Ryan Marino, MD – Associate Professor of Emergency Medicine and Psychiatry

Dear Colleagues:

Amazingly enough, it’s possible to exaggerate the dangers of fentanyl and its analogs.

After rapid increases over almost two decades, for all sorts of well-documented reasons, the COVID-19 crisis was associated with further growth in drug-involved overdose rates from about seventy thousand in 2019 to a hundred and seven thousand in 2021. In 2021, about two thirds of those deaths, according to the same report from the National Institute on Drug Abuse, were from “synthetic opioids other than methadone (primarily fentanyl).” And death rates have not fallen as the COVID-19 disruptions receded; the CDC estimated over 112,000 overdose-related deaths in 2023.

According to estimates as of late 2023, deaths from COVID-19 for the year were expected to be slightly below the number from “synthetic opioids other than methadone,” and with COVID-19 deaths being largely concentrated among those of age 65 and older, the number of life years lost from overdoses must have been much larger than for COVID-19. Not surprisingly, the overdose crisis has become a major talking point in political campaigns (just check the television advertisements from Ohio’s U.S. Senate race) and even led to some striking policy changes, including making Naloxone (an antidote) available over-the-counter.

So fentanyl is awful, deadly stuff. But that does not mean people can overdose by touching the drug, or that patients in the process of overdosing are a danger to physicians and nurses. “There was a patient in the hospital for other issues who used opioids and had an overdose, and when I showed up staff was actually attempting to place towels under the door instead of going in and resuscitating the patient,” Ryan Marino told one interviewer in 2019. In a 2022 column on MedPage Today, Dr. Marino cited numerous other examples of unjustified fear, such as an episode of NCIS Hawai’i in which “a sailor with abrasions on his feet steps in a tide pool containing a bag of fentanyl and is shown dying from a fentanyl overdose in under a minute.” The American College of Medical Toxicology has tried to dampen fears, but that has not prevented efforts such as a Florida bill that would make it a second-degree felony to “recklessly” expose a first responder to fentanyl or fentanyl analogues. And this is a problem because, as the President of the National Association of EMS Physicians pointed out, that law could “discourage bystanders or family members from reaching out for emergency assistance during an overdose.”

Of course excessive panic is par for the course in American drug policy. It’s still impressive that some people could manage to overdo it when the crisis is very real. It could be interesting to think about how the current overdose issue, which is largely a fentanyl issue, fits in the context of previous drug problems. There are many other issues, such as what proportion of the people who take fentanyl know they are doing so and, if so, why on earth anyone would do that. Dr. Marino will join us this coming Friday to discuss some of the many puzzles connected to the fentanyl epidemic, placing them in scientific and historical context.

In-Person and Virtual Attendance

We will meet this week in our regular location, the Dampeer Room on the second floor of Kelvin Smith Library.

We continue also to offer the meetings on Zoom. We do require pre-registering so as to avoid “zoom-bombing.” The pre-registration link is posted below.

The discussion begins at 12:30 p.m., but the room should be open no later than Noon. We try to have beverages and refreshments set up soon after that. Participants should be able to sign on to Zoom also by Noon. But please remember not much will be happening online until the talk begins at 12:30 pm. Please also be prepared to show identification when entering Kelvin Smith Library.

Zoom participants should speak up when asked for questions or comments, or submit thoughts through Zoom’s chat function. Please keep yourself muted until you are choosing to speak.

Each week we will send out this newsletter with information about the topic. It will also include a link to register (for free) for the discussion. When you register, you will automatically receive from the Zoom system the link to join the meeting. If you do not get the newsletter, you should also be able to get the information each Monday by checking http://fridaylunch.case.edu Then if you choose you can use the contact form on that website to request the registration link.

This week’s Zoom link for registration is:

https://cwru.zoom.us/meeting/register/tJYrc-GvqTopHtbSMxrdHgjvdsSuOIEdohmM

After registering, you will receive a confirmation email containing information about joining the meeting.

Please also e-mail padg@case.edu if you have questions about arrangements or any suggestions. Or call at 216 368-2426 and we’ll try to get back to you.

Best wishes for safety and security for you and yours,

Joe White
Luxenberg Family Professor of Public Policy and Director, Center for Policy Studies

About Our Guest

Ryan Marino, MD is a medical toxicologist, emergency physician and addiction medicine specialist at University Hospitals Cleveland Medical Center and an associate professor in the departments of emergency medicine and psychiatry at Case Western Reserve University School of Medicine. He recently started University Hospital’s medical toxicology division as well as UH’s emergency department addiction services and emergency addiction bridge clinic at Cleveland Medical Center.

His research and advocacy work focuses on better understanding and best practice medical management of substance use disorders, reducing barriers for both patients and providers in treating substance use disorders and combating stigma and misinformation. Outside of addiction work, he is also active in identifying and addressing social determinants of health and advocating for patients who have been traditionally overlooked by the medical establishment.

* Kelvin Smith Library requires all entrants to show identification when entering the building, unless they have a university i.d. that they can magnetically scan. We are sorry if that seems like a hassle, but it has been Library policy for a while in response to security concerns. Please do not complain to the library staff at the entrance, who are just doing their jobs.

Schedule of Friday Lunch Upcoming Topics and Speakers:

April 12: Conspiracy Theories and Climate Change Skepticism in Europe. With Andreas Sobisch, Ph.D., Associate Professor of Political Science, John Carroll University.

April 19: Why Our Children Struggle in School: Going Beyond the ADHD Metaphor. With Arthur Lavin MD, FAAP. Alternate Room: Kelvin Smith Library LL06

April 26: What Does It Mean for Us? Local Needs and the Bipartisan Infrastructure Law. With Howard Maier FAICP, Adjunct Professor of Political Science.