FENTANYL KILLS
What is Fentanyl?
Fentanyl is a very potent drug more powerful than morphine, anesthetic or prescription drug and one of the most common drugs in overdoses. It is classified as “synthetic opioids” because they are man made in laboratories. It was first discovered by a Belgian doctor-chemist Paul Janssen when he was trying to improve morphine, his goal was to make a more potent chemical with less time duration. It was eventually developed in 1959/1960’s as an “intravenous anesthetic” made from precursor chemicals from opioid poppies. It’s currently classified as Schedule 11 narcotic under the United States Controlled Substance Act of 1970.
This drug is usually made and used illegally but was originally used to treat severe pain after surgery or illness like cancer. It is taken as shots, patches, powder, nasal spray, or lozenges that are sucked. Even the smallest amounts like two milligrams are powerful enough that people can easily overdose on it. Fentanyl is fifty to a hundred times more powerful than military grade morphine. It is referred to as Apache, China Girl, Dance Fever, Jackpot, and more on the streets.
Fentanyl is used in small doses which makes it easier to smuggle into the US or other places. It starts out as chemicals in China and is produced and shipped to Mexico, eventually making its way to the US. Because it’s cheaper to produce, it’s often mixed in with other drugs like meth or cocaine. While not much about the creation process or what other ingredients are added are known, it is chemically identified as (CAS-437-38-7) and its systematic name is N-(1-phenethyl)-4-piperidinyl-N- phenyl-propanamide.
How is Fentanyl Used
Fentanyl is mainly in the form of powder or liquid. When prescribed by a doctor it can be taken as a shot, patch, or as a tablet. When taken illegally, it is in the form of powder and is put into things like eye drops, nasal sprays or pills that look like other prescription opioids. It is often taken by accident since it is mixed into other drugs which can lead to overdoses.
Effects of Fentanyl
Because fentanyl crosses the blood-barrier, it is deemed as a fast-acting opioid, causing sudden pain relief, pleasure, and sedation. The effects experienced after taking it are similar to those caused by morphine, a medicine used to treat patients, usually after surgery, with severe pain and chronic pain. Effects include relaxation, euphoria, confusion, drowsiness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression, extreme happiness, constipation, mood swings, problems breathing, and unconsciousness.
Fentanyl directly targets the central nervous system. The body naturally produces a pain killer known as endorphins, otherwise known as endogenous opioids. They are released by the hypothalamus and pituitary glands when experiencing pain or stress and act on the opiate receptors to relieve pain and promote feelings of pleasure. Synthetic opioids such as fentanyl mimic these endogenous peptides, binding itself to the body’s opioid receptors, but are intensely more pleasurable. After taking fentanyl several times, the brain adapts to the drug, diminishing its sensitivity and slowing the natural production of endorphins, making it difficult to experience pleasure from anything besides the drug. This ultimately leads to addiction and dependency.
When there is a lack of opioids in the system, one may experience withdrawal symptoms such as muscle and bone pain, sleep problems, diarrhea and vomiting, cold flashes with goosebumps, uncontrollable leg movement, and severe craving. These symptoms are extremely uncomfortable and the reason why many people find it difficult to stop taking fentanyl. Addiction is the most severe form of a substance use disorder, SUD, which is compulsive drug seeking and drug use that can be difficult to control. It can range from mild to severe and can cause health problems or issues at work, school, or home. This can ultimately result in overdose and death.
The overdose effects cause changes in pupillary size, cold, and clammy skin, cyanosis, coma, and respiratory failure leading to death. Comas, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning. Synthetic opioids like fentanyl are now the most common drugs involved in drug overdose deaths in the United States.
Where Can You Access Fentanyl?
You can access fentanyl by using underground drug markets located all throughout the city where drug dealers will supply fentanyl in exchange for payment. You can also pay people to smuggle them through the southern border in between the U.S and Mexico. The southern border is also primarily where most fentanyl is distributed to then spread throughout the country. In addition to that, fentanyl can also be found mixed in other drugs such as heroin, cocaine, crack, meth, and ketamine. It can also be hidden in pills like painkillers or benzodiazepines such as xanax, valium, and more.
Most fentanyl is produced in Mexico and shipped to the US and it can be found in colored pills targeted to kids as a Mexican cartel marketing tactic. In the US, you can find fentanyl through the open air or underground drug markets nationwide. In San Francisco specifically, you can find the drug in neighborhoods like South of Market (SOMA), Polk, Civic Center, Tenderloin, and the Mission. While it is a prevalent issue in San Francisco, the issue of fentanyl use is global.
What Drugs are Laced with Fentanyl?
People do not always use fentanyl intentionally. Drug dealers may lace drugs with fentanyl to cheapen them and get customers hooked on a stronger and more addictive substance. Many common drugs can be laced with fentanyl, including heroin, cocaine, and methamphetamine. Pharmaceutical products such as fentanyl “lollipops” (Actiq), effervescent buccal tablets (Abstral), sublingual sprays (Subsys), nasal sprays (Lazanda), and transdermal patches (Duragesic) can also be laced with fentanyl. Pain relief pills, percocet, oxycodone, norco pills, prescription anxiety meds, and xanax can all include fentanyl. To illustrate the scale and danger of these counterfeit pills, 9.5 million counterfeit pills were seized by the U.S drug supply in 2021. Two pills out of every five contain a possible lethal amount of fentanyl. A large amount of these laced counterfeit pills were made by drug cartels and appear identical to authentic prescription medications.
Why Does the Fentanyl Crisis Need to be Stopped?
The fentanyl crisis in San Francisco is not an issue that can be ignored or placed on the back-burner. This crisis is on the rise, not the decline, and it needs to be stopped. In just the first five months of 2023, 346 accidental overdoses occurred. This is an over forty-percent spike compared to the accidental overdoses that occurred in the same time frame last year. Nearly eighty percent of these accidental overdoses are due to fentanyl alone. According to the U.S CDC, in 2010, SF’s overdose death rate was 13 deaths per 100,000 overdoses, while in 2020 it was 49 deaths per 100,000 overdoses. San Francisco has the highest per capita fatal overdose rate, which necessitates intense efforts to help stop the fentanyl crisis from increasing in severity. However, 2022 data from medical examiners and county coroners indicates that efforts to help the fentanyl crisis in the bay area are failing. Josh Luftig, the co-founder of CA Bridge, stated, “The systems of care that were in place, pre-fentanyl, were just not up to the task of a fentanyl epidemic.” To further illustrate the scale of the issue, San Francisco is poised to surpass the numbers of deaths by overdose of 2020, 2021, and 2022. However, the fentanyl crisis isn’t specific to San Francisco. Fentanyl has spread to neighboring counties, driving up the overall overdose number. In the year 2022, there were 273 overdoses in Santa Clara County, 355 in Alameda County, 54 in Marin County, and 81 overdoses in San Mateo County (not counting December data).
Fentanyl is often added to other drugs, leading individuals to unknowingly use fentanyl while pursuing a different drug. In San Francisco, young people have overdosed on fentanyl expecting to use cocaine, and it doesn’t take much fentanyl to cause an overdose. Just two milligrams of the synthetic opioid can be deadly.
The fentanyl crisis is causing a steep incline in overdose deaths. It’s also leading to the accidental overdoses of people who believe they are using a different drug. If we want the number of overdoses and deaths by overdose to decrease, the fentanyl crisis needs to be put to an end.
Root Causes
The concerning amount of fentanyl related overdoses brings into question how and why people are gaining access to it, especially when fentanyl’s lethality is so spontaneous.
When fentanyl is used for medical purposes, the dosage is heavily regulated and is usually very pure so it’s unlikely for patients to grow addicted to the substance purely from that. Fentanyl is a cheap and stronger alternative to other illegal drugs on the market, so drug dealers have been sneaking fentanyl into other illegal drugs without the buyer’s knowledge. These drugs consist of opiates, MDMA, heroin, cocaine, methamphetamine, oxycodone, etc. A former fentanyl dealer, Eric Falkowski has told ABC News he could make over ten times the amount of counterfeit opioid pills with a kilo of fentanyl rather than with a kilo of traditional components.
Many wonder why dealers do this when they are losing profits from essentially killing off their customers. These dealers believe that if they regulate the dosage of fentanyl, the amount of overdoses is minimized and its addictive qualities will outweigh the risk, ultimately creating a wave of returning customers. The reason fentanyl is so deadly and easily accessed by drug dealers is because of the lack of quality control in fentanyl production, and how much more impure street fentanyl is compared to medical grade fentanyl.
To go even deeper, the reason drug abuse has run rampant in America is due to a mix of both genetic and environmental factors. In an international study consisting of 100 scientists who studied the behaviors and characteristics of drug users, and then connected these observations to genes suspected of affecting substance abuse, had made the discovery of at least 566 variants in more than 400 locations in their genome that influence substance abuse.
Those who grew up or are currently struggling with poverty are more likely to be exposed to substances whether it be because of the community around them or to cope with stress. People who live in impoverished areas have easier access to drugs due to the lack of regulation in low income areas or because they have relatives who are already facing drug addiction. Social stressors could include unemployment, homelessness, family issues, lack of support systems, unstable relationships, tragedies, unresolved mental health disorders or trauma, etc. Any of these can cause dependence of drugs when there is no other option in the eyes of the user. The surge in teens using drugs has only increased with the popularization and desensitization of drugs in media, causing teens to use drugs recreationally which could quickly turn into a lifelong addiction. Another factor in this could be attributed to the decline in parental supervision that makes teens think they could drink and do drugs without their parents’ knowledge. This idea of secrecy and potentially getting caught could also fuel their chase for adrenaline, encouraging them to keep going.
How to Prevent Fentanyl Use
In the past California has made many attempts to try and stop the fentanyl crisis but as you can see they aren’t really working too well. We think one thing that California can do to help prevent people from overdosing on fentanyl is to add a bigger punishment to shoplifting. Although it sounds off topic shoplifting is actually how a lot of drug addicts get money for drugs which is how they afford the drugs. We think instead of making it practically fine to steal anything as long as it adds up to less than 1000 we should fine people or in some cases even arrest them for a few months. This would cause a lot of drug addicts to steal less or get punished for stealing so they won't be able to buy drugs.
What is the SF Government Doing Currently?
The SF government has partnered with the California government to work together in a joint operation between the SFPD, the San Francisco District Attorney’s Office, California Highway Patrol, California National Guard, and the California Justice Department. Since the joint operation started on May 1st 2023, the operation has seized 4.2 kilograms of fentanyl in San Francisco, enough to kill 2.1 million people. For example, that’s enough to kill all of San Francisco, San Jose, and Berkeley through overdoses alone. And the operation is still ongoing to this day, taking fentanyl off the streets of our city.
Economics of Fentanyl
Traditional Economic Law dictates that the higher the demand for the product, the higher the price. However, this hasn’t been the case for fentanyl and other opioids. Although demand for fentanyl has increased drastically, it is now cheaper than ever. This model encourages fentanyl consumption and leads to more and more people becoming addicted.
Fentanyl’s main competitors are heroin and crack. There have been many cases where people take fentanyl mistaking it for another drug, or accidentally consuming Fentayl laced substances. However, in SF, there is a specific demand for fentanyl. Because of the scarcity of heroin and higher prices, people have turned to fentanyl as a cheaper alternative.
The business of fentanyl is complicated and there are many physical factors that play into the trade as a whole.The cartel that produces and sells the bulk of the product have their own issues. A lot have been taken down by police or drug busts so that led to major complications within the trade. The cartel may be a criminal empire, but they are also a business, and a business can’t thrive without paying customers. Before, the cartel was concerned with keeping a good reputation with its customers, at the very least. Now, the cartel needs to focus on surviving in the market and selling products.
There is also a changing culture when it comes to drug dealers themselves. Before, drug dealers often specialized in what type of drug they dealt. Now, it is becoming more and more common for a dealer to have more than one drug on their person, increasing their chances of cross-contamination. Because of cross-contamination, more and more people end up taking fentanyl unknowingly and have to suffer the consequences.
In all, fentanyl seems counterintuitive for long-term business because of how dangerous the drug is. The common overdoses lead to killing most of the dealer's customers and their main audience. However, some dealers counter that this risk is worth it because it gives a cheap high. Either way, the drug is extremely addictive and guarantees a constant flow of customers- even if the previous waves die off.
What Policy Can Be Implemented?
We came up with some solutions for the current fentanyl crisis, here is a list of idea from our researchers:
Quantity restrictions and prescription limits: Setting limits on the quantity of painkillers that can be prescribed within a specific timeframe can help prevent stockpiling and reduce the likelihood of overuse or diversion for illicit purposes
Monitoring programs: Implementing prescription drug monitoring programs (PDMPs) allows healthcare providers and pharmacists to track patients' prescription history. This can help identify potential cases of "doctor shopping" or excessive use across multiple providers.
Public education campaigns: Educating the public about the risks associated with painkiller misuse, the signs of addiction, and safe medication practices can promote responsible use and raise awareness about the potential dangers of painkiller addiction
Stop the drugs from coming over from our southern border. Having better policies and better border patrol at our border
Stop giving out free money and use it on things that can solve the issue
Narcan
Narcan or Naloxone is a medication approved by the Food and Drug Administration (FDA) made to reverse an opioid overdose. The medicine binds to opioid receptors and can reverse as well as block the effects of drugs. Police officers nationwide utilize narcan to prevent overdoses as it is legal in all fifty states. In San Francisco specifically, the city has employed a drug overdose protection plan that hands out Narcan citywide through programs and people for free to prevent overdoses.
As it’s usually free, you can have Narcan mailed to you or people you know who may be at risk. The Narcan spray or syringe is sold over the counter at grocery stores, doctors offices, pharmacies, and does not require a prescription. It can be taken as both but it is more commonly used as a spray because they are more effective. Narcan sprays are proven to be more impactful than syringes with a 3.5 fold to 6 fold compared to 0.4 mg syringe. Narcan sprays are also good up to 2-3 years so people can bring them everyday in case they see someone having an overdose.
In the case of an overdose, the administrator needs to take the spray and put it into the nose of the overdosed person and repeat every two to three minutes until the person wakes up. Using a syringe, the administrator just needs to add the liquid without air and stick it into the person’s muscle. People of all ages can use Narcan if facing an overdose so age is not a problem. There are cases where Narcan can react with other drugs so it’s best to call the hospital if further complications happen.
Rehabilitating on Fentanyl
Many rehab facilities have a requirement for patients to be clean for a specific duration before admission, which paradoxically undermines the purpose of these centers.
Addiction detox involves eliminating harmful substances from the body to overcome addiction. Symptoms of fentanyl withdrawal include nausea, vomiting, muscle pain, cold flashes, goosebumps, uncontrollable leg movements, diarrhea, insomnia, and intense cravings.
The Bay Area is home to approximately 34 drug rehab centers located in Fresno, San Jose, Silicon Valley, and San Francisco. The cost of rehab in San Francisco varies, but most centers accept private or state-funded insurance.
In California, 25.4% of rehab facilities accept state-financed health insurance (excluding Medicare or Medicaid), while Medicare is accepted by 35.8% and Medicaid by 65.5% of facilities. Nearly 45% of facilities in California offer free treatment or accept minimal payment, and 58.4% provide a sliding scale payment option. Cash payments are accepted by 89.8% of facilities.
Free detox programs are available, including state-funded detox centers for individuals without income or insurance. Private treatment centers run by religious organizations and non-profit organizations also offer free rehab programs. Some specific free rehab programs in San Francisco include the Father Alfred Center Addiction Recovery for Homeless Men, San Francisco AIDS Foundation Stonewall Project (focused on HIV prevention without requiring abstinence), Friendship House Association of American Indians (for the American Indian community), CityTeam San Francisco Recovery Program (residential recovery for men), and Walden House/Health RIGHT 360 (providing mental health services).
Additional free rehab programs in San Francisco include the Balboa Teen Health Center (for ages 11-18), Salvation Army Adult Rehabilitation Center (offering a twelve-step program for men and women in a long-term residential setting), Harbor House (providing chemical dependency treatment, housing, employment, and legal assistance), Haight Ashbury Free Clinic, Curry Senior Center, Center for Harm Reduction Therapy, Father Alfred Center Saint Anthony Foundation, Fort Help LLC, Epiphany Residential, Fort Help Mission, Jelani, Lee Woodward Counseling Center, Epiphany House, Mission Council Family Day Treatment, BSLP, Baker Places Inc Acceptance Place, Joe Healy Detoxification Program, Bayview Hunters Point Foundation Youth Services, Bayside Marin/SF Outpatient, Bayview Hunters Point Foundation, and Baker Places - Ferguson Place.
Implementing better policies and laws regarding painkillers can help limit their availability and misuse. Additionally, focusing on improving policies and border control at the southern border can help reduce drug smuggling, including opioids. It is crucial to crack down on bribery by cartels targeting government workers at the border to ensure a decrease in drug smuggling activities.
Preventing the proliferation and misuse of fentanyl in San Francisco (SF) requires a comprehensive approach that addresses multiple aspects of the issue. Here is a short summary of key strategies that can be implemented to help prevent fentanyl in SF:
Public Awareness and Education: Increasing public awareness about the dangers of fentanyl and its potential for overdose is crucial. Educational campaigns can be conducted through various platforms, including schools, community centers, healthcare facilities, and social media, to educate residents about the risks associated with fentanyl use.
Harm Reduction Programs: Implementing harm reduction programs, such as needle exchange programs and safe injection sites, can help reduce the transmission of diseases associated with drug use and provide a safer environment for individuals who use drugs. These programs can also offer counseling, overdose prevention training, and access to naloxone, an overdose-reversing medication.
Rehab Options
Fentanyl is obviously a very potent, dangerous, and addictive drug that can cause serious health problems. Therefore, it is important for users to go to rehab to reverse these effects as much as possible and stop fentanyl usage. Rehab is the best option as well due to fentanyl causing health problems whilst abstaining from it(The health problems are more serious while using it.) These health issues include nausea, aching, cold flashes, goosebumps, uncontrollable leg movements/cramps, diarrhea, insomnia, and cravings.
Rehab centers, institutions, and facilities are all over the Bay Area. Whether you live in SF or Antioch, you can find a rehab center that will treat your fentanyl addiction. In total their are 34 and they are located in Fresno, San Jose, Silicon Valley, and SF.
One of the problems with these rehab facilities is the fact that you have to be clean for a certain period of time prior to checking into a facility. This defeats the whole purpose of it and causes a lot of people to not be able to get clean and beat their addiction.
As far as finances go, rehab facilities in Sf usually accept private or state-funded insurance. In California, 25.4% of facilities accept state-financed health insurance (not counting Medicare or Medicaid). Medicare is accepted by 35.8% of facilities in CA. Medicaid is accepted by 65.5% of facilities in California. About 45% of California facilities offer free treatment or minimal payment. 58.4% of California facilities offer sliding scale to pay based on what one can afford. 89.8% of California facilities take cash as well.
Free rehab facilities throughout SF include: Father Alfred Center Addiction Recovery for Homeless men, San Francisco AIDS Foundation Stonewall Project, CityTeam San Francisco Recovery Program, Walden House Inc, Balboa Teen Health Center, Salvation Army Adult Rehabilitation Center, etc.
How is this Related to Local Governance?
If we don’t stop the fentanyl crisis here it will continue to spread to neighboring counties, like it’s already doing. SF also has a specific demand for fentanyl, unlike other places where fentanyl is disguised as heroin or cocaine. This of course is bad, as there is a demand along with supply of fentanyl and can create a culture where fentanyl is normalized
The fentanyl crisis is directly related to SF’s homelessness issue. San Francisco's SROs have been the site of at least 16% of all fatal overdoses citywide, though the buildings house less than 1% of the population. The poor conditions of SROs and lack of support available exacerbate the Fentanyl crisis. Systems that ensure tenants and workers can consistently access Narcan, the life-saving overdose reversal medication, are only deployed in seven of roughly 75 supportive housing SROs.
Breed’s administration funds a program that trains and pays residents to respond to overdoses in just eight of the hotels. Because of these poor conditions, residents of these programs rarely are able to transfer to stable housing. Reporters found that residents who left even some of San Francisco’s better-funded supportive housing programs were nearly twice as likely to return to homelessness or die — many from overdoses — as to move on to independent housing. The Breed administration, which has channeled millions of dollars toward combating overdoses and drug use in public spaces, has spent a drastically smaller amount trying to curb the deaths inside city-funded hotels. The fentanyl crisis is the result of the failure of SF to properly support its homeless population. We need to change our approach before SF gets overwhelmed by its problems.