Raising Joy: As Fentanyl Cases Rise at Cook Children's, a Grieving Mom Shares How She Helps Save Lives

On this episode of Raising Joy, we’re joined by Callie Crow, founder of the nonprofit Drew's 27 Chains, in honor of her son who died of an opioid overdose in June 2020.  The organization provides free Narcan and training to law enforcement agencies and other first responders and is credited with saving more than 30 lives to date.

By Ashley Antle

There is a new clear and present danger for children and it’s coming to them through virtual street corners and hidden social media messages. It’s the highly potent synthetic opioid called fentanyl. Similar to morphine but 50 to 100 times more powerful, fentanyl is sometimes prescribed to control severe or chronic pain. Like many opioids, it’s also made and used illegally with deadly consequences.

So far this year at Cook Children’s Medical Center, 15 children have been treated for fentanyl ingestion, some as a result of their own misuse of drugs and some as a result of exposure through someone else’s misuse. That’s up from zero in both 2019 and 2020, and 10 in all of 2021. 

This increase follows national trends. Fentanyl-related overdoses in the U.S. have exploded in recent years. For teens ages 14 to 18, death from fentanyl nearly doubled in 2020 and rose another 20% in 2021, according to researchers at the David Geffen School of Medicine at UCLA. It’s one tragic story after another of a child lost to the drug. A Los Angeles, California, teen dead and six others were hospitalized in September. Three teens from the same school in San Marcos, Texas, dead in August. Thirty-six Georgia teens dead in 2021, and the list goes on and on from coast to coast.

“What we're seeing in the littles is that they sometimes have exposure to fentanyl just because of their environment,” said Elizabeth Peeler, D.O., M.S., M.S.C.S. “They're at the mercy of their caregiver and it's kind of like a wrong place, wrong time situation. They're toddlers or babies, and so they toddle into drugs that are kept in the home. And that can be really scary because they're so small and fentanyl is so potent. It's so strong that just a little bit is enough to make a young child very sick.”

Dr. Peeler is a member of Cook Children’s Child Advocacy Resources and Evaluation (C.A.R.E.) Team. She and her fellow C.A.R.E. Team physicians specialize in examining and treating children who have suffered abuse, including from neglect and drug exposure. This year the team added fentanyl to their regular drug-testing panel due to a sharp increase in the number of fentanyl exposure cases they now encounter.

Drugs in Disguise

The clandestine nature of many fentanyl overdoses is what makes this battle a particularly difficult one.

When it comes to teens — and adults for that matter — it’s not that they are specifically buying fentanyl for a high, it’s that fentanyl is laced into other illicit or counterfeit drugs like Xanax, Percocet and Adderall, to name a few. These drugs don’t come with warning labels from their illegal dealers, so buyers have no idea their purchase may contain hidden fentanyl until it’s too late.

In the most recent fentanyl overdose cases at Cook Children’s, at least two were a result of marijuana laced with fentanyl and two from counterfeit Percocet pills containing fentanyl. The same is true in cases all across the country. According to the U.S. Drug Enforcement Agency (DEA), 42% of pills tested for fentanyl contained a potentially lethal dose of the drug. 

“There’s lots of different reasons why teenagers or adolescents may take a substance, whether it’s to have a good time because of peer pressure, whether it’s because they do suffer from depression or anxiety, whether it’s because they’re curious or because it was in the house and it was an accident,” said Artee Gandhi, M.D., Cook Children’s medical director for pain management and endowed chair for the Center for Pain Management and Integrative Health.

For dealers, adding a synthetic and highly addictive opioid that is cheap, easy to make, and keeps users coming back for more is easy money. However, get the dosage even slightly wrong and it’s deadly. Just two milligrams of fentanyl — the weight of a mosquito — can kill.

“Fentanyl is about 50 times stronger than heroin,” Dr. Peeler said. “Even a small amount can block the brain’s ability to remember to breathe. I want to remind all parents and children that substance misuse can have life-threatening consequences.”

A Mother’s Heartbreak

Callie Crow knows the devastation of fentanyl all too well. For years she watched her son, Drew, spiral into drug addiction, despite raising him in a home where alcohol and drugs were never a factor.

“He breaks that mold of what we sometimes think of as a stereotypical person that's addicted to drugs,” Crow said. “That's one of my biggest pushes is, you know, it's not even what I thought, because I've never done a drug in my life. I don't drink. I don't smoke. That's not something that my kids were exposed to in any way. And so in my mind, they were exempt and it wasn't going to happen to us.” 

Crow describes her son as having an old soul. He was articulate, even as a very young child, smart, funny and loved to learn. Drew was first offered cocaine by a trusted family friend at the age of 14. That eventually led to other drugs and pills and, by 17, he was addicted to opioids.

“We did detox. We did rehab. We did therapy. We did all of the things that, you know, are supposed to help,” Crow said. “And it just never, ever happened. I don't think he ever turned a corner from the time he was 17 on. It was really difficult watching that struggle.”

But there were moments of light. Drew got married and, at the time of his death at age 27, was studying political journalism at the University of North Texas. By then, his opioid use had morphed into a way to survive withdrawal, not necessarily to get high, Crow said, describing her son as a “functional addict.”

That’s what happened the night he died in June 2020. Crow says Drew purchased pills from someone in the town where he lived and took them to avoid withdrawal symptoms of nausea, vomiting, sweating and pain. The pill he took was unknowingly laced with fentanyl. Ten minutes after ingesting it, he was in cardiac arrest and died.

Four doses of Naloxone, also known as Narcan — the FDA-approved drug used to reverse the effects of fentanyl overdose — were within feet of Drew at the time of his overdose. Two on his bedside table that Drew’s wife did not know about and two on the police officer who initially responded to the 911 call placed by his wife. For reasons unknown to Crow, the officer did not administer the Naloxone he carried. Any one of the four doses in Drew’s presence at the time could have reversed the effects of the fentanyl and saved his life.

Since her son’s death, Crow, an EMT- paramedic, has made giving out Naloxone and teaching others how to administer it her life’s mission. She calls the organization she founded in her son’s honor Drew’s 27 Chains. The name is a reference to Drew’s love for disk golf. So far, 36 people have escaped a fentanyl-related overdose death as a result of Narcan handed out at a Drew’s 27 Chains event, and that’s just the ones Crow can track.

Like Crow, Dr. Gandhi is a proponent of keeping Narcan in your home and on your person.

“I think it is important for parents to know that there is a medication that's a nose spray that's available at any pharmacy and it does not require a prescription,” Dr. Gandhi said. “They can walk up to the counter and say, ‘Can I please have a dose of Naloxone?’”

Parental Interference Strongly Advised

“For the first time we are seeing an increase in overdose deaths in adolescents, and it’s predominantly due to the effect of fentanyl, which was not an intentional effect that the adolescent was going for,” Dr. Gandhi warned. “The number of overdose deaths itself has risen every year, but this is the first time that the adolescent population has actually had an increase.”

There are things parents can do to help protect their kids and teens. Running interference for your child against these dangers starts with a conversation. Not just one, but many.

“First and foremost, these conversations have got to happen all the time,” said Lisa Elliott, Ph.D., licensed psychologist and manager of Cook Children’s Behavioral Health Clinic in Denton. “There needs to be dinner conversations. There needs to be conversations in the car. They need to be constantly talking about it and making their kids very well aware of the reality and risks of drugs.”

Dr. Elliott says one way to talk to teens about these dangers is to frame the conversation as information they may need to help a friend. This takes the attention off your kid, she says, and they’re more likely to listen. These conversations should start early, as young children are at risk of fentanyl poisoning, too. Many dealers are disguising pills as candy, and there is always a risk of children ingesting a pill they’ve found on the ground.

Staying as involved as possible in your child’s life is the key to knowing if they are abusing drugs or participating in behaviors that could lead to addiction or overdose. This includes keeping a close eye on their online habits, social media accounts and text threads. A generation ago, keeping kids safe from drugs meant knowing their friends and steering them away from certain hangouts and street corners. Today, social media sites have brought an entire world of virtual street corners and strangers right into your child’s bedroom.

“Being vigilant about your kid’s social media use I think is important,” Dr. Gandhi said. “Your kids can have freedom on those devices but they still need monitoring.”

And for good reason. The prefrontal cortex of kids and adolescents is not fully developed until they are in their 20s. That’s the part of the brain that controls impulse, and that’s why young people have poor reasoning skills when it comes to risky behaviors.

“Kids and adolescents are basically a high-speed car going down a highway at a hundred miles an hour without any brakes,” Dr. Gandhi said. “They have no breaks. They have no self-regulation. They don't know the difference between what's real, what's not real, and what’s just something that you would think is a fluke. They don't understand the long-term implications or consequences of their actions. So don't fool yourself into thinking that your 15-year-old does. They don't. You've got to be involved in screening and monitoring and knowing what your children are having access to.”

Know their friends, Dr. Gandhi says, and communicate with their friends’ parents. She also encourages parents to find activities that kids enjoy but also make them feel like they’re a part of a community.

If you suspect your child is using opioids or other substances, reach out to their school counselor, drug counselor, a mental health professional or their pediatrician for help. If you suspect your child has overdosed on fentanyl or any other drug, call 911.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.