‘One pill can kill’: Drug expert warns of fentanyl dangers and offers advice at La Jolla prevention forum

Narcan nasal spray is widely available now to treat fentanyl overdoses,
Narcan nasal spray is widely available to treat fentanyl overdoses, which are the leading cause of death for Americans younger than 50.
(Elisabeth Frausto)

Fentanyl overdoses now cause more deaths in the United States of people younger than 50 than anything else, according to the U.S. Drug Enforcement Administration. “It can happen to anyone,” says drug expert William Perno.

Perno, a senior prevention specialist with Social Advocates for Youth, or SAY San Diego, spoke at a fentanyl forum sponsored by La Jolla United Methodist Church and the La Jolla-based Seaside chapter of the National Charity League.

For the record:

2:42 p.m. May 22, 2023This article has been updated to correct the spelling of William Perno’s last name.

The second National Fentanyl Awareness Day presentation drew about 140 people to the church on May 9, including dozens of teenagers.

Perno, who also is a retired San Diego County sheriff’s deputy, detailed the dangers of fentanyl abuse and provided advice for preventing and treating overdoses.

Fentanyl facts

William Perno of Social Advocates for Youth San Diego discusses the dangers of fentanyl on May 9 in La Jolla.
(Elisabeth Frausto)

Fentanyl, developed in the 1950s for use as an anesthetic, is in the opioid group of drugs that includes heroin, morphine, oxycodone, hydrocodone and carfentanil, a drug 100 times stronger than fentanyl.

Fentanyl and other opioids work to alleviate pain by attaching to receptors in the brain. They are used in hospital settings for surgical procedures or childbirth.

Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine, Perno said, with a high risk for addiction.

One pill can kill

Though it treats pain, fentanyl kills when too much of it attaches to too many receptors, located in an area of the brain that controls breathing, Perno said.

That leads to slowed breathing, and the resulting lack of oxygen can end in organ failure.

Fentanyl’s real danger lies in its use in illicit street drugs, Perno said. It is mixed into everything from counterfeit prescription pills, tablets and powders to liquids, vapes, blotter paper and sprays in order to encourage addiction among users and thus more business for those peddling the drugs.

Two milligrams of fentanyl — an amount equivalent to a few grains of salt — can cause an overdose.

“One pill can kill,” said Perno, who added that six out of 10 pills on the street contain more than 2 milligrams of fentanyl.

Fentanyl is even more dangerous because it is odorless, tasteless and indistinguishable when mixed with other drugs.

There are test strips, but Perno advised caution when using them because concentrations of fentanyl can vary even within the same pill or dose when mixed illegally and improperly.

Skyrocketing statistics

About 140 people attended a forum at La Jolla United Methodist Church about the dangers of fentanyl.
(Elisabeth Frausto)

San Diego County has experienced surging numbers of fentanyl-related overdose deaths in recent years, Perno said, jumping from 92 in 2018 to 151 in 2019 and 462 in 2020 before ballooning to 814 in 2021, the most recent data available.

Perno said he knows of people as young as 13 who have died because of fentanyl. The typical age of victims ranges from 18 to 25, he said.

At the May 9 forum, eight people raised their hands when Perno asked if anyone was close to someone who died of an opioid overdose.

“Fentanyl doesn’t discriminate,” he said. “We’ve never had a drug this dangerous on the streets before.”

Access to fentanyl

Most adults and teens do not use drugs, Perno said. Those who do often gain access through someone else’s prescription or on social media, which can be used to send messages about pills and to arrange handoffs.

Most people obtain the drugs through a peer, Perno said. He urged parents to have repeated conversations with their children about drug use, including role-playing to help them resist peer pressure. He also suggested establishing texts to send to a parent if a teen is in an uncomfortable situation.

“Fentanyl doesn’t discriminate. We’ve never had a drug this dangerous on the streets before.”

— William Penro

Youths 12-18 are undergoing rapid brain development, which “makes them more susceptible to a substance use disorder,” Perno said.

“Kids now [may] make a one-time choice [with] devastating consequences,” he said.

Preventing an overdose can be as simple as not taking prescription medication unless it is in your name and you are certain it’s from an actual pharmacy, Perno said.

“Even if it’s [from] your best friend … even if it’s in a prescription bottle, you don’t know where those pills came from,” he said.

Recognizing an overdose

Drug expert William Perno demonstrates how to administer Narcan, an opioid overdose medication.
(Elisabeth Frausto)

Signs of an overdose mimic those of sleepiness, making an overdose difficult to discern.

With a fentanyl overdose, the body is limp and unresponsive, Perno said. The person is unable to wake up when prodded.

The unresponsiveness often is accompanied by an exaggerated, rough snore, indicating the body is “fighting for oxygen,” he said.

The victim might have small, constricted pupils, and the lips and fingertips may become blue if the person is light-skinned and gray if dark-skinned, another sign of low oxygen.

Responding to an overdose

If a fentanyl overdose is suspected, call 911 and report that the person not breathing or not responding, Perno said.

While waiting for emergency services to arrive, administer CPR and stay with the person, he said.

The drug naloxone (brand name Narcan) is now widely available to rapidly reverse the effects of an opioid overdose. The U.S. Food and Drug Administration in March approved Narcan nasal spray for over-the-counter use.

Perno said he hopes Narcan will become as ubiquitous as fire extinguishers among emergency supplies.

People who attended the forum received free boxes of Narcan, which is available at certain pharmacies and health centers without a prescription for $130 or for free at some other locations in San Diego County (a list is at

Narcan “won’t hurt anyone who doesn’t need it,” Perno said. “You can’t give a person too much.”

Each box of Narcan contains two sprays with one dose each. Doses can be given every two minutes until emergency responders arrive.

Narcan is not, however, a guaranteed cure, Perno said. “This can save a life. But it may not be enough.”

California has established Good Samaritan laws to protect those who perform CPR and inadvertently cause injury or those who are in the presence of controlled substances while helping someone suspected of an overdose, he said.

The city of San Diego is getting a $40 million cut of a settlement in a nationwide federal lawsuit targeting prescription opioid drug makers and distributors. The payouts will be made over 18 years, but the first $4.4 million is in hand.

The city is working with local agencies and organizations to decide how to spend the money to address the opioid crisis.

How to get help

San Diego County offers a free, confidential 24-hour Access and Crisis Line at (888) 724-7240, staffed by licensed clinicians.

To find resources including treatment providers, social workers and therapists, call 211.

Call 988 for the suicide crisis line.

— San Diego Union-Tribune staff writer Teri Figueroa contributed to this report.