Erika D. Smith

How public policy contributed to fentanyl overdoses

Family and friends of Jerome Butler gather in south Sacramento on April 1 to remember the 28-year-old father of three who died after taking a counterfeit version of the painkiller fentanyl.
Family and friends of Jerome Butler gather in south Sacramento on April 1 to remember the 28-year-old father of three who died after taking a counterfeit version of the painkiller fentanyl.

Dr. Angella Barr spends her days in East Sacramento, talking to an ever-growing group of people who are “sick and tired of being sick and tired.” Opioid addicts who have hit rock bottom.

She helps housewives who’ve developed a tolerance to prescription painkillers, but are terrified by heroin. She helps college students who have already turned to the illicit drug. And the IV drug users who wear long-sleeves because they don’t want to be judged by their track marks.

But no fentanyl addicts. Just like everybody else, she has followed the spate of overdoses in the Sacramento region, all linked to a counterfeit version of the opioid painkiller. As of Friday, that number was 48. Ten have died.

“That’s really one of the scarier things. I don’t get one of those people in my outpatient clinic saying, ‘I took one of those fentanyl pills and I’m addicted,’ ” said Barr, an addiction specialist at Chemical Dependency Treatment Associates Inc. “They’re dying.”

Yet, she doesn’t seem as lost as the rest of us about how we got here. How we got to a point where a guy like Jerome Butler, a 28-year-old father of three, can one minute be hanging out drinking beer with friends, and the next minute be unconscious and never wake up.

How we got to where chemists working for Mexican drug cartels are cooking up deadly doses of synthetic fentanyl and pressing them into pills designed to look like the prescription painkiller Norco. And how, despite the apparent risks, people continue to take them.

Natasha Butler, told The Bee that her son “can’t just die and no one is accountable for what happened to my baby.”

The truth is, in addition to whoever is producing this stuff and selling it, there are lots of people to hold accountable. What’s happening with fentanyl, meth and other synthetic drugs, such as spice, is partly the result of a series of public policy decisions by state and federal governments and private industry over several years. Think of it as a perfect storm of good intentions and unintended consequences. One that created a demand and an incentive to supply a new era of drug use.

Think about it.

In the United States today, we have a vast and growing market of opioid addicts. Addicts, in many cases, who won’t even admit to themselves that they are addicts because of the stubborn stigma of addiction, lingering tendency of our laws to criminalize it and the notion that “addicts” are fiends wandering the streets in a zombie-like daze.

Dr. Melody Law ran headfirst into that line of thinking when she took a job as an addiction specialist at a clinic in opioid-ravaged Lake County. Her new bosses had expected a flood of people seeking help when she arrived. It didn’t happen.

Asked why, Law lamented: “Patients do not like to be labeled addicts. Addicts in society are not treated very kindly,” she said. “To understand addiction as a chronic disease would be helpful.”

Also in the United States today, we have a medical profession that is largely just coming around to the idea that it must cut back on prescribing opioids so it doesn’t create even more addicts.

The American Medical Association and the Centers for Disease Control and Prevention have issued updated guidelines. Doctors in many states have expressed a willingness to follow them, although political battles remain.

The initial push to prescribe more medication for pain came from a good place. For years, doctors had downplayed patients’ complaints about pain. That thinking began to change in the 1990s, when the U.S. Food and Drug Administration approved the slow-release opioid OxyContin. The motto became “pain management” to reduce suffering. A noble cause, for sure.

Of course, that mindset has changed again because of the current epidemic of opioid abuse, which has been driven largely by prescription drugs. That epidemic went on under the radar for far too long. Now, everyone wants to talk about it. People running for president. Pastors. Police. Baristas. Newspaper columnists. Pushy editorial boards.

The statistic you’re most likely to hear about opioids is that more Americans die of overdoses than car crashes. And that, in one year, doctors prescribed enough opioids for every American adult to have a bottle.

Most people now agree that doctors need to rein it in – and rightly so. Good intentions again. But a lot of the damage has already been done.

Some patients who have been taking opioids for years are grumbling about how new limits on prescriptions are making it harder to get the drugs they say they need.

How many of those Americans will turn to the black market when they get cut off by their doctors remains to be seen, but I’m not optimistic. It has been happening for years, as evidenced by the rising rates of heroin use.

Not surprisingly then, another thing we have in the United States today is a rising rate of heroin seizures at the border, most of it being trafficked from Asia and South America. The Drug Enforcement Administration, in its 2015 National Drug Threat Assessment Summary, also notes that “Mexican traffickers are making a concerted effort to increase heroin availability in the U.S. market.”

Although plenty of marijuana is still seized at the border, there has been a decline over the last few years. Some say the Mexican cartels are changing their tactics, shifting their business model from marijuana to heroin, meth and synthetic drugs, including fentanyl.

The why is pretty obvious. Not only is there a demand for it in the United States, but with more states legalizing marijuana and allowing Americans to grow it, there’s not as much of a market for it.

That’s not to say voters shouldn’t vote to legalize cannabis for recreational use in November. It’s about time California had some certainty on that front. But we need to be realistic about what we’re doing, too. We’re not, as experts once predicted, killing the cartels’ business. We might instead just be giving it an unintended, final push in a more dangerous direction.

But what of fentanyl?

Authorities say they suspect the fake Norco pills that caused so many overdoses in Sacramento County are coming from traffickers, probably from Mexico using materials they got from China. And last week, heeding warnings from police about fentanyl being the new go-to drug for cartels, a Senate committee passed SB 1323 to stiffen penalties for traffickers.

The idea of the drug ripping through Sacramento’s homeless population, for example, is terrifying.

Barr doubts it will happen, though. Many addicts, she says, don’t think like that. Some will take anything, chasing an even higher high despite the risks, but most addicts – the housewives, the college students – will stay away from mysterious pills for a while.

The cartels are another story.

“Drugmakers, they’re very smart chemists. They evaluate and re-evaluate what their purpose is and see how their products have affected people,” she predicted. “They’ll wait a few months and change the formula to something (not as deadly). Then they’ll put it back out there, and then it will really be scary.”

I hope she’s wrong – that fentanyl won’t take root in California the way it has on the East Coast. But either way, there’s something rather troubling about knowing that thanks, in part, to years of unintended consequences from incremental public policy decisions, the very possibility is there.

Erika D. Smith: 916-321-1185, @Erika_D_Smith

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