Most Americans remember their first sip of alcohol or experience with marijuana. Maybe it was ceremonious, at a bar on their 21st birthday, or maybe it happened at a party in high school, hidden from the watchful eye of an adult.
But as age of first use trends younger and younger while access continues to widen, risks associated with fentanyl-laced counterfeit drugs and other powerful, lab-based substances are expanding to broader populations. This reality is something Heather Harlan, a health program coordinator and facilitator at Boone County Overdose Response Coalition, has witnessed for years.
“The days of youthful experimentation with drugs and alcohol, sort of as a rite of passage, being able to do that within any degree of safety is gone,” Harlan said. “It is not there anymore.”
“Anything that you buy off the streets is suspect,” she continued.
In late March, the Missouri Department of Public Safety released a report detailing traces of nitazene, an illegal class of highly potent synthetic opioids, in school water samples from 22 counties across the state.
This weekly wastewater surveillance program started the first week of January. Of the 37 schools that opted in, two located in mid-Missouri tested positive for nitazene: Hallsville High School in Boone County and Boonville High School in Cooper County, each about a 25 minute drive outside Columbia. Columbia Public Schools was not part of the survey group.
On March 25, Superintendent of Boonville Schools Mark Harvey notified Boonville families of the findings — which were revealed in a wastewater sample collected on Feb. 10 — via email and provided resources for those who believe they may have been exposed to nitazenes.
In an email statement to the Missourian, Boonville Schools Communication Specialist Leigh Anne Reynolds wrote that data from the program allows the district to take a proactive approach in “addressing concerns early.”
“At this time, the district plans to continue participating because the program provides valuable trend data that supports our prevention and safety efforts,” Reynolds said in the statement. “We will continue to evaluate its effectiveness as part of our overall approach to student health and safety.”
Tyler Walker, superintendent of Hallsville Schools, shared similar sentiments with Hallsville families. According to the email statement sent on Feb. 23, Hallsville Schools administration was first made aware of the presence of nitazenes in mid-February.
“We encourage families to have conversations at home about the risks of unknown or counterfeit substances and the importance of asking for help right away,” Walker said in the statement.
Moving forward, Hallsville Schools are working with state and local law enforcement. The Columbia Police Department, Hallsville Police Department and Boone County Sheriff’s Department could not be reached after several attempts for comment.
The Boone County Overdose Response Coalition stepped up to offer aid to the Hallsville community, hosting one of its signature Save-A-Life events on March 11. These events aim to equip participants with basic lifesaving skills, provide education on opioid use and distribute naloxone, or Narcan — a medication that can reverse opioid overdoses.
Harlan, who presented at the Hallsville event, said around 30 people attended, and that the organization’s relationship with the school is ongoing. Ultimately though, Harlan’s main takeaway was how potent nitazenes are — up to 10 times more so than fentanyl — and how illicit drug use is perpetrated by the environment a person is in.
“If your high school student is in a class with someone who’s using drugs, your high school student is much more likely to use,” Harlan said. “It’s sort of like you catch it from other people. It’s in the environment.”
A slippery slope
Opioid use in the U.S. did not start with a stereotypical drug dealer or an international trafficking ring.
It began in working-class regions from Appalachia to rural New Mexico, in communities where industrial labor, isolation and chronic pain created fertile ground for widespread prescribing. In the late 1990s, pharmaceutical companies such as Purdue Pharma started aggressively marketing Oxycontin to doctors as miraculous prescription painkillers.
“If you’re not treating pain, you are missing your mission as a doctor,” journalist and author Sam Quinones said, referencing the pressure medical professionals faced when opioids first entered the prescription market. “And here’s the tool to use.”
Quinones is deeply familiar with the evolution of the American synthetic drug industry. He’s published two books on the topic, “Dreamland: The True Tale of America’s Opiate Epidemic” and “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth,” for which he spent years traveling the U.S. and abroad in the height of the nationwide opioid epidemic and after.
He talked to local doctors, sheriffs and community members, working to connect the dots between prescription opiate use and the rise of more potent synthetic drugs.
“(Doctors) are not some shady dealer at the Motel 6,” Quinones said. “They’re like some venerated profession in your county. You got lab coats, linoleum and fluorescent lights.”
But since the 2010s, access has shifted from reliance on something Quinones calls “doctor-shopping,” or prescription-seeking from multiple physicians at a time, to illicit deals for counterfeit pills. Now, most illegal opioids are synthetically produced and sold in larger, cheaper and more potent quantities.
“There’s less risk: no farmers, no sunlight, its possible to make (drugs) all day, all year long, no seasons; all you need are the ingredients,” Quinones said. “The trafficking world has really figured this out in the last 15-20 years.”
Nitazenes fall into that class of synthetic, illegal opioids that were originally produced for medical painkillers but shelved for high potency and fatal side effects. Quinones said that although the re-emergence of nitazenes has been slower than fentanyl, it still poses “alarming” risks for youth.
“Opioids have absolutely a very important role in medicine,” Quinones said. “It’s just not meant to be in every American medicine cabinet, every American home.”
Moving forward
Although it is not known for certain at this time whether nitazenes are present in the Columbia community, Harlan said it is typically “only a matter of time” before drugs cross city and county lines. The coalition works with agencies at all governmental levels, such as local law enforcement and the Center for Disease Control, to be in touch with the flow of drugs into Missouri. Harlan said they’ve been seeing nitazenes in Missouri for over a year.
“Access is the mother of use,” Harlan said. “The more there is anything in the community, the more likely a young person is to use it.”
Harlan explained that offering a comprehensive approach to treatment that addresses factors like access and environment is part of why Boone County Overdose Response Coalition exists.
Last summer, the coalition received a grant from the Substance Abuse and Mental Health Services Administration that allowed it to begin placing what Harlan describes as “Narcan boxes” at central locations throughout Boone County. Community members can grab a box of Narcan at no cost for immediate use or as a preventative measure.
The coalition is currently expanding access further into more rural areas, and Harlan said once those new boxes are placed, Boone County will be home to 40 Narcan boxes.
“A couple of years ago there was no place in the county that had 24/7 access to naloxone, and now we’re going to have 40” Harlan said. “We feel that’s very, very significant.”
One of Boone County Overdose Response Coalition’s newest programs is SYNC, a prevention initiative working to reduce substance use by addressing underlying contributors such as trauma, stress and limited access to positive activities. What makes SYNC unique, Harlan said, is its focus on youth.
“If we blame young people for experimenting with drugs, it’s like blaming a fish for swimming in a polluted stream,” Harlan said.
Additionally, this program aims to reduce the broader stigmas associated with drug use.
“I think a lot of it is the stigma of people not understanding (addiction) is chronic, and it’s the brain that’s harmed,” Harlan said. “To do what we can to understand this as a chronic health issue is just really important. It’s critical.”
SYNC meets on the first and third Thursdays of each month at 3:30 p.m. in the Columbia/Boone County Public Health and Human Services Department building, welcoming volunteers or those in need of its services.
