Enough fentanyl to kill San Francisco: the new wave of the opioid crisis sweeping California

Photo: Patrick T. Fallon / AFP / Getty Images
When San Francisco police seized seven kilos of powder-filled bags containing the deadly opioid fentanyl last week, the city police chief warned the bust contained "enough fatal overdoses to wipe out the population of San Francisco four times."
However, drug addiction experts say the prey could be just a tiny fraction of the massive volume of the potent synthetic drug that inundated California after being primarily an east coast phenomenon for years.
The proof lies in the rapidly increasing death rates. The number of fentanyl overdose deaths in California has risen more than 2,100% in five years, state figures show. Synthetic opioid (mostly fentanyl) overdoses killed nearly 4,000 residents in the state last year, according to the latest estimate from the U.S. Centers for Disease Control and Prevention.
Nearly two drug users die a day in San Francisco, many of them on the streets of the city's Tenderloin District. In San Diego, Fentanyl is circulating among the homeless population, according to experts and current media reports. In the Santa Clara district, fentanyl deaths more than doubled in the past year, KQED reported, with victims on average younger than in previous years.
"Fentanyl moved west," said Dr. Daniel Ciccarone, an addiction medicine professor at the University of California at San Francisco. Ciccarone said the lab-made drug was barely seen in western states before 2017. Instead, he said, it used to be marketed by drug trafficking networks supplying the east coast, which they often put in heroin stocks without telling users.
In a newspaper published this month, Ciccarone describes the explosion of accidental overdose deaths west of the Mississippi as part of a "fourth wave" of the opioid crisis.
"The number of deaths from fentanyl is now increasing faster in the west than it is in the east," said Ciccarone.
In California, the drug is sold under its own name as a powder or tablets. It is also mixed with stimulants such as methamphetamines.
Fentanyl is so powerful that an amount small enough to fit under a fingernail can be fatal in minutes. Dr. Aimee Moulin, a professor of emergency medicine at the University of California, Davis Medical Center in Sacramento, said she overdosed on teenagers as young as 13 years old with counterfeit opioid pills that can be delivered to their homes over the internet.
"The potency is so high that a difference in concentration after the decimal point can be fatal," she said.
"This is older than the pandemic," said David Panush, the head of the California Health Policy Strategies consultancy, which produced a report that found fentanyl to be "largely responsible for the unprecedented growth in overdose deaths" in California. "The pandemic probably made it worse, but you had these addiction trends that skyrocketed and fentanyl is like pouring gasoline on a fire."
Another paper, co-authored by Stanford University researcher Chelsea Sover, said the west coast may be three years behind the same dire trend in overdose deaths that hit the east coast a few years ago.
"Given how fentanyl has so dramatically worsened the overdose death rate in the US while it is widespread in only one part of the country, its national spread could make the epidemic much worse," the journal Drug and said Alcohol Dependence report published.
Fentanyl is an attractive product for drug cartels because it can be cheaply made in secret labs abroad and can be substituted for more expensive drugs like the white powdered heroin commonly sold on the east coast or compressed into counterfeit pills sold as OxyContin or Percocet, according to the 2020 National Drug Threat Assessment by the US Drug Enforcement Administration. The Sinaloa cartel and the Jalisco New Generation cartel of Mexico have taken over production and distribution from previous sources, which included China, the report said.
The June 3 drug demonstration by the San Francisco Police in Oakland, which resulted in five arrests, the seizure of seven kilos of fentanyl, $ 45,000 in cash, and two unregistered "ghost weapons" was just the latest in a series of larger fentanyl Attacks in Northern California.
"Fentanyl remains the main culprit in the record-breaking number of fatal overdoses plaguing our city," San Francisco Police Chief Bill Scott said in a statement.
Related: Revealed: How Mexico's Sinaloa Cartel Created a Global Network to Rule the Fentanyl Trade
"And the recovery of semi-automatic ghost weapons along with this amount of deadly drugs that are most likely destined for the tenderloin is ominous."
However, Ciccarone said he had little confidence that the busts severely curtail supplies on the street.
"When I hear about these busts, I get a sense of fear," he said. "I see it as a sign that the supply has increased."
He believes more resources need to be used to curb drug demand by treating addiction and addressing the causes of overdose risk such as incarceration, unstable housing, economic stagnation and class-related despair.
"We just haven't received an adequate response to an uncontrolled crisis," he said, noting that although the nation has invested resources in tackling the opioid crisis, the death toll has still increased across the country, driven in part by the increase the overdose on the west coast. "America still doesn't have enough places for medication."
Dr. Moulin, who runs a program that enables drug users to easily be treated in any hospital in California, agreed.
"Opioid use disorder is treatable and we have powerful drugs," she said. "We just need an all-hands-on-deck approach."

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