In the deadly world of opioid overdoses, fentanyl is only the latest high-profile killer.
Opioid abuse cuts across all demographics, from celebrities such as Prince, whose recent death was confirmed as an “accidental” fentanyl overdose, to victims in upscale El Dorado Hills neighborhoods and worn south Sacramento streets.
Calling it a public health epidemic, legislators, law enforcement, health officials and families here and across the country are ramping up new efforts to combat opiate addiction and deaths, including those attributed to fentanyl.
This week, a state Assembly committee voted 16-0 to approve a bill that would require doctors to check California’s prescription drug database before prescribing certain addictive drugs. The bill, SB 482 by state Sen. Ricardo Lara, D-Bell Gardens, is expected to be heard before the full Assembly in late August.
“California is in the middle of this crisis,” said Carmen Balber, executive director of Consumer Watchdog, the Santa Monica-based lobbying group that supports the bill. “I cannot tell you how many families we’ve been in contact with who have been touched by opiate abuse. So many have lost children because of this overprescribing epidemic.”
In 2014, California had a record number of drug overdose deaths – 4,521 – the highest of any state in the country that year. In Sacramento, street sales of counterfeit fentanyl have caused 52 overdoses and 12 deaths this year.
Nationwide, the scourge of opiate overdoses – mainly from heroin and prescription drugs such as OxyContin and Vicodin – has been well-documented. On Tuesday, the White House held a press briefing urging Congress to allocate an additional $1.1 billion to expand treatment facilities, overdose prevention programs and crackdowns on illegal drug sales. Under the proposal, California could be eligible for up to $78 million over two years to improve opioid users’ access to treatment.
“We are seeing more people killed because of opioid overdose than from traffic accidents,” President Barack Obama said in March at a national summit on heroin and prescription drug abuse.
Also in March, the Centers for Disease Control and Prevention issued new guidelines for physicians who prescribe opiates for chronic pain, advising them to “start low and go slow” with the smallest dosage and shortest duration possible. It also recommended alternative solutions for pain management, such as exercise and behavior modification.
Locally, Sacramento County officials in February formed an opioid task force to look at overdose prevention and education.
While opioids have plagued communities in many states, fentanyl, typically used as a skin patch pain reliever for cancer patients, has emerged as a particularly deadly killer in its illegal form.
Often disguised in counterfeit versions of Norco or mixed with heroin, it is cheaper and more profitable for drug traffickers to produce. Up to 50 times more potent than heroin, fentanyl has become a sought-after high among some addicts. In California, several bills are tackling the problem of fentanyl and opiates.
Senate Bill 1323, by state Sens. Patricia Bates, R-Laguna Niguel, and Bob Huff, R-San Dimas, would stiffen state prison terms for those caught illegally selling or distributing fentanyl. Under the legislation, which passed the state Senate and is pending in the Assembly, those prison sentences would be enhanced, based on fentanyl’s weight. Similar to existing laws for heroin and cocaine trafficking, the new guidelines would sentence someone caught distributing up to 10 kilograms of fentanyl to an additional 10 years in state prison.
78: Number of Americans who die daily from an opioid overdose, primarily heroin or prescription drugs, according to the Centers for Disease Control and Prevention
The other Senate bill, SB 482, would require doctors to check a patient’s prescription history on the state’s electronic prescription drug database – known as CURES (Controlled Substance Utilization Review and Evaluation System) – before prescribing an opiate to a patient. Currently, there’s no mandatory requirement that doctors check the database.
SB 482 aims to prevent lethal combinations of prescription drugs but also thwart so-called “doctor shopping,” when addicted patients seek out different doctors for multiple prescriptions. The mandatory check would apply to prescriptions for Schedule II (including fentanyl, cocaine, OxyContin), Schedule III (Tylenol with codeine, ketamine, anabolic steroids, testosterone) and Schedule IV (Xanax, Valium, Ambien) drugs.
About 20 witnesses spoke this week in favor of SB 482, including parents holding photographs of their teen and young adult children who died from prescribed opiates. One of them, Roseville resident Linda Chapman, said her daughter Tiffany died in 2004 after a 10-year battle to wean herself off OxyContin, Vicodin and Norco, which were prescribed to treat pain after breaking her neck in a serious car accident. She was 27.
“She was the sweetest girl in all respects,” Chapman said. “There’s such a stigma and shame attached to addiction. People don’t understand that it’s a disease.”
The Lara bill is also supported by Gary Mendell, founder and CEO of Shatterproof, a Connecticut-based nonprofit that works to prevent opiate addiction and change state laws related to opioid.
4,521: Number of Californians who died of drug overdoses - mostly heroin or prescription drugs - in 2014, the highest in the country, according to Centers for Disease Control and Prevention
“We want doctors to check every single time they prescribe Schedule II, III and IV drugs,” said Mendell, who testified at Tuesday’s hearing. Prescription drug abuse, he said, is “an epidemic no different than the spread of an infectious disease. Hundreds of our loved ones are dying every single day.”
Mendell, a former hotel industry executive, knows the risks of opioids from personal heartache. In 2011, his 25-year-old son Brian, who had battled an addiction to marijuana and opiates since his teens, committed suicide.
Although fentanyl has been blamed for dozens of deaths back East in recent years, illegal versions of the drug only began claiming victims in Sacramento in late March, causing dozens of deaths and overdoses.
For some family members of overdose victims, the lack of drug dealer arrests has been frustrating.
“It’s been 55 days since Jerome passed,” said Natasha Butler, whose 28-year-old son Jerome Butler died March 30 after swallowing counterfeit Norco tablets believed to be laced with fentanyl. “I’m that angry mother. No one is being held accountable for my son’s death. These people (drug dealers) are still walking the streets. Why?”
Law enforcement officials say the Sacramento investigation is very much alive.
14,000: Record number of U.S. deaths involving prescription opioid overdoses in 2014. That number has nearly quadrupled since 1999, according to the Centers for Disease Control and Prevention
“I understand the frustrations, but we are making progress,” said Casey Rettig, a special agent with the federal Drug Enforcement Administration, adding that it’s not uncommon for a complicated investigation to take this long. “We want to find the source – or multiple sources – of the drug. We hope there’ll be a conclusion soon. It’s a fluid investigation, with a lot of moving parts.”
Rettig has called the Sacramento investigation the “No. 1 priority” for the DEA’s Northern California district, which stretches from Bakersfield to the Oregon border. She said the DEA is still accepting the public’s anonymous tips on its fentanyl-focused hotline: 530-722-7577.
In most cases, the DEA said, the chemical components of illegal fentanyl are imported from China, illicitly manufactured into pills in Mexico and smuggled into California by major drug traffickers. But Rettig said fentanyl is also readily available on “the Dark Net,” the online marketplace for illicit drug sales.
As the investigation continues, the Sacramento region’s rash of fentanyl-related overdoses and deaths appears to have abated. It has been more than seven weeks – April 22 – since any local hospitals have reported fentanyl cases, according to Sacramento County public health officials.
“The dealers could be lying low, based on the rash of overdoses, deaths and the threat of law enforcement action,” said DEA spokeswoman Rettig. “It could be word got out on the street that this stuff is deadly.”