Dying to get high — Part One

We may live in rural Northeastern California, nearly 100 miles away from a major metropolitan area. But it’s not far enough to remove us from the front lines of the opioid epidemic. We may turn our heads and believe it can’t happen here, but no matter how hard we try to act like nothing’s wrong — the deadly drug fentanyl and others take lives right here in our county, right here in our city. And things aren’t getting better. Local law enforcement tells us fentanyl use is on the rise.

This fentanyl scourge potentially touches all our lives. Some of the victims are experienced drug addicts playing another round of Russian Roulette chasing that always elusive high one more time, but some are unsuspectedly new to the drug world, experimenting and looking for that good time someone, somewhere told them about.

To some, the victims are just faceless, nameless, unknown casualties of the opioid epidemic. But to those of us who loved them, they are our sons and daughters, brothers and sisters, fathers and mothers, nieces and nephews, cousins and dear friends taken long before their time, leaving us only to grieve and remember. Ask anyone who’s lost someone to drugs, and they will tell you it’s a deep wound that never heals.

Remember even the rich and famous are vulnerable. Prince died of a fentanyl overdose, and Tom Petty succumbed to an opioid overdose (perhaps fentanyl). Why would such people be using street drugs? It’s a question for which we may never find an answer. They’re not here to tell us how it happened.

Fentanyl goes by a variety of names according to the Drug Enforcement Agency — Apace, China Girl, China Town, Dance Fever, Friend, Goodfellas, Great Bear, He-Man, Jackpot, King Ivory, Murder 8, Poison and Tango & Cash. It is snorted/sniffed, smoked, taken orally by pill or tablet, spiked onto blotter paper and patches, sold alone or in combination with heroin and other substances and has been identified in fake pills, mimicking pharmaceutical drugs such as oxycodone.

According to the Placer County District Attorney’s Office, fentanyl is now the number one killer of 18 to 45 year olds, surpassing car accidents and suicides.  Placer County saw a staggering 450 percent increase in fentanyl deaths from 2019 to 2021. Since taking office in 2020, PCDA Morgan Gire has made the fighting fentanyl crisis one his office’s priorities.

So, what is fentanyl?
Those who only get as far into the news as the brief soundbites on radio or TV probably believe fentanyl is a new drug, manufactured in China and smuggled across our southern border by the invading hordes from the Mexican drug cartels seeking to destroy America. And sure, that is happening.

But did you know Dr. Paul Janssen created fentanyl, a synthetic opioid, as an intravenous surgical analgesic way back in 1959. The drug is generally considered 50 to 100 times more potent than morphine. It was designed to treat severe pain after surgery or for advanced-stage cancer patients, and it is generally prescribed as transdermal patches or lozenges.

So, there are two kinds of fentanyl — pharmaceutical fentanyl and illicitly manufactured fentanyl. Most recent cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl. It is often added to other drugs because of its extreme potency, which makes the drugs cheaper, more powerful, more addictive and vastly more dangerous. It is often mixed with heroin and/or cocaine as a combination product to increase its euphoric effects. Some addicts on YouTube claim a person can become addicted to fentanyl with just one use.

But the real danger with these street drugs is much worse. According to the Centers for Disease Control, “There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700. Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illegally made fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine.”

The rates of overdose deaths in the United States involving synthetic opioids other than methadone increased by more than 22 percent for 2020 to 2021, and the 2021 rate was 22 times higher than the rate less than 10 years earlier in 2013.

Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths, and even in small doses, they can be deadly. You can’t see it, taste it or smell it and it is nearly impossible to tell if drugs have been laced with fentanyl unless you test your drugs with fentanyl testing strips. Testing strips are inexpensive, typically give results within 5 minutes, and can be the difference between life or death. But even if the test is negative, caution should be taken as test strips might not detect more potent fentanyl-like drugs, like carfentanil.

Fake rainbow oxycodone M30 tablets containing fentanyl.

Here are some things to look for if you suspect an opioid or fentanyl overdose:

  • Small, constricted “pinpoint pupils.”
  • Falling asleep or losing consciousness.
  • Slow, weak, or no breathing.
  • Choking or gurgling sounds.
  • Limp body.
  • Cold, clammy, and/or discolored skin.

Narcan Nasal Spray
Narcan Nasal Spray can help save a life if someone is overdosing. It is easy to use — no swabs or needles necessary. It is easy to use, even if opioids are not present. It works quickly, reversing an opioid overdose in minutes.

More on fentanyl to come. Watch this space.