Having witnessed the power of fentanyl, anesthesiologist Joseph Forand ’77 knew many people were likely to die when nonprescription use of the drug began to climb in the mid 2010s. Fentanyl, a synthetic opioid, has deadly appeal: It is 100 times stronger than morphine and cheaper to make than heroin.
In the 1980s and ’90s, anesthesiologists routinely used fentanyl for cardiac surgeries. “It’s a beautiful anesthetic,” Forand says, “except you quit breathing.” That’s fine when an anesthesiologist is there to breathe for the patient, but it can be lethal for abusers.
Forand, who lives in St. Louis, grew increasingly alarmed about prescription drug overdoses while he served on the Missouri State Board of Health. By 2007, the annual number of prescription drug overdoses had tripled nationally since 1999, and roughly 80% of heroin users started with prescription drugs. Scouting out data to learn more, he absorbed relevant public health literature, including a 2009 Morbidity and Mortality Weekly Report from the Centers for Disease Control that indicated heroin was being cut with fentanyl.
As heroin/fentanyl overdoses and deaths continued to climb, overwhelmed police officials and experts took to town hall meetings to educate the public about the opioid epidemic. In 2010, Forand’s wife was mayor of a small town in St. Louis County, and he routinely attended her public meetings, sitting in the back with members of the police department. At one point a sergeant leaned over to implore, “Doc, you got to do something. We’re finding these kids dead with the needle still in their arm.”
Forand had already been thinking about how to grab the attention of teenagers, a group that had seen a large increase in opioid use. He’d pondered whether he could motivate them by showing how quickly fentanyl stops a person from breathing. Would watching a patient’s last breath tracked on an anesthesia monitoring screen make the point? Forand even considered whether a movie could be an effective vehicle to deliver that image.
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Two weeks after the police sergeant’s plea, Forand was sitting with representatives of a production company. The result is his short film, Anatomy of an Overdose. Forand is one of two executive producers. The movie, supported by the Missouri Society of Anesthesiologists and St. Anthony’s Charitable Foundation, debuted in 2014, and is available on YouTube. It presents personal accounts of recovering addicts who survived an overdose and the science of what happens. The film drew attention from the media and a range of health and community organizations.
Forand remains in the fight. He’s still talking to groups (he recently led a Hamilton alumni event) and serves on the county board of health. St. Louis County has its own prescription monitoring program, and he’s on its advisory board.
Missouri is the only state without a prescription drug monitoring program, Forand says, and he’s been working hard to change that. He frequently points out that he’s not an expert on the epidemic, that his interest is really just a hobby. It looks more like a cause.
“We’re in healthcare to save lives,” he says.
