Whenever Marya Lieberman leaves her house or laboratory, one item is certain to be in her handbag: a single aerosol dose of naloxone, a fast-acting antidote to an opioid overdose.
“I haven’t yet had to use it,” says Lieberman, a Notre Dame chemist. The average person is more likely to encounter someone who has overdosed than someone who is experiencing a heart attack, she says, “and the efficacy of naloxone is 90 to 99 percent.”
Lieberman’s lab designs paper analytical devices (PADs) to solve chemical problems. For years she has conducted research that screens for dangerously high lead levels in older homes in South Bend. She and her team also developed PADs that can quickly determine the purity of medicines. More recently, she’s turned her attention to the scourge of street drugs.
The crisis started around 2000, when physicians and other medical professionals were legally prescribing opioids to their patients to treat pain and other ills. Many doctors didn’t think the drugs were as addictive as they are, Lieberman says. Soon, though, the drugs were everywhere. In St. Joseph County in 2015, physicians wrote 115 opioid prescriptions for every 100 residents — more than one prescription per person, she points out.
As opioid-related deaths soared nationwide, efforts mounted to reduce the drugs’ supply. Some addicted people then switched to street heroin. “And then around 2018 or 2019, heroin started to get mixed with fentanyl,” Lieberman says.
“Fentanyl is about 50 times stronger than heroin, but it’s not used pure. It’s always mixed with some kind of carrier material,” she explains. “The reason people die from overdoses is because the drug that they’re taking is changing rapidly.”
No region has been spared during the opioid crisis in the United States. Drug overdose deaths in Indiana quadrupled in the 2000s and early 2010s. From 2012 to 2016, deaths related to synthetic opioids in the state rose by more than 600 percent.
Around that time, Lieberman began wondering how she could address the problem. She realized her lab could test for the varieties and strengths of synthetic opioids circulating in the community.
They encountered many hurdles while getting started.
As the first Notre Dame facility to work with illegal drugs, the lab had to obtain licenses from the Indiana Board of Pharmacy and the U.S. Drug Enforcement Administration. Lieberman had get-acquainted meetings with the St. Joseph County prosecutor and sheriff. In 2018, she created an extra-secure research area within her existing lab space, complete with an 850-pound safe and a video feed monitored by local law enforcement.
As fentanyl and other synthetic drugs became more prevalent, users often didn’t know the potency of what they were taking. Overdose emergencies again increased dramatically. “Some users were thinking they were buying heroin or fentanyl. But it turns out there’s a whole bunch of other synthetic varieties that are similar but not identical,” says Lieberman, a 28-year faculty member in the Department of Chemistry and Biochemistry.
Heroin and the synthetics look alike. “They’re both white powders. You can’t tell them apart by sight,” she says.
Lieberman and her colleagues identified many variants of fentanyl of differing potencies in local circulation. They found other drugs as well, including xylazine, an animal tranquilizer.
In this work, Lieberman’s lab relies on commercially sold paper test strips that can signal what type of opioid is present in a sample. These test strips can generally identify scores of fentanyl analogs — illicit and often deadly alterations of the drug. “The concentration of fentanyl in those street drugs could vary from half a percent to 10 percent,” she says. Her lab — which includes undergraduate student research assistants — also examines the effectiveness of existing test strips, determining which brands can’t adequately detect all fentanyl analogs.
To get test strips into the hands of drug users or people in recovery — who might be in regular contact with others who are still using — Lieberman partners with Naxos Neighbors, a South Bend-based nonprofit harm-reduction organization that educates the public and distributes naloxone in an effort to save lives.
In 2023, Naxos Neighbors began producing kits that include test strips, a small tube of clean water, gloves and a postage-paid mailing envelope. The used strips can be mailed to Lieberman’s lab anonymously to test for more than 70 types of drugs. The lab shares results with Naxos Neighbors, which in turn provides information to first responders and others who may encounter the drugs in their work.
“It could help to predict future overdose crises before they happen,” Lieberman explains. “It could help first responders understand better what they’re likely to be faced with when they’re called out to an overdose. They are called out to several overdoses a day.”
Overdose deaths in the U.S. now appear to be declining sharply. Preliminary data, compiled by states and released by the Centers for Disease Control and Prevention in August 2024, show a 10 percent drop in deaths during the 12-month period ending the previous April. Still, more than 100,000 people died from overdoses in that timeframe.
Lieberman says the data appear to be accurate, but the decline in overdose deaths does not reflect a decline in emergencies, or in the use of these drugs. Instead, experts attribute the drop to the greater availability of naloxone, which is not a cure-all but can restore normal breathing to an overdose patient within three minutes. And, when a person overdoses, they’re more likely to be using a drug with another current or former user who knows how to use the overdose-reversal medication, she says.
Lieberman and her team hope eventually to partner with organizations across the Midwest. “We can be a regional center to help get a better understanding of the drug supply that’s killing so many people,” she says.
As the work has progressed, she has been surprised and touched by people at Notre Dame who have shared personal stories about themselves, relatives or friends directly — and sometimes tragically — impacted by the opioid crisis. “People need to understand this is not a problem for other people,” she says. “Everyone needs to solve this together.”
Margaret Fosmoe is an associate editor of this magazine. She can be reached at mfosmoe@nd.edu.