By Dr. Anthony Policastro

Russian roulette is a game played with revolvers. A bullet is put into one of the six chambers. The chambers are then spun. The individual puts the gun to his/her head and pulls the trigger. 

There is a one in six chance of the bullet being in that chamber and killing the person. Fortunately, people are smart enough to not do this. We see about one death every two years in this country from Russian roulette.

Drinking and driving is a little more sophisticated. A drunken driver has a real chance of killing themselves or someone else. We are less fortunate in this area. In 2020 there were 11,654 drunken driver related deaths in the United States.

We now have a new form of Russian roulette. It comes in the form of Fentanyl. Fentanyl is an opioid related drug. It is in the same family as heroin. We have long known about heroin overdoses. But we tended to attribute them to chronic heroin addicts.

Fentanyl is different. The main difference is the amount it takes to get a fatal dose. 

Drug dealers like to use Fentanyl for multiple reasons. It gives the drug a bigger bang for the buck because of the Fentanyl effects. It allows them to stretch their drug supply further by using Fentanyl instead of the more expensive drug. 

Only a foolish person would think that the drug dealer would bother to carefully measure the dose. They really do not care if one of their customers overdoses and dies. There are plenty more out there.

Rates of opioid deaths are increasing by over 50 percent per year. In Delaware alone there were 444 deaths in 2020. There is no clear breakdown as to how many were actually from Fentanyl. However, we do know that Fentanyl accounts for much of the increase that we are seeing.

We have also tested illicit drugs. About 42 percent of those tested have fatal doses of Fentanyl in them. It is like playing Russian roulette with three of the six chambers filled with bullets. Good luck with that.

In the early 2000s, I was the medical director at Nanticoke Hospital. One of the doctors came to me wanting to use Fentanyl in the outpatient surgical area. After the procedure he could use Narcan to wake the patient up quickly and thus do more procedures each day.

I told him that even in those circumstances the therapeutic dose was too close to the dose that could stop someone from breathing. He could not do it unless he hired an anesthesiologist to care for the patient’s airway during the procedure. He was unhappy with me.

There are some simple rules to follow. Do not buy illegal drugs. Do not buy drugs on the Internet. Do not accept drugs from friends or strangers. That is true even if they tell you what the drug is. They may be lying. They may not know for sure but think they do. 

That is nothing new. We already know that. It is like telling your child never to get into a car with a stranger. There are some things you should not do. One of them is to not play games like Russian roulette with three bullets already in the chambers.