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‘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 on Tuesday unanimously agreed 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 U.S., opioid overdoses claimed more than 107,000 last year. Fentanyl now is the No. 1 cause of death of people ages 18 to 45 — in the county and and in the country.

By declaring fentanyl a crisis, the board directed the county’s 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 were directed to return to the board in 180 days to update them on the plan.

While no dollars were allocated with the crisis declaration, Board Chair Nathan Fletcher indicated some of the expected $100 million the county believes it will receive from a lawsuit settlement with opioid manufactures could be directed toward the effort. Hearings on setting funding priorities for settlement dollars 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,” county Supervisor Terra Lawson-Remer 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, county Supervisor Jim Desmond and county 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 teenagers in San Diego County under the age of 17 died from fentanyl overdoses, with the youngest victim being 13.

Fentanyl is a synthetic opioid that is 50 to 100 times stronger than morphine, according to the Drug Enforcement Administration. Pharmaceutical fentanyl was developed to help treat pain in cancer patients. Illicit fentanyl is often manufactured in Mexico and pressed into pills that look like legitimate medication like 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 border, the county is the largest gateway for fentanyl in the nation, Stephan told the board. In 2021, federal officials seized more than 6,350 pounds of powder fentanyl at San Ysidro, Otay Mesa and Tecate ports of entry, according to the county board letter. The DEA has said four out 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, said Stephan, who is the county’s top prosecutor.

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

Stephan said her office prosecuted 395 fentanyl dealers in 2020 and 2021, and charged five people with homicides when someone they sold to ended up dead. 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. “At every intersection, whether it is a pediatric appointment” or when a patient is getting shots, they should be told the deadly effects of fentanyl “at every entry way,” she said.

For anyone dealing with an addiction issue, the county says it has treatment services available. Residents needing help can call the access and crisis line at (888) 724-7240 or 2-1-1 San Diego.

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