‘One pill can kill’: Board of Supervisors declares illegal fentanyl a public health emergency

Citing the historic rise in deaths locally and nationally from fentanyl overdoses, the San Diego County Board of Supervisors unanimously agreed this week to declare illegal fentanyl a public health crisis.

Accidental fentanyl overdose deaths in the region jumped from 151 in 2019 to more than 800 by the end of 2021, according to county authorities. In the United States, opioid overdoses claimed more than 107,000 lives last year. Fentanyl now is the No. 1 cause of death among people ages 18-45 in the county and the country.

By declaring fentanyl a crisis, the board on June 28 directed county Chief Administrative Officer Helen Robbins-Meyer and Health and Human Services Agency Director Nick Macchione to develop a comprehensive strategy to address the problem. Officials want a holistic approach that includes reducing supply, cutting demand, educating users about the dangers, providing treatment, and distributing and tracking the use of naloxone, a nasal spray that can reverse the effects of opioid overdoses.

County staff was directed to return to the board in 180 days to update the supervisors on the plan.

Though no dollars were allocated with the crisis declaration, board Chairman Nathan Fletcher indicated that some of the $100 million the county believes it will receive from a lawsuit settlement with opioid manufacturers could be directed toward the effort. Hearings on setting funding priorities for settlement money have been scheduled for summer and early fall.

“We really need to focus so many more resources in a much more creative way on addressing this issue,” Supervisor Terra Lawson-Remer, whose District 3 includes La Jolla, said during the meeting. “We know it is going to take tactics across the board, from harm reduction to supply interdiction to prevention to education. ... I know this is an issue we have all talked about, but if we don’t have the tools at our disposal to really focus, then we are not able to make the difference that I think we all know we need to make.”

County officials have been sounding the alarm over the rise in fentanyl deaths. In early June, Supervisor Jim Desmond and District Attorney Summer Stephan hosted a virtual town hall directed at parents.

Officials are especially alarmed about a rise in deaths among youths. In 2021,12 people in San Diego County younger than 17 died from fentanyl overdoses, with the youngest being 13.

Fentanyl is a synthetic opioid that is 50 to 100 times stronger than morphine, according to the U.S. Drug Enforcement Administration. Pharmaceutical fentanyl was developed to help treat pain in cancer patients. Illicit fentanyl often is manufactured in Mexico and pressed into pills that look like legitimate medication such as OxyContin, Percocet and Xanax. Dealers can mix powder fentanyl with street drugs sold as heroin, cocaine and methamphetamine.

Officials are trying to get the word out that people can’t risk experimenting with drugs, particularly what they think are prescription drugs, because “one pill can kill.” Fentanyl overdoses don’t typically occur because someone took too many pills, Desmond said — it is more like a poisoning, because users think they are taking something else but unwittingly ingest fentanyl.

With its proximity to the U.S.-Mexico border, San Diego County is America’s largest gateway for fentanyl, Stephan told the board. In 2021, federal officials seized more than 6,350 pounds of powder fentanyl at the San Ysidro, Otay Mesa and Tecate ports of entry, according to the county. The DEA has said that four of every 10 counterfeit pills may contain a fatal dose of fentanyl.

Declaring fentanyl a public health emergency should help the county tackle the problem, Stephan said.

“Whenever the county has set its sights on a big complex issue, we have been able to break it down into pieces, resource it and really address it. And fentanyl deserves that attention,” she said.

Stephan said her office prosecuted 395 fentanyl dealers in 2020 and ’21 and charged five people with homicide when someone they sold to died.

But, she said, the fight against fentanyl can’t be handled by law enforcement alone.

Education about the dangers of the drug and other prevention steps also are needed — such as getting pediatricians involved in the public health fight, Stephan said. “At every intersection, whether it is a pediatric appointment” or when patients are getting shots, they should be told about the deadly effects of fentanyl “at every entryway,” she said.

Anyone dealing with an addiction issue can call (888) 724-7240 or 211. ◆