Forensic scientist Terry Baisz shows pills masking as other pharmaceutical drugs but they are actually Fentanyl at the Orange County Sheriff’s Department crime lab MICHAEL GOULDING, ORANGE COUNTY REGISTER

An autopsy found fatal levels of fentanyl in 10-month-old Leo Holtz’s stomach and bloodstream. (Cuyahoga County Medical Examiner’s Office via AP)

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Tyler Skaggs of Los Angels Angels was found dead in his Texas hotel room on July 1, 2019. An autopsy found fentanyl in his system. (Photo by Kevin Sullivan, Orange County Register/SCNG)

Mac Miller, shown here performing at the 2017 Coachella Valley Music and Arts Festival in Indio, died of an overdose on Friday, Sept. 7, 2018. He had fentanyl in his system.(File photo by Thomas R. Cordova, Press-Telegram/SCNG)

Tom Petty performed in Tennessee in 2016. He died at age 66 on Oct. 2, 2017, with fentanyl in his system. (AP Photo/Mark Humphrey, File)



File photo of Prince during the halftime show at the Super Bowl XLI football game at Dolphin Stadium in Miami. Prince was 57 when he was found alone and unresponsive in an elevator at his Paisley Park estate on April 21, 2016. An autopsy found he died of an accidental overdose of fentanyl. (AP Photo/David J. Phillip, File)

A Los Angeles Angels fan takes a picture of the memorial to the late pitcher Tyler Skaggs (Photo by Keith Birmingham, Pasadena Star-News/SCNG)

A memorial to the late pitcher Tyler Skaggs of the Los Angeles Angels. (Photo by Keith Birmingham, Pasadena Star-News/SCNG)

A group pays homage to Tom Petty at the 40th annual Doo Dah parade in Pasadena. (Photo by David Crane/Los Angeles Daily News-SCNG)

The good news, if there is any, is that opioid prescriptions and drug-related emergency room visits have declined in Orange, Los Angeles, Riverside and San Bernardino counties — as well as in California as a whole — since 2014.

The not-so-good news — and there’s plenty — is that fentanyl-related deaths have skyrocketed over the past five years, especially in Los Angeles County, which far outpaces the state average.

Fifteen people died from fentanyl overdoses in 2014 in L.A. County. In 2018, deaths spiked 1,247% — to 202, according to data from the California Department of Public Health.

Statewide, fentanyl deaths leaped by 614% to 743 in 2018.

The jump was smaller, but still staggering, in Orange and Riverside counties, where fentanyl deaths rose by 564% and 563%, respectively. In San Bernardino, they rose 267%.

Overdose deaths related to other drugs rose in the counties and state as well, but at a much more modest pace than did fentanyl-related deaths.

“It has become increasingly common for us to see drug dealers peddling counterfeit pharmaceuticals made with fentanyl,” said United States Attorney Nick Hanna in a statement. “As a consequence, fentanyl is now the number one cause of overdose deaths in the United States.”

Fentanyl is easily cut into authentic-looking pills that purport to be oxycodone, the prescription opioid-of-choice for many who become dependent on its chemically induced euphoria. Real oxy “takes away the pain — all the pain. In the brain, in the heart, in the body. That’s what we’re up against,” Joe DeSanto, an addiction medicine specialist, has said.

Pills made to look like the real thing are cut with fentanyl and can be made for about $1 each. They can sell for 20 times that on the streets of Southern California, prosecutors said.

High-profiles deaths

The dangers of the drug — a powerful synthetic opioid 50 to 100 times stronger than heroin — are illustrated by the high-profile deaths of Los Angeles Angels pitcher Tyler Skaggs and rapper Mac Miller.

Skaggs, 27, was found dead in his hotel room in Texas on July 1, just hours before the Angels were to face off against the Texas Rangers. An autopsy found Skaggs died from a mixture of fentanyl, oxycodone and alcohol.

Last year, 26-year-old rapper and record producer Miller died after snorting blue pills that looked like real oxys, but were laced with fentanyl, prosecutors said. His alleged dealer was arrested in September and charged with distributing a controlled substance.

The list of celebrity deaths linked to fentanyl goes on — Lil Peep, Tom Petty, Prince — but most of the dead were just regular people. Baby Leo Holtz, 10 months old, was snuggling in bed with his parents in 2017 when he swallowed blue pills that had spilled from his father’s pocket. The pills were marked as oxycodone. The baby died with fatal levels of fentanyl in his system.

“Fentanyl disguised as a genuine pharmaceutical is a killer — which is being proven every day in America,” U.S. Attorney Hanna said in a statement after the arrest of Miller’s alleged dealer. “Drugs laced with cheap and potent fentanyl are increasingly common, and we owe it to the victims and their families to aggressively target the drug dealers that cause these overdose deaths.”

All told, 1,649 people died from fentanyl in California over the five-year period examined.

The overwhelming majority — 59% — of those who died in 2018 were white, 28% were Latino, 9% were black, 3% were Asian and less than 1% were American Indian.

Though the problem is growing in California, it is still dwarfed by struggles elsewhere in the nation. There were 1.3 deaths per 100,000 people due to synthetic opioids in the Golden State in 2017. West Virginia, by comparison, had 37.4 such deaths per 100,000 people, according to the Centers for Disease Control and Prevention.

Why the jump?

Fentanyl can be manufactured illegally. It’s powerful. It’s cheap. And there are no quality controls, as there are with pharmaceutical-grade fentanyl, the Los Angeles County Department of Public Health said in an emailed statement.

“Illegally manufactured fentanyl is commonly sold as a powder or made into counterfeit pills that look like other prescription opioids,” the health agency said. “Additionally, fentanyl is mixed into other drugs such as heroin, cocaine, methamphetamine and MDMA. This poses profound overdose risks to drug users who often do not know that fentanyl is present in their drug supply.”

The rise in overdose deaths in California also coincides with major changes in how the legal system views drug-related offenses, and many in law enforcement see a link between the two.

“Since 2015, we have seen a reduction of people attending treatment programs because of Proposition 47, which passed in November 2014, and the prison realignment, AB 109, passing in 2011,” said Jodi Miller, a spokeswoman for the San Bernardino County Sheriff’s Department.

Assembly Bill 109 diverted those convicted of less-serious felonies from state prisons to county jails, while Prop. 47 recategorized many nonviolent offenses — such as drug and property crimes — from felonies to misdemeanors, thus eliminating or reducing jail time.

Without the real threat of prison or jail for drug offenses, the “stick” once used to compel desired behavior has disappeared, officials said.

San Bernardino County jails offer recovery programs such as Alcoholics Anonymous and Narcotics Anonymous, and there are more than 260 inmates currently enrolled, Miller said, but many simply don’t spend enough time in jail to complete treatment. And following through on the outside can be difficult.

“When a person is not court-ordered to attend these classes while incarcerated, they will avoid or come up with excuses to not attend the programs,” Miller said.

L.A. officials said that the coroner made testing for fentanyl part of standard procedure in 2016, which may be responsible for some of the increase there.

What to do?

Beyond having Narcan more widely available to reverse overdoses and controversial “supervised drug consumption” sites — which have been found to reduce overdose deaths — harm-reduction advocates say drug-testing kits can be used before drugs are ingested.

Originally intended to detect fentanyl in urine, fentanyl test strips also can detect the deadly substance in drugs themselves. Testing at Vancouver’s Insite supervised injection site showed that, during a single month in 2016, 86% of all drugs tested came up positive for fentanyl, whether pills or powder.

“While population-level data on the impact of FTS (fentanyl test strips) on overdoses is still emerging, recent studies suggest that FTS change individual behavior and promote safety precautions among drug users to reduce their risk of overdosing,” the L.A. County Department of Public Health said in a statement.

The test strips are available at syringe exchange programs across L.A. County, but access is limited beyond harm reduction-oriented programs, officials said.

In Los Angeles County, where 404 people have died over the five-year period — half of them in 2018 alone — the county has launched a public education campaign in English and Spanish “to increase awareness of the risks and harms of prescription pain medication misuse and abuse.”

“Opioid misuse trends in Los Angeles County are a serious public health concern,” Director Barbara Ferrer said in a statement when the campaign launched in June. “A key component in preventing addiction, overdose, and death is educating people about the significant risks associated with using prescription pain medications.

“If anyone is struggling with dependency, we want them to know and feel hopeful that treatment and recovery are possible. We are here to help with dozens of service providers throughout the county.”

The county launched a new website — available at ManagePainSafely.org and ManageAddiction.org — offering information and resources. It also has a Substance Abuse Service Helpline at 844-804-7500 to connect people with treatment.

Federal prosecutors, in the meantime, promise to crack down on those selling the deadly drug. On Wednesday, Oct. 2, three men were indicted by a federal grand jury in a scheme to distribute the fentanyl-laced pills that killed rapper Miller.

Crackdown consequences

The three men charged in the federal indictment — Cameron Pettit, 28, of West Hollywood; Stephen Andrew Walter, 46, of Westwood; and Ryan Michael Reavis, 36, a former West Los Angeles resident who relocated to Arizona — allegedly continued to sell narcotics after Miller’s death “with full knowledge of the risks their products posed to human life,” Hanna said.

“We will continue to aggressively target drug dealers responsible for the spread of this dangerous chemical,” he said.

Tighter regulations on opioid prescriptions by doctors has led to a decrease in the number of such prescriptions in California, but “unintended negative consequences to people with chronic pain are an emerging concern,” L.A. County health officials said.

“Abrupt tapering or discontinuation of prescription opioids for patients with chronic pain, particularly in the absence of offering effective alternatives, can lead to overdose and physical and psychological suffering.”