Kym Gentry-Peck was at her job as a Big Island event planner on Oct. 25 when she received a heartbreaking phone call.

“My husband said, ‘Come home right away. (Our daughter) is dead.”

The girl was two weeks shy of her 15th birthday and attended high school in Kona.

Gentry-Peck raced home, screaming the entire way. When she pulled into the driveway of her Kona Palisades residence, police were swarming everywhere. Her daughter’s body lay on the family’s lanai, a sheet covering her.

“I completely broke down. I lost it,” said Gentry-Peck.

Toxicology results revealed that their daughter had died of a fentanyl overdose, she said.

Extremely Lethal

Fentanyl is a particularly lethal drug. It’s up to 50 times stronger than heroin and 100 times stronger than morphine, according to the federal Centers for Disease Control and Prevention. It’s often mixed with other drugs and made to look like prescription medications such as Percocet, Vicodin or other painkillers. Sometimes it’s cut into marijuana and cocaine.

People can pop a single pill, lose consciousness, and never wake up. Fentanyl is so deadly that a single 2-milligram dose – the equivalent of 10 to 15 grains of table salt — can kill, according to the U.S. Drug Enforcement Administration.

“If one person was being killed every 11 days by a serial killer, everybody would be up in arms.” — Addiction specialist Dr. Kevin Kunz of Kona

It’s hitting kids particularly hard. Monthly overdose deaths for children ages 10 to 19 increased nationally by 109% from the six month-period of July to December 2019 to the same period in 2021, according to data released by the CDC in December. Adolescent deaths involving fentanyl increased 182%. Most of the deaths occurred at home with potential bystanders nearby, unaware of what was happening.

It’s a similar grim picture for adults, too.

Some 107,375 people in the United States died from drug overdoses or drug poisonings in 2021, according to the CDC. Nearly 70% of those deaths involved synthetic opioids like fentanyl. The victims cut across socioeconomic lines and demographics, but many tend to be younger, under the age of 40, experts say.

Many are unaware they are consuming a fentanyl-laced drug.

Fentanyl use is dramatically increasing in Hawaii, with at least 17 fentanyl overdose deaths in Honolulu alone in 2022, according to a report released in October by the Hawaii High Intensity Drug Trafficking Area initiative.

The report says 48 people in Hawaii died from fentanyl in 2021 compared to 28 the year before.

According to CDC figures, one person dies of a drug overdose every 11 days on the Big Island, which is a hotbed for fentanyl use. While the Big Island is home to just 14% of the state’s population, 57% of fentanyl confiscated in the state between 2016 and 2021 was on Hawaii island, according to HIDTA.

Methamphetamine still poses Hawaii’s most widespread drug threat, killing 207 people in 2021. But meth tends to kill much more slowly.

“Methamphetamine is like cancer. It will kill you one day at a time,” said Gary Yabuta, executive director of HIDTA. “Fentanyl can kill you with just one application.”

Wounds That Can’t Be Seen

That’s what happened to Gentry-Peck’s daughter. The teenager was never known to take street drugs, the mother said.

She was a girl who loved to read Dostoyevsky, Nietzsche and Edgar Allen Poe. She loved to write what her mom called “dark poetry.”

The 14-year-old had been taking medication to treat her anxiety and depression, but her mental health had worsened in the period leading up to her death.

Gentry-Peck had made an appointment for the girl at one of the island’s few providers of child and adolescent psychiatry services. She had waited months for the appointment.

The clinic abruptly canceled the appointment because of staffing issues, Gentry-Peck said. Not long afterwards, her daughter was dead.

It’s unclear if the girl intentionally killed herself or if she took the drug not realizing it contained fentanyl.

Either way, Gentry-Peck said she believes her daughter’s decision to take the drug was a way to self-medicate to ease her emotional and psychological pain, the kind that’s often hidden from public view.

“These wounds can’t be seen. These wounds are felt.”

A number of professional organizations declared adolescent mental health a national emergency in 2021 with approximately one-third of kids in this age group reporting poor mental health during the Covid-19 pandemic.

With the rates of teenage depression, anxiety, self-harm and suicide rising sharply in the U.S., the advent of fentanyl makes for a “perfect storm” engulfing adolescents and young people, said Gentry-Peck.

“It’s a clear and present danger,” she said.

Delivered to your door

Gentry-Peck learned that the fentanyl her daughter took was ordered from the internet and delivered to the family home by the U.S. Postal Service. Most fentanyl comes to Hawaii either by the post office, FedEx, or UPS, according to Yabuta.

The chemicals used to manufacture fentanyl often originate in China. They’re shipped to Mexico where they’re formulated into fentanyl at illicit labs run by cartels, he said. The drug then makes its way across the U.S. border.

From West Coast cities, the fentanyl is distributed to Hawaii mostly by air, said Yabuta, a retired Maui police chief.

Buyers can readily purchase it on social media platforms used by children, including Instagram, Snapchat and TikTok, said Dr. Kevin Kunz, a Big Island physician who specializes in addiction medicine.

Fentanyl’s easy availability is part of why the problem is so insidious. It’s relatively easy to get and it’s cheap, with a single dose fetching a street price of less than $20, according to the DEA.

“We’re in a new era of substance use in America. This is a new day. This isn’t your parent’s pakalolo. This isn’t Dad’s Budweiser or your Mom’s cigarette. Everything is much more potent,” said Kunz.

“You have no idea what you’re taking if you buy it on the street.”

By the street, Kunz means the internet, delivered to your door.

Getting Narcan Into Schools

Kunz is a member of the Big Island Fentanyl Task Force, an entity created in March to raise awareness of fentanyl’s growing presence on the island, to educate the public about its dangers and how to protect themselves, and to advocate for policy-level changes to address the growing problem.

Kimo Alameda is leading the effort. Born and raised on the Big Island, Alameda is a psychologist and vice president of business development with Hawaii Island Community Health Center.

Alameda is pushing hard to make a medication that reverses opioid overdoses more widely available to the public.

It’s called Narcan, the brand name for the generic naloxone. Narcan is an opioid antagonist that can quickly reverse an opioid overdose.

It can be administered through a nasal spray or by injection. If given to someone without opioids in their system, Narcan has no effect.

Alameda has organized two Narcan giveaways in Hilo and Kona recently where people drove up in their cars and received two free doses of the spray. Hundreds of Narcan kits were given away at the events.

Two more giveaways are coming up:  in Waimea on Saturday and in Kau on Jan. 21.

Alameda wants every public school in Hawaii to have Narcan on hand, just like other lifesaving medications and devices like EpiPens and AEDs.

EpiPens are auto-injectors of epinephrine to reverse the effects of a serious allergic reaction and AEDs are automated external defibrillators, designed to treat people experiencing sudden cardiac arrest.

Alameda would like to see Narcan become an over-the-counter medication. In the meantime, he thinks pharmacists should be required to provide it to anyone who receives an opioid medication by prescription.

“We can’t treat our way out of this problem. We have to prevent it,” Alameda said.

The Hawaii Department of Education is collaborating with the Department of Health and the Hawaii Keiki program to improve access to Narcan at schools, said Nanea Kalani, communications director for the DOE.

Narcan is already available at schools that have nursing services provided by Hawaii Keiki, a partnership between the University of Hawaii Manoa nursing school and the Hawaii Department of Education.

Planning for Narcan distribution to all schools is under development. Training sessions for key employees began in December and will continue early this year, Kalani said.

The Need To Reduce Stigma

While making Narcan widely available is an important step to addressing the Big Island’s fentanyl problem, access to mental health services is equally important, in Gentry-Peck’s view.

If her daughter had been able to see a child psychiatrist in a timely fashion, it could have saved her life, Gentry-Peck said.

“My daughter died while we were waiting for appropriate care,” she said.

Kunz, the addiction specialist, said CDC data indicates that 41% of teens who use substances are experiencing mental health challenges like depression and anxiety, he said.

“It’s an extremely high-risk group” of kids whose brains are still developing until around age 25.

Solutions to address the fentanyl crisis must include reducing the stigma around mental health and substance use, and also beefing up the health care system to treat mental illness and addiction adequately, according to task force members.

In America, if you have cancer, diabetes, or hypertension, you can usually find someone to treat you, assuming you have health insurance. Not so if you’re suffering from depression or drug addiction.

Kunz offered an example from his own life — his mother who died a few years ago at age 94.

“On short notice they would medevac her to Honolulu. But you can have a 16-year-old come in who is suicidal or using drugs that could kill them and we go, ‘We’re not sure what to do,’” Kunz said.

Mental health care, in some ways, is more complicated than surgery, Kunz says. With surgery, you can cut out the problem but mental health care requires relationship building that takes place over time. But that doesn’t mean it shouldn’t be prioritized, he says.

If one person is dying of a drug overdose on the Big Island every 11 days, that’s a tragedy worth addressing.

“If one person was being killed every 11 days by a serial killer, everybody would be up in arms. If the Ebola virus was here and we lost one person a year, everybody would be up in arms. Here we have disease where we are losing one person every 11 days, a life cut short, and we’re not putting the same resources into it as if you have a fingernail rash,” Kunz said.

“It’s kind of crazy.”

Read the report from the Hawaii High Intensity Drug Trafficking Area initiative: