A Hawaii island drug sting made headlines this week for preventing four ounces of highly potent fentanyl from reaching the streets. The bust marks one battle won in a quickly-expanding war, but local vice squads have their hands full with a steady stream of the smuggled synthetic opioid. Action must be taken to not only stem the flow, but inform the public of its lethality.

Less than a decade ago, Hawaii became the newest front in a nationwide fight against fentanyl. Once a rare occurrence, overdoses involving the opioid began to skyrocket nationally in 2015. A similar trend played out in the islands, with the percent of opioid-related deaths involving fentanyl reaching 13% in 2018 and steadily increasing to 45% in 2021, according to the High Intensity Drug Trafficking Areas (HIDTA) program. State Department of Health (DOH) data shows that, of the state’s 915 drug overdose fatalities in 2021, 112 were associated with fentanyl and other synthetic opioids. Deaths related to methamphetamine and other psychostimulants still account for a majority of local overdose deaths, hitting 685 in 2021, but the fentanyl tide is rising.

On Hawaii island, the state’s current locus of fentanyl-related activity, the opioid was first reported in 2017 and has since proliferated, quickly finding its way into street drugs as a highly effective, and cheap, additive. Hawaii County police seizes the lion’s share of product entering the state, with West Hawaii registering a majority of busts, reports Hawaii News Now. But for every success, another route is established, a new smuggler is tapped and fresh sources secured. The fight goes on.

Pharmaceutical fentanyl is Food and Drug Administration-approved and legitimately administered by physicians to blunt pain and as an anesthetic, among other uses. About 100 times more powerful than morphine and 50 times more powerful than heroin, fentanyl is viciously potent. Just 2 milligrams, as much as can fit on a sharpened pencil tip in powdered form, is enough to kill. It is also highly addictive. Opioids — organic, semi-synthetic and synthetic — alter brain chemistry to block pain signals and trigger massive release of dopamine in reward centers, causing a feeling of euphoria that some chase with tenacity.

State lawmakers and agencies are adjusting to the threat with targeted legislation and outreach programs like the Hawaii Opioid Initiative, but some efforts have seemingly petered out. This cannot be allowed.

Earlier this month, the Hawaii Island Fentanyl Task Force (HIFTF) hosted its third annual Fentanyl and Addictions Summit, bringing together state and county agencies, nonprofits, health care organizations and others, the Hawaii Tribune-Herald reports. Dr. Kevin Kunz, chairman of HIFTF, presented statistics — featured prominently on the group’s website at hiftf.org — that put in stark relief the gravity of what has rightly been termed an epidemic. DOH representative Dan Galanis echoed Hawaii island police in noting an uptick in fentanyl overdoses, which in 2023 accounted for roughly 34% of all overdoses in the state, up from about 15% in 2020. Separately, DOH data shows hospital emergency departments discharged 1,860 opioid-related cases in 2023.

State legislators in 2023 passed Senate Bill 671, signed into law by Gov. Josh Green, to decriminalize fentanyl test strips, a major step toward recognizing the crisis’ severity. That pairs with an effort by the Hawaii Health & Harm Reduction Center to regularly stock specialized vending machines across the state with kits containing naloxone, an opioid overdose-reversing medicine, free of charge thanks in part to federal grant money. A list of vending machine locations can be found at hhhrc.org/naloxone.

Strong legislation and enforcement are pieces of the puzzle, and outreach from resources like HIFTF plays a role in collecting and disseminating information from field experts. But more can and must be done to raise awareness. Prevention is the best medicine.