The TV advertisements featuring actor Danny Trejo have a serious topic, “Bad meds kill real people.” The spot is designed to target vulnerable patients, including minority and homeless communities which are at-risk for receiving counterfeit drugs.
The Trejo ad notes that 95% of all online pharmacies operate illegally.
“A lot of pills that people are getting are not necessarily from a pharmacy,” said Brian Hurley, medical director of Substance Abuse Prevention and Control (SAPC) division of the LA County Department of Public Health (DPH).
Hurley explained that some entities masquerade as pharmacies online, but most illicit drugs are sold in parks and schools.
Authorities hope that the recent arrest of Mexican drug cartel leader Ovidio Guzman may help stem the tide of one of the more prominent killer drugs — fentanyl — which is colorless and odorless.
Nationwide, there has been a growing trend of illicit drugs (particularly methamphetamine, heroin, and cocaine) and counterfeit pills contaminated with fentanyl and other life-threatening substances. This has impacted both adults and youth.
In 2021, fentanyl was identified in about 77% of adolescent overdose deaths nationally. Fentanyl and methamphetamine-related overdose deaths have increased in Los Angeles County even prior to the pandemic and continue to rise at an alarming rate.
Fentanyl has surpassed crack cocaine, marijuana and heroin to become the third most common drug type in the federal criminal sentencing caseload. (It follows Meth and powder cocaine on that list).
Last September, the DPH issued an alert following the deaths of four teenagers, one of them found deceased on a Hollywood school campus. All of them had overdosed after purchasing counterfeit narcotic pills.
Fentanyl is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl has legally been used by physicians for their patients and for anesthesia for years.
It is also produced illicitly by drug cartels as a recreational drug, sometimes mixed with heroin, cocaine, benzodiazepines or methamphetamine, among others.
“Fentanyl is not poisonous, but it is potent,” Hurley said, adding that the fentanyl that people are dying from on the street is not coming from a doctor’s office. “These are drug cartels that are using high potency opioids to help increase the strength of their products.”
Hurley explained that fentanyl is 50 times more potent than heroin and is economically cheaper to manufacture.
“That’s one of the reasons that we’re seeing an increase of fentanyl in our system,” he said, noting that legitimate patients who are prescribed the drug by a doctor for pain may build up a tolerance for it.
Recreational drug users and those using drugs outside of a medical context, however don’t have that tolerance.
There has been a rash of overdose cases where illicit use — even when mixed with sedatives like Xanax or Valium — has resulted in death.
Antidotes must be administered quickly
Often drugs that look like pharmaceutical medications are not.
Unfortunately, many persons who want to purchase pain medications do not go to a registered doctor or legitimate medical source for a pharmacy prescription. They go online instead, and a number of counterfeit pharmaceuticals contain fentanyl.
“Fetanyl is now becoming the number one drug involved in overdoses in LA County,” Hurley said, pointing to data compiled for 2021.
Its potentially deadly overdose effects can be neutralized by naloxone, better known as narcan.
“Administer narcan as soon as it’s feasible. That’s one of the other core messages,” Herley said. “Oftentimes we can’t wait for the emergency medical system to arrive. Even if they are arriving in minutes, minutes can make the difference between being alive and being dead.”
Schools can sign up with the state’s naloxone distribution system to get free narcan. It can easily be administered as a nasal spray. There are no age limitations as to who can access narcan.
“Education is the best way to fight fentanyl overdoses and save lives,” said Supervisor Kathryn Barger, who held a town hall meeting on the subject recently. “The danger of fentanyl poisoning lurks in every community and it’s naïve to think it’s not present in our local schools.
“Parents, family members, and the community at large need to know how to spot the signs of drug use and how to talk with youth to reach them effectively,” she added.
Take steps against poisonings
Parents and guardians should consider that not all youth immediately show changes in behaviors if they are using substances, so parents should initiate age-appropriate conversations with their children about substance use. There are a few steps readers can take to help prevent loved ones from being poisoned by drugs:
• Use honest language that emphasizes their values and concerns around drug use. Open conversations that evoke adolescents’ understanding and experiences are more effective than lecturing and utilizing scare tactics. Visit https://tinyurl.com/yc2uzx5f
• Get educated about the dangers of drug use. Be sure to talk to children about the risks of illicit drug use. Make sure they understand that taking drugs that have been made in clandestine labs can be extremely dangerous. It’s also essential to be up-to-date on the latest information about which drugs are most prevalent and dangerous in your area.
• Provide teenagers with support systems of family and friends who can help them stay away from drugs and ensure they have access to counseling or treatment if they start using drugs.
• Let them know that one single pill can kill them. Often drugs that look like pharmaceutical medications are not. They are actually deadly fentanyl looking like Percoset, Xanax, or other commonly used drugs.
• Be aware of youth activities and whom they are hanging out with.
• Keep an eye on teenager’s behavior and look for warning signs that they may be engaging in risky behaviors like excessive drinking or drug use.
The DPH is hosting virtual Public Health Ambassador training sessions for students and parents to learn more about fentanyl, including the current overdose trends, risk factors associated with youth opioid use, how to recognize an opioid overdose, and how naloxone (Narcan) can reverse opioid overdose.
The trainings will also review effective communication strategies families can use to talk about opioids and fentanyl, and youth-specific resources for accessing ongoing support and treatment.
Participants who are first time Public Health Ambassador Program attendees will receive a $25 stipend and opportunity to earn an additional $25 for outreach.
Healthcare providers may prescribe naloxone to patients who are at an increased risk of opioid overdose or who have household members, including children, who are at risk for accidental ingestion or opioid overdose. Ask a primary healthcare provider about being prescribed naloxone if not automatically co-prescribed to you.
Pharmacies in California may now provide naloxone without a prescription, although availability is pharmacy and pharmacist dependent. Find a list of participating pharmacies at https://tinyurl.com/3cmx9638.
Community members who are unable to access naloxone through their primary healthcare provider or via a local pharmacy, can visit a community-based naloxone access point or a mail-based naloxone distributor. Find a list of participating naloxone access points at https://tinyurl.com/mtw47fek.
Drug dealers misrepresent
substances when selling
There are five fentanyl analogues: carfentanil, furanyl fentanyl, acetyl fentanyl, 4-fluoroisobutyryl fentanyl (or para-fluoroisobutyryl fentanyl), and cyclopropyl fentanyl. They accounted for 76.4 percent of the fentanyl analogues trafficked in fiscal year 2019.
Fentanyl analogues are more lethal than fentanyl, as evidenced by the higher rate of death and serious bodily injury resulting from use. Significantly more fentanyl analogue offenses (29.2%) resulted in a user’s death, compared to fentanyl offenses (14.1%).
Nearly all fentanyl and fentanyl analogues trafficked in fiscal year 2019 were illicitly manufactured.
For offenders sentenced in fiscal year 2019, fentanyl and fentanyl analogues had distinct trafficking patterns. Fentanyl was more likely to enter the United States through the United States/Mexico border, while fentanyl analogues were more likely to be purchased directly over the Internet or dark web, frequently from China, and shipped by international mail or express package services.
Roughly one-third or more of fentanyl and fentanyl analogue offenders (31.0% and 42.9%, respectively) sold these substances as a different drug, almost always heroin or a diverted prescription medication.
Just under five percent (4.5%) of fentanyl offenders and nine percent (9.0%) of fentanyl analogue offenders knowingly misrepresented these substances as another drug during a drug transaction.
If youth use substances, parents and guardians should explore reasons behind substance use. For adolescents who are using substances regularly, a professional assessment may be needed.
Find substance use treatment services and bed availability in Los Angeles using an online, filterable service locator known as the Services and Bed Availability Tool (SBAT), going on www.RecoverLA.org on mobile devices, or by calling the Substance Abuse Service Helpline (SASH).
Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs. Visit http://sapccis.ph.lacounty.gov/sbat/, or the Mobile-friendly RecoverLA platform: www.RecoverLA.org, or call the Substance Abuse Service Helpline: (844) 804-7500.