Synthetic opioids spread at alarming rates across the U.S.

As of September 2023, Narcan, the reversal medication for opioid overdose will be made available at Walgreens, CVS, Walmart and Rite Aid. The U.S. hit an all time record high of over 100,000 opioid deaths in the last two years. 

Nearly a decade ago, the opioid fentanyl made its first appearance in the streets, causing a major spike of availability and death rates, especially since 2018-19. The hazardous drug holds the power to kill a grown adult with less than two milligrams.

Fentanyl is 100 times more potent than morphine and 50 times more potent than heroin, the DEA has found. It is sold in counterfeit pills, powder form or in a combination of different drugs.

While the drug is commonly used in hospitals for surgeries and patients in immense pain, the dosage must be exact. Average amount for patients is 50 to 70 micrograms. Alarmingly, street fentanyl can contain up to 400 micrograms per pill. Just 100 micrograms is enough to fatally harm someone.

The chemicals to make fentanyl are manufactured in China, India and Pakistan and then sent to Mexico or Honduras. Fentanyl is mainly smuggled into the U.S. over the Mexico-U.S. border by Mexican drug cartels.

Paco Balderrama, second year police chief for Fresno PD, has dealt with the fentanyl crisis his whole term. Through his department, the DEA partnered with local law enforcement to create FORT, a team comprised of police, sheriff, homeland security and DEA members that respond to and investigate fentanyl overdoses.

“One of our main targets right now is the distribution of fentanyl in our community,” Balderrama said. “Fresno is a great stopping point for the cartels as it is right between LA and the bay area.”

Cartels mass-produce rainbow fentanyl pills in order to disguise them as prescription pills to deceive younger people. This has proven even more dangerous, as they tend to look like common candies.

Patil Armenian is a board-certified physician in emergency medicine and medical toxicology, and serves as an ER doctor at Community Regional Medical Center. She became an expert on the fentanyl crisis in Fresno, dealing with victims through all stages of drug use.

“We happen to be the microcosm of a macrocosm,” Armenian said. “The Fresno area is not isolated from this problem and our patterns very closely mimic the greater patterns in the state and the country.”

According to Balderrama, fentanyl has been seen as cheap as $5 per pill, and now, with modern technology, is easier to obtain. Social media is a common place to buy and sell drugs, creating a “fentanyl grub hub.”

There is no stereotype applied to the use of fentanyl. The drug affects everyone regardless of color, race or socioeconomic status. It can happen to anyone, regardless of how they present themselves. This makes it an equal opportunity offender.  – Patil Armenian

Many experienced drug users lack the knowledge that the drug they consume may be fentanyl or laced with fentanyl. Fentanyl is purposefully disguised as prescription or street drugs, including cocaine, vicodin, xanax and oxycontin.

“The landscape of the drug market changed when fentanyl started being laced into the opioid drug supply,” Armenian said. “If you get a pill at this point that’s not from a real pharmacy, assume the pill has fentanyl in it until proven otherwise.”

Fentanyl is commonly sold in M-30 pill form, which mimics other prescription drugs. This enforces the mindset of “fentanyl until proven otherwise.”

Because of this, those who overdose do not fit the stereotype of a drug addict. The only way to know whether something contains fentanyl is to use a fentanyl testing strip, but even that may not pick up fentanyl-like drugs.

“There is a lot of stigma around drugs, where people want to say ‘not in my neighborhood,’ ‘not in my family,’ ‘not in my school,’” Armenian said. “Anyone who acts like drugs aren’t in their community is lying to themselves.”

There is no stereotype applied to the use of fentanyl. The drug affects everyone regardless of color, race or socioeconomic status. It can happen to anyone, regardless of how they present themselves. This makes it an “equal opportunity offender,” according to Armenian.

Laced drugs also lead to drug addiction. Eventually, people start actively seeking out fentanyl to avoid withdrawals.

Mental health conditions are leading causes in drug abuse which is something to take into consideration when evaluating drug usage. Growing anxiety and pressure amongst teens has encouraged the use of various coping methods.

An anonymous Fresno Christian high schooler confessed their struggles with mental health, revealing that teens are immensely affected by their surroundings.

“Since my parents divorced I started doing drugs, they haven’t even noticed,” they said. “At this point I don’t think they would even care if I die. I don’t.”

Fresno County District Attorney Lisa Smittcamp now spends over half her time dealing with fentanyl related issues. She helps lead an awareness campaign for the community, as well as prosecuting drug related cases.

Teens are also becoming numb to the risk factor, even as the “threat matrix is greater” according to Smittcamp. It only becomes worse as drug traffickers focus on kids wanting a cheap, quick high with instant gratification.

“The difference between when I was young versus now is that when we made those mistakes, the chances of us dying were very slim,” Smittcamp said.

Starting in 2010, opioid poisonings occurred more than car crashes. Now, poisonings happen more than car crashes and gunshot wounds combined.

Between Jan.- Aug. 2022, there have been 25 documented deaths by fentanyl overdoses in Fresno. This does not include any deaths that occurred without the city’s knowledge.

“With fentanyl, you might as well put a gun to your head,” Balderrama said. “You could take a revolver, put three bullets in it and start pulling the trigger.”

The young overdose victims seen by Balderrama tend to be 15 to 16 years old. However, it has been known to affect those as young as 12 to 13.

Many teens aren’t looking to use fentanyl. They are experimenting, like young people tend to do, and are paying for it. The problem with fentanyl is that it doesn’t give people second chances.

“The unfortunate part is we’ve found so much fentanyl in pills that even one can kill an adult size person,” Armenian said. “You take this one pill and it actually does have the potential to cause an overdose.”

Preventative measures are available

Narcan (naloxone) can be used to reverse the effects of opioid overdose, specifically fentanyl, by restoring the part of the brain that allows for involuntary breathing. It is primarily injected through a nasal spray sprayed into one nostril of an overdose victim.

However, Narcan doesn’t always work the first time, which can require multiple doses. Narcan can cost anywhere between $130-140 for a two dose package over the counter.

With fentanyl, you might as well put a gun to your head. You could take a revolver, put three bullets in it and start pulling the trigger. – Paco Balderrama

Police and fire departments began carrying Narcan in 2019. They are trained on how to use it in case they encounter a civilian on a call who is overdosing, or if an officer is exposed to fentanyl and needs to be saved.

“Every officer is an expert on fentanyl now,” Balderrama said. “We carry narcan in every police car in case we encounter a citizen having an overdose or one of our officers is exposed to fentanyl.”

Narcan is available for free to the public at a few different locations. Anyone can walk into Regional Community ER and Clovis Community ER without registering as a patient and request Narcan. It is also available at Fresno County’s public health office downtown in their triage area.

The county of Fresno, under the leadership of DA Lisa Smittcamp, started many campaigns to combat the fentanyl crisis in the area. Billboards, TV and radio ads, geofencing around schools and local PSAs have been pushed out in an effort to educated and inform citizens.

“This fentanyl education and awareness campaign really showed us how important it is to have a public information officer at the DA’s office,” Smittcamp said. “To tell the community what we’re doing.”

The DA office also works to interact with addicts, steering them towards rehab. They are also working with hospitals to create a new drug testing protocol that is specific to fentanyl, as there is none currently.

What happens to dealers who knowingly distribute fentanyl? Currently drug related cases fall under AB 109, which moves criminals from state jail to county jails with very limited space. Prosecutors successfully find ways to increase fentanyl related cases to second degree murder charges for repeat offenders.

Narcan is available on Fresno Christian’s campus. Teachers will be given the opportunity to attend an optional training course to learn how to administer Narcan in the case of a student overdose.

Fresno Christian also hosted a Town Hall on Wednesday, Nov. 9, led by Lisa Smittcamp in the GL Johnson Chapel with 50-60 attendees.

Balderrama views this as an issue that may be solved with honesty between young people and their authority figures. Adults must expose kids to what is truly going on, even if it may seem scary, as that is the only way to get through to some people.

Being tough on teens is important, according to Balderrama, but it is also important to treat them with fairness and honesty. A good samara tin policy, or safety net, is always helpful to have with young people. It shows that you care and provides them a safe place if they ever find themselves in trouble.

If you or someone you know may be struggling with drug use, call 1-844-289-0879, California’s toll free Drug Abuse Hotline.

 

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Infographic created by: Zoe Bull

To learn more about fentanyl in the Fresno area, watch ABC30‘s Emmy nominated documentary Killer High: The Silent Crisis. [Warning: Graphic Content]

The Institute of Human Anatomy produced Why Fentanyl Is So Incredibly Dangerous, detailing the effects of fentanyl on the body.

In a National Geographic episode of Trafficked, Mariana Van Zeller goes undercover with a Mexican drug cartel to better understand the process of making fentanyl. [Warning: Graphic Content]

To read more from The Feather, go to Seniors honored with AP awards or Bob Cole: the 100-year-old WW2 survivor.