Experts discuss fentanyl facts Crisis worsens

BY HALEY LENA HLENA@COLORADOCOMMUNITYMEDIA.COM

As part of Douglas County’s Youth Initiative Facts about Fentanyl discussion, Lindsey Simbeye, an external relations strategist for Colorado Consortium for Prescription Drug Abuse Prevention explained how opioids such as fentanyl work in the body and how to reverse an overdose.

Both illicitly manufactured fentanyl and pharmaceutical fentanyl are considered synthetic opioids. It is often used in labor and delivery, for acute pain situations and for end of life measures for pain suppression.

Fentanyl goes into the system quickly and lasts for 30 to 60 minutes. It is also up to 50 times stronger than heroin and up to 100 times stronger than morphine, according to the Centers for Disease Control and Prevention.

e body has opioid receptors all throughout and when a person takes an opioid, it binds to those receptors and transfers information to di erent systems throughout the body, such as the limbic and central nervous system.

When the opioid a ects the limbic system, it is a ecting the brain reward system, which causes the euphoric feeling. Opioids chemically connect to the central nervous system which a ect the automated body responses within the brainstem and can suppress the respiratory system, causing the overdose. e long-term e ects of using can include irritability, hallucinations, hypoxia, anxiety, depression and hyperalgesia, which is an increased response to pain. ere are also additional factors that increase the risk of an opioid overdose such as poor health, purchasing from the black market, history of substance use disorder and using di erent sources of drugs, according to Simbeye.

Tolerance builds quickly to the euphoria and to the pain, said Simbeye. e respiratory depression tolerance does not build as quickly, which is what makes opioids so fatal or so potentially fatal when they’re being misused or used in excess.

“ e latest I’ve heard is that an average dose for someone who is in active use for fentanyl, they can be using anywhere from 20 to 50 pills a day, that is purely so they can survive throughout the day and stave o withdrawal symptoms,” said Simbeye.

However, recent discharge from incarceration or any kind of institutionalization for previous users increases their chance for an overdose if they choose to use again as their tolerance for the drug decreases.

“ ey may not recognize that their tolerance has decreased and they are likely to use at the same amount that they used before going into that institutional setting,” said Simbeye. “ ey are highly susceptible to overdosing because now their respiratory system doesn’t have the same high tolerance and it’s going to be overwhelmed and suppressed to the point of not breathing.” e other high risk factor is taking opioids in combination with any other drug, speci cally benzodiazepines, Valium and Xanax for example. Any kind of anti-anxiety drug combined with opioids is 10 times more likely to have an overdose because of how the drugs interact with one another, said Simbeye. ree indicative signs of an overdose are shallow or slow breathing, also known as the “death rattle”, lips and nails turning blue and loss of consciousness.

In the event that an individual is overdosing, it is important to understand how to administer Naloxone if it is with you. According to Simbeye, Naloxone is the umbrella category for all di erent name brand medicines such as Narcan and Kloxxado.

When administering a nasal pump, provide support to the back of the neck and insert the pump in the nostril up to the ngertips and plunge. If the patient is still unre- sponsive after two to three minutes, their breastbone while applying pressure.

It is important to call 911 and stay with the individual until help arrives.

If the individual is still not responsive and a second nasal pump is available, administer the second spray in the opposite nostril, Simbeye said.

When Naloxone goes into the body, it knocks the opioid o the re- ceptor and due to its strong bond, it continues to block the receptors and cuts o communication with the central nervous system and allows the body to go back to the automated responses.

“ e Naloxone only lasts 30 to 90 minutes, so if you have a longer acting opioid that you’ve consumed, you could overdose again once the Naloxone wears o without using anymore opioids,” said Simbeye. e planning commissioners serve as an advisory group, and the county’s board of three elected commissioners — George Teal, Lora omas and Abe Laydon — generally make the nal call on development decisions in areas outside of municipalities. ough it attracted backlash, the proposal is misunderstood, according to county sta . e county heard concerns that the change “would make the process for someone to amend a planned development much easier or to get a development of a di erent type approved much easier — that it would be a signi cant thing,” said Steven Koster, assistant director of planning services for Douglas County. “And I’m not sure exactly how that understanding came to be.”

Once the individual is breathing, place them in the recovery position.

According to the Good Samaritan Law, a person is immune from arrest and prosecution if the person reports in good faith to a law enforcement o cer if there is an emergency concerning an overdose, the person remains on the scene and cooperates. e immunity also extends to the individual who su ered the emergency.

Additional resources include Bring Naloxone Home, keepthepartysafe. org, and Take Meds Seriously.

He spoke at a meeting of the group of Douglas County residents who advise the county’s elected leaders on development as the group considered whether to edit the criteria that developers need to meet to make changes to “planned developments,” properties in a special type of zoning that only applies to certain areas. (Zoning is a local government’s rules for what can be built where.)

After hearing more than a dozen speak against the proposal at the meeting, along with dozens of other comments the county received from residents in April, the Douglas County Planning Commission voted 5-1 against the language changes.

‘Meant to be flexible’

An area with “planned development” zoning can feature a mix of property types — including residential, commercial, recreational and others — in a way that standard zoning districts can’t, Koster said.

Planned developments are also intended “to encourage innovative and creative design,” Douglas County’s zoning policy says.

Planned developments can be small or spread over a large area: Highlands Ranch is a planned development, for example.

Over time, planned developments can change, or be “amended,” if the county gives the OK. At issue during the April 17 county Planning Commission meeting was a proposal to edit the criteria that would allow for those changes.

Among several approval criteria, the sta held up two for edits. ey included:

• A change from the wording

“Whether the amendment is consistent with the development standards, commitments, and overall intent of the planned development” to “Whether the amendment is consistent with the overall intent of the planned development”; and

• A change from the wording

“Whether the amendment is consistent with the intent, e cient development and preservation of the entire planned development” to “Whether the amendment is consistent with the e cient development of the entire planned development.” at may sound like dry, inconsequential language. But the proposed removal of some words — particularly “preservation” — raised some residents’ eyebrows.

“For some county developments numerous residents have been in place for decades,” Tim Knaus, of the Roxborough Park area, wrote to the county. “Lifelong decisions regarding how they would live depended on the planned development. Preservation must be addressed.”

In a report to the county Planning Commission, county sta wrote that “planned developments are intended to be documents that may be amended from time to time.”

“ e word ‘preservation’ could be confusing and could be construed as keeping the planned development in (its current) state,” Matt Jakubowski, a chief planner on county sta , said during the meeting.

But “by the very fact” that a developer ever proposes to amend a planned development, that inher- ently implies change, he said.

“ ey’re meant to be exible — they’re not meant to be a fossil,” Jakubowski said.

‘The soul of Douglas County’ County residents expressed fears of “high-density” multifamily buildings — a term that often means apartments. (“Density” is a term for how many people or housing units occupy an area.)

Area resident Evelyn Zur framed the backlash at the meeting as “ ghting for the soul of Douglas County” and “ ghting for the soul of the taxpayer.”

“What we’re talking about here with the zoning change is allowing more apartments, more renters. When you have a majority of (home) ownership in a county, you have a quality county. When you have a majority of renters, that quality gets diluted,” Zur said at the meeting.

“ ere’s a reason people move here,” said resident Holly Green, who warned of “an erosion of our property rights.”

Another commenter saw the changes in a larger context, saying “our freedoms, our liberties, our rights” are at risk.

Asked whether the proposed language edits would lead to more new, high-density multifamily buildings in longtime single-family neighborhoods, Koster told Colorado Community Media: “I don’t think it changes the probabilities around that happening, no.” e concept of “preservation” is mentioned elsewhere in Douglas County’s zoning rules regarding planned developments, such as in saying: “Development within this district should be designed to … ensure that environmentally and visually sensitive areas are preserved.”

“ ere are more than just those two approval criteria,” Koster said.

‘Overall intent’ e county’s existing zoning regulations already mention the possibility of changes to commitments in cases where a developer asks to change a planned development.

Also mentioned in the proposed language change are “commitments” — agreements a developer makes to donate land for a school, allow for parks to be built or have roads constructed, for example.

“An amendment request shall be considered a major amendment if it meets one or more of the following criteria (including) … Substantial changes to … commitments,” the zoning rules say in a part of the regulations that aren’t proposed to be edited.

Jakubowski, the county sta member, said the parts that are proposed to be edited would no longer mention commitments “not because those things aren’t important.” at’s been done when the type of property was changed from a nonresidential use to an all-residential use or an almost-all-residential use, he said.

But, for example, if there were a type of boundary that a developer asked to change, that would not concern a commitment, Jakubowski said.

“ e idea is to go back to the overall intent of the planned development,” Jakubowski said.

Extreme changes to a planned development wouldn’t depend on the language that county sta are proposing editing.

“ ere does come a point where the changes somebody wants to make are too fundamental,” and then “we would say that the proper (process) is a full rezoning” rather than mere tweaks based on the planned development rules, Koster told CCM.

One example sits in the Highlands Ranch area, where the community known as Wind Crest used to be in the Highlands Ranch planned development.

“It was an industrial planning area. e landowners wanted to change it to this retirement residential community,” which was a change so substantial that it went to a full rezoning, Koster said.

Polis proposal not a factor, sta says Douglas County’s zoning language change proposal, while unrelated to Polis and the Democrats’ broader proposed changes in housing density across the state, has met backlash from local residents who fear the county is moving in a direction of higher density.

“Polis, for instance, he wants renters — he (doesn’t want) homeownership,” Zur said at the meeting.

Koster noted that county o cials started the process of the proposed edits last fall, before any state legislature bill on land use arose.

“We weren’t factoring any of that into that process,” Koster said. County sta didn’t have a particular reason for the timing of the proposed zoning language edits, Koster said.

“As sta , we’re tasked to always be reviewing, looking at our regulations, making sure they’re e cient, making sure that they’re clear,” said Koster, noting that these rules sections were also amended about eight years ago.

“As you apply regulations, work with regulations over time, you learn things about them … and then you see ways to say, ‘ is could be worded better,’” he said. e board of county commissioners ultimately decides whether to approve the proposed edits.

Asked whether there are any recent proposed changes to planned developments in Douglas County whose approval or denial hinged on the wording that would be modified by the proposed language edits, Koster said: “I can’t think of any developments where these (provisions) has been the linchpin in any decisions on the development.”