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TALANOA – a Cultural Psychoeducational Approach with Pacific Islander youths on Fentanyl
“O le tele o lima e mama ai se avega”
 “E so’o le fau i le fau”
“E le tu fa’amauga se tagata”
Whether spoken in Samoan, Maori, Hawaiian, or other indigenous languages of the Pacific Islands, the message of these adages remains consistent throughout time and emphasizes the significance of collective collaboration in addressing community concerns.
The exponential rise of fentanyl-related fatalities among adolescents necessitates urgent attention and culturally sensitive interventions.  From 1999 to 2021, reported juvenile opioid poisonings involving fentanyl increased from 5% to 94%. Since 2013, there has been a 3,000% increase in fentanyl-related mortality among children and adults (Gaither, 2023). In 2021, 133 deaths were attributed to fentanyl, impacting vulnerable children. The US is grappling with its deadliest drug crisis, with over 100,000 Americans dying from overdoses and poisonings between August 2021 and August 2022, primarily due to fentanyl (To the Point: The Fentanyl Crisis, Why Now, Why so Deadly? 2023). 
A study that looked at factors that were associated with indirect exposure to and knowledge of fentanyl among youth reported that 56.5% of participants were unaware of fentanyl, and 53.6% knew someone who would likely be exposed to it if taking drugs (Manuel et al., 2024). The research indicated that over half of the participants knew nothing about fentanyl, and half knew someone who would be exposed to it if they used narcotics. Moreover, the study revealed that multiracial youth were more likely to encounter fentanyl indirectly. Asian American, Pacific Islanders and Native Hawaiian youth were less informed about fentanyl, potentially due to limited access to information and resources (Manuel et al., 2024). Amidst this dire landscape, it is imperative to equip Pacific Islander youths with the knowledge and skills to navigate the fentanyl epidemic safely.

Why Fentanyl Is The World’s Deadliest Drug?

“The proliferation of illegally manufactured fentanyl poses a grave threat to public health, with pharmaceutical fentanyl, originally intended for severe pain management, being diverted into illegal markets (CDC, 2023).” According to the Centers for Disease Control and Prevention, pharmaceutical fentanyl, a strong man-made opioid, is given for intense pain, commonly used in treating advanced cancer. Recent overdose and death instances in the U.S. are connected to illegally produced fentanyl, frequently combined with heroin or cocaine. Fentanyl is 100 times more potent than morphine, codeine, or heroin at delivering a specific effect. This potent synthetic opioid, surpassing morphine and heroin in potency, has fueled a surge in overdose deaths and poisonings, exacerbated by the COVID-19 pandemic (CDC, 2023). From 2020 to 2021, synthetic opioid overdose deaths, including fentanyl and analogs, went up by 22%, roughly 22 times higher than in 2013.

How is Fentanyl Illegally Used?

Many individuals unknowingly consume illicit fentanyl. Some dealers advertise pills as typical pain medication, such as Percocet or OxyContin (Casil, 2020) and frequently contain fentanyl. Prolonged usage of these medications can result in addiction, accidental poisoning and death. Swift identification of fentanyl overdose symptoms is critical in averting fatalities. The mnemonic "BBLUE" serves as a mnemonic aid, encapsulating key indicators, such as shallow breathing, cyanosis, and unconsciousness, signaling the need for immediate intervention (To The Point: The Fentanyl Crisis, Why Now, Why so Deadly? 2023).

Recognizing the Signs of Fentanyl Overdose 


B: Breathing is shallow, slowed, or absent
B: Blue or gray skin and/or lips
L: Life-threatening snoring or gurgling sounds
U: Unconscious
E: Emergency! Seek Help immediately!
As we highlight the necessity of recognizing overdose indications and intervening quickly, it becomes clear that tailored approaches are necessary to address the needs of diverse communities. The escalating opioid-related deaths among teenagers must be addressed with consideration to Pacific Islander youths. Cultural nuances and community dynamics play a significant role in shaping awareness and prevention strategies. So, the goal is to promote a culturally appropriate intervention that empowers Pacific Islander communities to effectively address the increasing problem of opioid usage and protect the well-being of our young people. 

TALANOA – A Culturally Tailored Approach for Awareness & Prevention

In addressing the fentanyl crisis among Pacific Islander youths, the TALANOA approach emerges as a culturally resonant framework for fostering dialogue and awareness. Rooted in Samoan principles, TALANOA embodies inclusivity, respect, and collaborative discourse (Seiuli & Malaela, 2013). This approach, delineated by its acronym, emphasizes trust-building, active listening, and shared navigation of sensitive topics.
TALANOA is a Samoan term for a process of inclusive, participatory, and respectful dialogue. Applying this approach can make discussions about fentanyl awareness more engaging and effective with your Pacific Islander teen.


Establishing a safe and accepting environment for discussing sensitive or taboo topics is the first step in establishing trust.


Be accessible, welcoming and open so that your youth feel at ease discussing their questions or problems with you.


Practice active listening with your youth, giving them the opportunity to share their thoughts and emotions without being interrupted.


Asking open-ended questions that encourage meaningful responses is a great way to encourage dialogue. Be curious and show genuine interest in what your youth has to say. You can also ask questions like “Have you heard of fentanyl and how dangerous it might be?”


While avoiding an approach that is similar to a lecture, you should steer the conversation together in order to encourage participation. Remember “talk with” your youth not “talk to” when having these conversations.


Explain the dangers and effects of fentanyl in a way that is both accurate and suitable for your youth. 


Make sure your youth understand everything by addressing any questions or misunderstandings they may have. Let your youth ask you questions, and take the time to answer any concerns they may have.
Most Pacific Islander communities thrive on relationships. Hospitality and community service build trust. To TALANOA, or discuss taboo matters like drug use, addiction, and overdose, Pacific Islander parents must build a strong relationship with their teens. In most Pacific Islander communities, close family ties are very important. A Samoan concept,‘teu le va,’ emphasizes the need to nurture and cherish the relational space within one's family and extend that care to the wider community (Seiuli & Malaela, 2013). When this safe and accepting relational environment is fostered and nurtured, it can help Pacific Islander families deal with issues such as addiction or overdose that their youths might encounter. This trusting environment can also ensure that both cultural beliefs and values are passed down through generations, especially when it comes to addressing these tapu or taboo topics. 
Incorporating the TALANOA approach transcends cultural boundaries, offering a universally applicable method for fostering understanding and addressing sensitive issues like the fentanyl crisis. By embracing the principles of inclusivity, respect, and collaborative discourse inherent in TALANOA, individuals from diverse cultural backgrounds can create safe spaces for dialogue and effectively tackle pressing societal challenges. Whether in Pacific Islander communities or beyond, the TALANOA approach is a beacon of hope, guiding conversations toward empathy, awareness, and actionable solutions.


Alexander Street (Producer), (2016). Relapse and Recovery: The Screening, Assessment & Treatment of Substance Use Disorders Part 1. [Video/DVD] Alexander Street. https://video.alexanderstreet.com/watch/relapse-and-recovery-the-screening-assessment-treatment-of-substance-use-disorders-part-1

Amy Sterling Casil. (2020). Fentanyl: The World’s Deadliest Drug. National Highlights Inc.

Gaither, J. R. (2023). National Trends in Pediatric Deaths From Fentanyl, 1999-2021. JAMA Pediatrics, 177(7), 733–735. https://doi.org/10.1001/jamapediatrics.2023.0793

Manuel, J. I., Baslock, D., DeBarros, T., Halliday, T., Pietruszewski, P., Plante, A., Razaa, J. W., Sloyer, W., & Stanhope, V. (2024). Factors Associated With Indirect Exposure to and Knowledge of Fentanyl Among Youth. Journal of Adolescent Health, 74(2), 312–319. https://doi.org/10.1016/j.jadohealth.2023.08.040

Overdose data dashboards - King County, Washington. (n.d.). https://kingcounty.gov/en/dept/dph/health-safety/safety-injury-prevention/overdose-prevention-response/data-dashboards

Overdose outreach, education and training resources - King County, Washington. (n.d.). https://kingcounty.gov/en/dept/dph/health-safety/safety-injury-prevention/overdose-prevention-response/learn

Patty Housman (2023). To the Point: The Fentanyl Crisis, Why Now, Why So Deadly? (2023, May 17). American University. https://www.american.edu/cas/news/to-the-point-the-fentanyl-crisis.cfm

Seiuli, S., & Malaela, B. (2013). Counseling psychology from a Samoan perspective.