Raising Awareness and Knowledge: Employer Investments in Public Health and Public Safety

The Milken Institute’s Employer Action Exchange (EAE) provides a trusted platform that includes expert guidance, briefings, and networking led by the Public Health team to advance customized, tangible actions on whole-person health priorities . Employers have a unique opportunity to serve as critical partners in advancing public health and public safety priorities.

As part of the EAE, in April 2024, the Public Health team held a briefing titled, “Employers at the Intersection of Public Health and Public Safety,” hosted by Frank A. Tarentino III, special agent in charge of the Drug Enforcement Administration’s (DEA) New York Division. The briefing brought together employers and leaders to explore the intersections of public safety and public health and to understand the risks posed by global illicit financing and synthetic drugs. The remarks shared by both the DEA and attending stakeholders focused on advancing three key priorities: fostering trust, pursuing a whole-of-society approach, and stressing prevention through education .

One of the biggest threats to communities across the US is counterfeit pills that contain fentanyl. Mass-produced by drug cartels, these replicas are so well made that they are nearly indiscernible, even to experts, from the legitimate pills manufactured by pharmaceutical companies. Fentanyl has taken the lives of tens of thousands of Americans, many of whom took the drug unknowingly, believing they were taking a pharmaceutical product.

When we consider workforce safety, we often think in terms of our physical safety. In recent years, however, there has been growing recognition of the need for psychological safety in the workplace, often accomplished by shaping workplace culture through internal policy changes. By sharing public health announcements and resources, employers can make a positive impact not just on their employees' health, but also on the health of the communities in which they operate.

The impacts of fentanyl sit at the juncture of both physical and psychological safety. Employers are positioned to advocate for policy change on systemic fentanyl interventions, due in part to their sizeable collective reach, which spans the local communities surrounding them to their operations in national and/or global markets. The fentanyl crisis is both a national and international threat, in which employers can make actionable impacts through their internal and external investments as well as policy change. As reported by the National Conference of State Legislatures, Congress, and the Health Resources and Services Administration, policy changes can take the form of legislative efforts at both the state and federal levels of government, ranging from increased awareness about the crisis to enhanced funding levels, collectively part of the whole-of-government approach. This is why the DEA, Centers for Disease Control and Prevention (CDC), and the White House have all made recent investments and commitments to counter the fentanyl crisis.

Several DEA divisions are partnering with employers to align whole-person health efforts at the intersection of public health and public safety. Two examples come from major metropolitan areas in the United States: Washington, DC, and New York City. The lessons from both divisions can be adapted and applied in other locations to protect lives and advance whole-person health.

Building on the insights and actions from the briefing held in New York, Sabrina Spitaletta, senior director, Public Health at the Milken Institute, sat down with Jarod Forget, special agent in charge of DEA’s Washington Division, to gain additional learnings from another region, discuss the impact of fentanyl in the District of Columbia, Maryland, and Virginia (DMV), employer involvement as partners in public health and safety, and the purpose of the DEA Washington Division’s Annual Family Summit.

What are the biggest public health and public safety issues you have seen with fentanyl in the DC/Metro region?

The DEA is a federal agency entrusted with enforcing the controlled substance laws and regulations of the United States. We use three main strategies: 1) Enforcement: Enforce controlled substances laws and regulations of the US; 2) Regulation: Monitor the system of distribution of all controlled substances, including prescription drugs; and 3) Outreach: Initiatives and resources aimed at reducing the availability of illicit controlled substances in domestic and international markets. We are seeing many of our fellow citizens, especially our young people, exposed to a powerful illegal drug supply. Just like the rest of the country, communities in the DMV are experiencing an uptick in youth overdoses and fentanyl poisonings, especially on school grounds. Fentanyl remains the deadliest drug threat facing our country and is often accompanied by violent crimes in our communities.

Moreover, with the proliferation of smartphones, criminal drug networks are using social media to sell fake pills containing fentanyl and methamphetamine that look identical to real prescription pills made in FDA-approved labs. Social media extends the reach of the Drug Trafficking Organizations (DTOs) directly into phones, with potentially fatal consequences. DTOs use social media to advertise and conduct illicit drug sales. Illicit individual distributors and buyers often use emojis, numeric codes, or coded language to communicate drug availability and drug interest. Social media allows illicit individual distributors to post photos and prices of the drugs available for purchase, share sales locations via map pins, deliver drugs to customers through rideshare applications, and communicate with their criminal partners and customers through open or encrypted messaging apps. Social media pushes much of the drug dealing off the streets, shielding the illicit individual distributors from law enforcement attention. Street crews and gang members also recruit new members using social media platforms. Also, these platforms and apps are used to boast and glamorize travel, money, cars, weapons, and clothes, and to intimidate rival criminal groups by brandishing weapons, bragging about crimes committed, or threatening acts of violence. Social media drug trafficking affects all age groups; however, adolescents and young adults are particularly susceptible given their high rates of social media use and stages of brain development. The DEA has connected social media drug sales to poisoning deaths, and the National Crime Prevention Council estimates 80 percent of teen and young adult fentanyl poisoning deaths can be traced to some social media contact, as reported by PBS News.

Individuals should only take pills prescribed by their own licensed health-care professional and dispensed by a trusted pharmacy. Illicit fentanyl, which is a synthetic opioid, and methamphetamine are widely available throughout the DEA Washington Division’s area of responsibility. Their distribution is attributed to local gangs and drug trafficking networks that maintain connections with the Sinaloa and Jalisco Cartels in Mexico. In 2023, the DEA Washington Division saw a surge of over 250 percent in fentanyl pill seizures. Maryland recorded the largest increase in fentanyl pill seizures with 132,000 pills, a 471 percent increase over 2022 totals. Virginia seized over 415,300 pills in 2023, which was a 260 percent increase from the previous year. The number of pills seized in the District of Columbia increased by nearly 60 percent, from 17,500 in 2022 to 27,600 in 2023.

The Centers for Disease Control and Prevention, for the 12-month period ending in June 2023, estimates that 112,323 Americans died from drug poisonings in the United States, for which approximately 70 percent involved fentanyl. To visually capture the magnitude of this number, this is more people than any college football stadium can hold at maximum capacity.

It’s heartbreaking how many lives have been lost to fentanyl, and what's worse is how many didn't even know they were taking it. Just two milligrams, the amount that fits on the tip of a pencil, can kill someone. A DEA analysis of fentanyl pill seizures determined that seven out of every 10 pills (or 70 percent) contained more than two milligrams. Many deaths are also attributed to fentanyl mixed with other illicit drugs like cocaine, crack, and meth, with many users unaware they were taking fentanyl mixed in with those drugs. Our teams are constantly monitoring the news and reaching out to local and state government officials, including schools, to offer our operational expertise and resources to support their efforts in addressing this national poisoning crisis.

What are the most productive actions employers can take as partners in the community?

We understand that law enforcement alone is not enough, which is why the DEA maintains a variety of resources for local and state governments, health care and drug prevention professionals, employees, businesses, youth, parents, caregivers, and educators to promote education and awareness about the handling, use, and misuse of controlled substances (including prescription drugs). Acknowledging the reality of opioid misuse in the workplace is a productive step for any business and a benefit to every community. A great tool for both employees and employers is our Operation Prevention website, created in collaboration with Discovery Education. Operation Prevention is a no-cost, award-winning educational program designed to inspire life-changing conversations and equip people from all walks of life with the knowledge and refusal skills they need to steer clear of substance misuse. The program’s workplace section tapped into the expertise of scientists, adult learning specialists, and instructional designers to raise awareness and knowledge about the opioid epidemic, specifically for adults. The program includes four self-paced, interactive, evidence-informed modules, complete with a confidence rating assessment at the end of each module. With the help of Operation Prevention, employers can empower their staff and strengthen their organization with simple, no-cost workplace resources that increase awareness of the opioid epidemic, including perspectives on science, health, society, and the legal system.

It is critical for employers, parents, caregivers, students, and educators to understand the dangers of substance misuse. Employers can support caregivers in learning about drug threats and staying informed and aware of the ever-evolving drug landscape, as well as prevention-related resources. As the drug landscape has grown dramatically different even from just a few years ago, it is important that caregivers of youth learn about current drug threats to be able to have informed conversations with their children and families, to teach them about controlled substances and about caregivers’ expectations if they are offered drugs. These conversations are not a one-time event. Caregivers should start talking with children when they are young; continue as they grow older and their level of interest and understanding changes. The willingness to talk (and listen) tells them you care about what they are interested in and provides caregivers with insight into their world. Conversations should include topics like the consequences of using substances, such as how even the one-time use of substances can lead to misuse and a substance use disorder. Caregivers can continue to teach and encourage wise choices around healthy living while establishing rituals that afford uninterrupted conversations with children, such as having meals or a brief, after-school walk together. Each of these examples provides an opportunity to check in with each other and develop a trusted relationship of open honesty and self-expression.

Having open and honest conversations about these risks can help keep our loved ones safe and healthy, and we should not underestimate the far-reaching impact that a single conversation can have.

Could you tell us about the DEA Family Summit and its purpose?

As I mentioned before, we acknowledge that while law enforcement is important, we know it is not the only solution. We believe that a more comprehensive approach involving engagement with those impacted by violent drug trafficking organizations is essential to making a meaningful impact. On June 18, the DEA Washington Division hosted its third Family Summit in support of those who have lost loved ones to fentanyl poisoning in the DMV. In alignment with DEA's mission, the event provided opportunities to disseminate information about current drug threats, educated attendees on how DEA can assist families and organizations in their prevention efforts, and offered a platform for family members to narrate their experiences, establish connections, and pinpoint potential areas for collaboration among family groups.

The summit, held at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, saw a strong turnout with over 90 participants, including families from throughout the DMV. The diverse array of participants significantly contributed to the event's success, enriching the experience with both emotional depth and educational value for all attendees. Throughout the day, attendees heard remarks from DEA Administrator Anne Milgram and several US Attorneys, including Jessica Aber of the Eastern District of Virginia, Matt Graves of the District of Columbia, and Erek Barron of the District of Maryland, who collectively discussed what steps can be taken from a litigation perspective to address the fentanyl crisis in the DMV. Experts from the Johns Hopkins Bloomberg School of Public Health discussed public health interventions to reduce harms associated with drug use and engage individuals in effective treatment programs.

Attendees were also able to learn updated information regarding local opioid settlements and opportunities for the families to become involved. Based on the feedback from previous events, the program also included a session about the legal process of prosecuting federal fentanyl death cases. Two discussion panels in the afternoon offered attendees an opportunity to hear directly from multisectoral speakers. “Champions of Change” panelists shared examples of ways they turned their experiences into power, while “Conversations: Approach for Safer Schools” panelists focused on strategies for collaborating with schools to educate children, school staff, and parents on the availability and dangers of drugs mixed with fentanyl.

Resources for Education and Increased Awareness

• CDC | Overdose Prevention Education and Learning Hub
• Substance Abuse and Mental Health Services Administration | Overdose Prevention Toolkit
• US Department of Health and Human Services | Overdose Prevention Strategy
• The White House | White House Challenge on Saving Lives from Overdose
• DEA | One Pill Can Kill
• DEA | Operation Prevention
• DEA | Community Outreach (Education and Prevention)
• DEA | Take Back Day

Conclusion

The fentanyl crisis has seeped into the fabric of local communities across the US, exacting a high personal and societal toll with no industries or workplaces spared. As SAC Forget stated, the DEA Washington Division experienced more than a 250 percent surge in fentanyl pill seizures in 2023. Caregivers, parents, youth, schools, and employers can each work alongside the DEA to meet people where they are and protect our communities at the local level by both anticipating needs and sharing critical drug prevention resources. Being aware and informed is the first step in ensuring a positive impact on the health and safety of the communities in which we all live, work, and play.