hey, what about BirdieLight? Let's have them come talk to our kids. Or let's get some information from them." That's our goal. Our goal, and it's pretty lofty, is to get this education in the hands of every American young person and to get into their hands of fentanyl test strip if they need it.


And rarely, this is rare, but we sometimes get a little pushback, "Well, if you give those strips out, aren't you just teaching kids how to use drugs?" And our response to that is that we understand a parent's fear. We understand that what a heavy, serious topic this is, and it's scary.




But we feel so strongly that, with the drug landscape right now, so dangerous, that having that test strip or having this knowledge is going to change how an entire generation thinks. It's going to become, like I said, so commonplace that we're just going to talk about it like we do seatbelts, sunscreen, vaping, tobacco education, safe sex. It just has to become part of the conversations that are always happening.


Dr. Mike Patrick: And I've mentioned many times in this program that those conversations are easiest when you begin talking to kids openly and non-judgmentally when they're very young. And just answering their questions honestly, not steering away from any topics, and just really making communication within your family something that is just natural, that you can really talk about anything.


And the earlier that you kind of encourage that culture within your family, I think the easier it is to talk about very difficult things when they become teenagers and young adults.




Dr. Beth Weinstock: Absolutely.


Dr. Mike Patrick: Let's talk a little bit about how pediatricians and family practice doctors, primary care providers, nurse practitioners, physician assistants, how can we, as medical providers taking care of teenagers, bring this up? When should we do it? How should we do it?


Do we need a parent's permission to do it? What are your thoughts on the role of the primary care provider in keeping teenagers safe?


So in my clinical practice, I saw young people, kids for many years. I stopped doing that about five years ago. But I know that when I would do a well check on a teenager or even middle school and up, we would do their annual physical.


And there was a checklist that we went through. We talked about ways to keep themselves safe. We talked about vaping and tobacco use.




And it was really sort of routine, the checklist. And I firmly believe that this conversation should be added to the checklist for any provider who has a touch point with a middle school or teenager. And it doesn't have to be long. I know as physicians, sometimes we're like, "Well, you've only got so many minutes in that room and it's hard to fit it all in." But again, reminding, of course, that this is the leading cause of death for age 18 to 45 right now.


So in my opinion, this needs to be moved to the top of the list. One of the problems, though, is that in medical school, in PE school, as we go through our Continuing Medical Education, there's not a real robust curriculum about this.


In fact, I spoke to a group of OSU medical students a few weeks ago. And I asked them if they had learned anything about the fentanyl crisis in their first through third year of medical school, and none of them had. A few fourth-year students knew about the crisis because they had done rotations through substance use recovery centers. That was it.


And I thought, if we are not going to educate our health care providers about the crisis in a robust way, we're not going to get that information to the patient, the young patient sitting in their room, in their exam room.




So it has to happen on both ends. We need to get this into medical journals about how to talk to your young patients about it. We need to get every society, American Academy of Pediatrics, AAFP, et cetera, to put out a bulletin or a white paper or whatever to say, this now needs to be added to everything you talk to with children.


Dr. Mike Patrick: Yeah, absolutely. And we also have the opportunity not only to touch families lives in the exam room, but more and more doctors are having social media accounts. They are curating and sharing content online, creating content. That's the reason we're having this podcast right now.


There are lots of ways that we can serve in a public health fashion through our social media channels to raise awareness about the problem and then to really point out those talking points of always using a test strip, making sure you're not doing it alone, and being sure that Narcan is available.




That makes a beautiful infographic that you could create with Canva and share on Instagram, if you are so inclined to get involved with social media as part of your professional presence.


You have really been passionate about this topic since Eli and you formed BirdieLight. Tell us a little bit more about that organization.


Dr. Beth Weinstock: So BirdieLight was formed by my daughter and I, about six months after Eli died. My daughter, Olivia, is 23 and lives near me here in Columbus. And we really actually were sitting by his grave site and just talking and said, "These numbers are so overwhelming." And Olivia said at college, she had seen pills and powders around at parties all the time.




And she said, "Mom, I can guarantee you that nobody using those knows anything about fentanyl, as I'm sure Eli did not either." And so we said, "Well, let's occupy that area." There's so many people doing such great work in the substance use disorder arena. We didn't want to get involved with that because we thought let's sort of be true to Eli's story and try to think about what could we have done to help him.


And my strong opinion, as with my daughter's, was that what we can do is to get in front of young people who don't know what they don't know, and to talk to them in really honest, non-judgmental ways about what fentanyl is, where it's found and how to stay safe from it. And so we launched BirdieLight, which that's 15 months ago, and we have so far reached thousands of young people, health care providers, public health administration, educators, religious groups.




We've spoken to a small fraternity of 20 boys, or I should say young men, all the way up to an entire suburban high school population that numbered above 2,500. So we go everywhere, we talk everywhere, most of it's in person. Sometimes, it's on Zoom.


And then, of course, we are creating our own, what we're calling Birdie Boxes, which includes a digital fentanyl education curriculum, educational videos, as well as posters and printable materials so that… Of course, we can't be everywhere, so we are creating these Birdie Boxes so that people out in the middle of nowhere or even just down the street can just order that and then their own health teacher or homeroom teacher can spend a day on fentanyl.


Dr. Mike Patrick: And we'll put a link to BirdieLight in the show notes for this episode, 531, over at


I'm also going to put a link to the Substance Abuse Program at Nationwide Children's Hospital. We obviously treat kids and families who are impacted by substance abuse of all kinds and so you can easily request an appointment.




We'll put a link to that in the show notes. Also, the Adolescent Medicine Program at Nationwide Children's Hospital can also be helpful on the medical front. And BirdieLight is really there mostly for prevention and raising awareness about the problem, again, getting the education and the word out about those test strips and having Narcan available readily.


Dr. Beth Weinstock: Absolutely. And we try to stress the "knowledge is power" component mostly. We don't want to purely be an organization that's passing out fentanyl test strips because we're very hopeful that the education we bring to young people will deter them from risking everything in this day and age.


Dr. Mike Patrick: Yeah, well, Dr. Beth Weinstock, family medicine physician and founder of BirdieLight, thank you so much for sharing your expertise with us today.


Dr. Beth Weinstock: Absolutely, thank you so much for having me.






Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.


Also, thanks to our guest this week, Dr. Beth Weinstock, family medicine physician and founder of BirdieLight. Don't forget, you can find us wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android.




Our landing site is You'll find our entire archive of past programs there, along with show notes for each of the episodes, our Terms of Use Agreement, and that handy contact page, if you would like to suggest a future topic for the show.


Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about our program.


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If you are a medical professional and would like Continuing Medical Education on pediatric topics and free Category 1 Continuing Medical Education, then check out PediaCast CME. It's similar to this program. We do turn the science up a couple of notches.


And as I said, we offer free Category 1 Continuing Medical Education credit for those who listen. And that, of course, includes physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.


And since Nationwide Children's is jointly accredited by all of these professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.




Shows and details are available at the landing site for that program, You can also listen wherever podcasts are found. Simply search for PediaCast CME.


Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.




Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.


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