What is Fentanyl? Fentanyl is a powerful synthetic opioid that is 50 -100 times more powerful than morphine. Originally developed as a pharmaceutical for pain management treatment of stage 4 and terminally ill cancer patients, it is applied in micro-dosages through a patch on the skin. It's also used by anesthesiologists, in combination with other
other medications, in surgical settings.
Increasingly, fentanyl is being abused or is surreptitiously being laced into other drugs. Fentanyl is the third epidemic wave of overdose and drug deaths in the U.S. The first began in 1999 with opioids; the second in 2010 with heroin and fentanyl began the third wave in 2013. Deaths by fentanyl have only accelerated with each year since then and particularly have worsened during the Covid pandemic.
By itself, it's in powder or liquid form; it looks identical to heroin. But it is far deadlier: a lethal dose of heroin is 30 milligrams whereas just a 3 milligram dose of fentanyl can kill. A dose as small as a grain of salt or speck of sand can be lethal.
Illicit fentanyl is produced in clandestine makeshift labs and industrial warehouses, mostly in Mexico, with chemicals mostly supplied by China. It has flooded US markets, mixed and laced into counterfeit pills of every kind and drugs such as heroin, cocaine, methamphetamines. Though very rare, even marijuana and other seemingly innocuous drugs, both synthetic and natural, illegal and legal, have been found with fentanyl.
In his new book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth, former LA Times reporter Sam Quinones writes, "fentanyl has become so commonplace that dealers now use it the way we use salt on our food. They liberally sprinkle it into anything they're selling ... motivated by the belief that fentanyl can boost the potency of any drug."
What are "Fentapills"? Fentanyl is being pressed into millions of counterfeit pills, also known as Fentapills, that look exactly like traditional pharmaceutical pills such as Xanax, Percocet, Oxycontin, Vicodin, Adderall, Ecstasy (aka "Molly") and others. These pills are what the majority of our kids our dying from - the counterfeit Xanax, Oxy or Percoset
they might be taking at home to destress or fall asleep or to self-medicate so they can get through their days and ease their pain. The Molly they take might take at a party or a music festival to have fun. The Adderall they are using to study or cram for exams. They may be experimenting with these drugs for the very first time. And as their parents can tell you, #OnePillCanKill.
Fentanyl is unlikely to go away. Author Sam Quinones calls this the "synthetic era of drugs". Although synthetic drugs made with chemicals of all kinds have been around for decades, none have had the huge supply and deadly threat of fentanyl (and also methamphetamine). Quinones predicts these synthetics won't be going away any time soon because they make huge business sense to Mexican drug traffickers.
Using chemicals over plants means no land, irrigation, pesticides or farmworkers are needed and there are no weather or seasons to deal with. Synthetic drugs can be made year-round in labs and warehouses. And they're quicker to manufacture. In the case of fentanyl, it's easier and more profitable to smuggle because so little is needed to make extraordinary profits. So as traffickers transition from a bulky plant to an easy synthetic, heroin is disappearing from the US streets and the more deadly fentanyl is replacing it.
What other drugs are laced with Fentanyl these days? Fentanyl isn't just being laced into pills; it's showing up in other street drugs in powder form.
Cocaine. Fentanyl laced cocaine has been happening for years but the incidents are increasing. Just last week, on March 17, 2022, the San Francisco Department of Public
Health issued a health alert on fentanyl laced cocaine after three fatal and nine non-fatal fentanyl poisonings occurred in the prior two weeks. Cocaine is typically sold as a white or lavender powder. And it's commonly used by our youth, college kids and 20-something young professionals. Like street pills, cocaine is a game of Russian Roulette. Please share the risks of cocaine with your children, in addition to the One Pill Can Kill messaging.
What about Marijuana? There have been law enforcement and public health alerts, especially over the past year, of fentanyl laced marijuana in several states, from the East Coast (Vermont, Connecticut) to the Midwest (Michigan, after 8 suspected cases, and Iowa) to the West (Colorado).
These are still very rare (so far) and in some cases where samples were available and sent to labs for further testing, no fentanyl was discovered. For example, in Vermont, after three people were arrested in connection with two overdose incidents suspected to be fentanyl laced marijuana, DEA lab testing did not find any traces of fentanyl.
Confirmed Connecticut case. However, in November 2021, the Connecticut State Forensic Science Laboratory confirmed the presence of fentanyl in marijuana in one
sampling after 39 recentoverdoses where people needed naloxone to be revived and the patients said they had only used marijuana. An investigation found that 30 had a history of opioid use. Yet the one sample of several grams of marijuana sent to lab examiners confirmed the presence of fentanyl.
A spokesperson for Connecticut's Commissioner of the Department of Emergency Services and Public Protection told reporters that narcotics dealers say adding fentanyl keeps them competitive with the growing legalized commercial marijuana market, and increasingly potent cannabis. "It’s so easy to get, add in the addiction factor and it just keeps people coming back to that same dealer," he said.
In another more recent case in Connecticut in February 2022 involving a 16-year old and cannabis, the investigation and lab testing is still continuing.
Iowa. Also in February 2022, a vaping device found in a high school had THC and fentanyl, according to a field test. The vape liquid has been sent to a lab for confirmation.
Colorado. In Pueblo, CO, a recent March 2022 public service announcement warned the community about an increase in overdoses tied to laced cannabis in both smoked form and THC products such as wax and oil variants sold by street dealers. Samples have been sent to a lab for confirmation.
While the public health alerts, reports, warnings, investigations and lab testing continue, the cannabis industry claims these reports are alarmist and law enforcement scare tactics. They argue it doesn't make sense to lace their product. Moreover, they point out that it's
impossible to be poisoned by fentanyl with smoked cannabis because any flame that is hot enough to combust plant material should destroy the fentanyl. And they say that the few confirmed cases out there are likely accidental cases of contamination. They speculate that the drug dealer may have cut the substances on the same table, exposing the cannabis to fentanyl or didn't properly clean the surface after cutting the fentanyl product. This is certainly plausible, as minuscule amounts that resemble a grain of salt or speck of sand can be deadly if mixed with anything consumed.
But as one drug expert in academia noted "all you need is one idiot to think it's a good idea to mix and you have a cluster" of fentanyl poisonings. Health authorities are putting out the word and warning that if you observe someone having trouble breaking or staying awake after consuming cannabis, administer Narcan immediately if you have it and call 911.
The bottom line on marijuana and fentanyl? There is too little known right now. Fentanyl poisonings from cannabis have been extremely rare. But those who purchase any drugs outside a pharmacy or a tightly regulated legal market should assume fentanyl can show up anywhere. Just ask Eli Weinstock's parents about Kratom...
Eli Weinstock, forever 20
Eli grew up in a suburb of Cleveland, Ohio and was a sophomore at American University in Washington, D.C. He was found dead in his off-campus apartment in March of 2021. The coronor found two substances in his body: fentanyl and Kratom.
What is Kratom? Found in some CBD stores and head shops, it's a legal herbal supplement, extracted from the leaves of an evergreen tree grown in Southeast Asia. It can be made into a liquid product, powder supplement or pill.
Eli's family will never know why, in what form or where he got Kratom. Did he take it as an
energy booster? A mood enhancer? For muscle pain? It's marketed for all those things and more. Low doses can act as a stimulant, making the user more energetic, higher doses may
bring euphoria (for this reason Kratom is sometimes used at music festivals) and at really high doses, it can have a sedating effect. Or did Eli take a pill thinking it was something else but instead had Kratom and fentanyl. The Weinstock family will never know. But they are certain about one thing: he wasn't struggling with substance use.
And, as Beth Weinstock says, death by fentanyl doesn't just happen to "addicts".
Fentanyl can show up in any form. Last year, Alameda County issued an alert that bags of brightly colored gummy-like substances containing fentanyl had been confiscated by police. The yellow, blue and purple colors signified different strengths and potencies.
What's a Parent to do?
Of course, the vast majority of teens will not use street drugs or counterfeit pills laced with fentanyl. Nonetheless, parents should make every effort possible to prevent any substance use that could result in a fentanyl overdose or poisoning. If it happens, you will know you did everything a parent can do. Common sense measures include:
Talk with your child and pay attention as to what's going on with them. First, share these fentanyl facts and stories with your children. Don't just drop fentanyl and kids dying in one big drug talk. The topic of substance use needs to be an ongoing
conversation and not a lecture.
Know that your child will be more receptive if you are communicating effectively and your relationship is already strong. So keep working on that relationship with your child, staying attuned to what's REALLY going on with them (not just that they are getting good grades). Ask questions from a place of curiosity, then listen and keep the conversations continuing. Our BTI website has many practical tips on talking with your child, attachment and authoritative parenting, setting boundaries and more to help. And never fail to tell your children that you love them, no matter what.
Lock up any prescription medications you are using. Keeping them lying around in your medicine cabinet increases the chances your child will be curious and perhaps even try some. And if they like the way it feels, the next time they may get it on SnapChat.
Safely dispose of unused or expired prescription medication. Twice a year, in October and April, the DEA sponsors Prescription Drug Take Back Days. The next one is April 30, 2022. Go to RxSafe Marin's list of safe disposal sites for locations near you or do a google search for the ones in your community. Many neighborhood pharmacies and police stations accept returned prescription drugs year round.
Model healthy ways to cope with stress, anxiety and pain. We say it over and over again - what parents do matters more than what we say. If you need pain medication, emphasize the need to use it as little as possible for short periods of time. Don't joke about needing a Xanax after a stressful day!
Monitor your child's social media, Venmo account or spending as much as possible. This can be challenging, but it is a matter of their health and safety to do so and know passcodes. And check out the Bark app to see if your child's social media accepts the software.
If you think your child is struggling or having substance use issues, seek professional help, whether it's a mental health professional or an addiction therapist for your options (it's not just wilderness programs or rehab facilities).
Learn about and consider the "Invitation to Change Approach", an innovative evidence-based approach that Marion Kregeloh is passionately spreading the word on. It's to help parents and others address substance use and mental health issues in their children and
loved ones. Through a program by the Center for Motivation and Change (CMC) that incorporates "CRAFT" (Community Reinforcement and Family Training, developed by Robert Myers (author of "Get Your Loved Ones Sober") and motivational and behavioral strategies, parents learn techniques to spur change in their children.
The book by Dr. Jeffrey Foote and others at CMC, "Beyond Addiction: How Science and Kindness Help People Change”, together with their "20-Minute Parent Guide" teaches these
techniques. It dispels traditional notions and old myths about addiction (eg., "let them hit rock bottom"). There are also trainings through the CMC Foundation, a non-profit dedicated to sharing this approach through workshops, support groups, written resources and training.
Listen to our kids. Last week, students from Redwood, Archie Williams, San Rafael and Novato High Schools led an excellent presentation, "CALL TO ACTION: The Fentanyl Crisis in Marin". Sponsored by the community coalition RxSafe Marin, the students offered excellent perspectives and ideas on what our community can do. It is well worth a view; please click here to do so.
Spread the word on fentanyl and other drugs and join us - through community organizations, such as RxSafe Marin, Marin Healthy Youth Partnerships or Marin Residents for Public Health Cannabis Policies (BTI works with all of these groups) - or by reaching out to the many parents and their own organizations mentioned in this newsletter. They are working on a multitude of fronts, from education to advocacy.
Know what drug education is in your schools. Chances are it's lacking, either without any standardized curriculum taught the same way by qualified instructors. Or it may not be enough - a few lessons in middle school in Gym class or freshman year in Social Issues Classes.
Make sure it's strong on fentanyl and the message that "One Kill Can Pill", that fentanyl can be laced into any street drug and that no one should ever buy a pill off social media. And
see whether it properly addresses today's potent forms of cannabis, that are being normalized and marketed as safe and natural. If it's not all of these things, then advocate with other parents and students for more. The students at Redwood HS are already doing so in this excellent recent Redwood HS Bark Editorial. Our students know best what is needed and most impactful. Support them and advocate for what they are asking for!
Know these signs of an overdose - and share with your child:
Shallow and slow or absent breathing
Unresponsiveness
Slow heartbeat
Vomiting or making of gurgling noise
Cold and clammy skin
Bluish color to lips, nails, and fingertips
Tiny/pinpoint pupils
Most importantly get Narcan (Naloxone) into your First Aid Kits. Have it at the ready, at home and in your car. Narcan can be administered through a nasal
spray or an injection that reverses an overdose of fentanyl, as well as opioids, heroin and other substances. It blocks opioid receptors in the brain.
Narcan works and it is available for free in certain locations. See this RxSafe Marin webpage for how it works and a list of locations where it can be obtained. Know it can take several doses or hits to reduce the fentanyl levels so be sure to have more than one dose. They often come in 4-packs. Administer it right away and call 911. It can save a life.
Know that it is safe to help someone in distress from fentanyl. It is a myth that fentanyl poisonings or overdoses can occur through touching. Fentanyl will not penetrate the skin on its own and needs to make its way into the blood stream to be harmful. This occurs after being in contact with the mucous membrane in the nose or mouth. Fentanyl must be ingested or inhaled for a prolonged period in a poorly ventilated space.
Finally, make sure your child knows about Good Samaritan laws. Explained in our BTI blog, When to Call 911 and What to Do, if you seek medical help and stay with the person who is overdosing, you will be protected from legal consequences. Tragically many people don't do this.
Dimitri Mustaca's story. Dimitri was 20 years old when he died in Marin County in 2018 of a counterfeit Xanax laced with fentanyl. Dimitri's grandmother, Lisa, says he regularly used cannabis and at times, took pills to get to sleep. A year before he died, she remembers
talking with him about the dangers of fentanyl. She'll never forget his reply: "Nana, do you think I'm dumb? You have nothing to worry about". The night before he died, he went to a concert at Terrapin Crossroads with his girlfriend of one year and a friend he was living with. Lisa believes that someone there gave him the pill he took that night to sleep, thinking it was a Xanax. Instead it was laced with fentanyl.
What is most tragic is that Dimitri might have been saved. When his girlfriend and friend saw that he was in trouble, they they ran off instead of calling for help. Nine hours later, someone who didn't identify himself (most probably the "friend") called 911 from a throw-away phone, saying that "someone should check on" Dimitri. It was way too late. California's good samaritan laws would have protected Dimitri's accomplices had they called for help right away.
What else can our communities do? Advocate for legislation to protect our youth - and Vote
CA Legislation on punishment of Fentanyl drug traffickers and dealers. Alexandra Capelouto's parents, Matt and Christine, have worked tirelessly in Sacramento on legislation they hope will pass someday, SB 350 called Alexandra's Law. It applies the same penalties to traffickers and dealers for fentanyl fatalities as drunk drivers who cause fatalities through "implied malice" in a murder charge.
Opponents say the penalties would increase incarceration rates and would do nothing to deter dealers. In March 2021 and again in January 2022, the bill failed to make it out CA State Senate Public Safety Committee. The Capeloutos are continuing their advocacy, hoping to place an initiative on the CA state ballot and defeat the four state senators on the Public Safety Committee who voted to kill the legislation. Laura and Chris Didier, parents of Zach Didier, called the committee out too after the vote in Sacramento, as the suspected dealer who sold Zach the deadly fentanyl pill was being held without bail in a Placer County Jail.
At the same time in January 2022, the CA Senate Public Safety Committee rejected another bill to address fentanyl, SB 75. It would have added fentanyl to the same category of illicit drugs as heroin and cocaine, resulting in increased sentences of dealers.
Who killed this legislation that would punish fentanyl drug traffickers and dealers who are killing our youth? The following state senators, all representing districts which have experienced enormous fentanyl death tolls:
Senator Scott Weiner, representing San Francisco County. (Wiener has also proposed legislation in the past to allow bars and restaurants sell alcohol until 4 am, citing the economic benefits, as well as legislation to decriminalize LSD and MDMA aka ecstasy).
Senator Nancy Skinner, representing Alameda County
Senator Sydney Kamlager, representing parts of Los Angeles County
Senator Steven Bradford, Committee Chair, representing parts of Los Angeles County
Only Committee Vice-Chair Senator Rosilicie Ochoa Bogh voted to pass these two bills out of committee. So while the CA Senate Public Safety Committee does nothing to hold dealers responsible, the deaths by fentanyl continue ...
We're suffering such losses. If you haven't read our accompanying bog, Death by Fentanyl: Young Lives Cut Short in Our Communities, please take just a few more minutes to do so. It brings it all home. As does this short video, "The Lost Voices of Fentanyl" has too many senior year photos of the young lives cut short by fentanyl. #GoneButNotForgotten.
As Michelle Leopold often laments, "kids should learn from their mistakes - not die from them."