Fentanyl Epidemic: Opiate addiction fueling uptick in fentanyl overdoses

Last December, the San Diego County Medical Examiner's office released statistics warning the public about a rise in fentanyl-related overdoses.

"Unintentional fentanyl overdose deaths in the San Diego region increased by 68% when comparing this year's midyear data with the same period for 2018," according to the report. "The medical examiner has continued to see more fentanyl accidental overdose deaths and the county is on track to exceed last year's statistics."

Just north of Fallbrook, Jan. 23, the Riverside County Sheriff's Department's Temecula Station issued a special bulletin pertaining to counterfeit pill-related overdoses and deaths in Riverside County.

The warning came on the heels of the deaths of four young adults in or from the city of Temecula a month earlier involving a drug called fentanyl, which is a drug many, many times more potent than morphine.

"Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America," according to the bulletin, adding there has been an "alarming number" of overdose incidents involving counterfeit "Percocet" and "Oxycodone" pills.

"A number of overdoses resulted in the unfortunate death of the individual," according to the sheriff's bulletin. "Multiple overdoses have already occurred in the Temecula Valley."

The warning by the department was a welcome one for area drug counseling and treatment centers like Hill Alcohol and Drug Treatment in Temecula, which has been dealing with the meteoric rise of opiate addiction in the area for the past 15 years.

"We've seen over the course of the last 15 years there's been the rise in opiate addiction; that's nothing new," Erin Hill, director of Hill Alcohol and Drug Treatment, said in a phone interview. "The fentanyl, however, we've really seen a rise even just in the last six months. Overdoses, people coming in testing positive for it and not even realizing they have taken it. Non-opiate substances, cocaine, Xanax is being cut with it."

Essentially, she said, people were experiencing overdoses on drugs and in drug screenings, no opiates were found in their system.

"Fentanyl won't show up on a standard drug screen," Hill said. "So they're testing negative for opiates. We've realized through trial and error over the last six months that they are taking fentanyl unbeknownst to them. So, these kids are getting substances with the fentanyl in it and having no idea, which makes it extra scary."

Makers of the illegal street drugs are cutting fentanyl into drugs like Oxycontin, oxycodone, Xanax, cocaine and heroin to get addicts hooked faster.

"What happens is you get your client hooked faster, and it's more aggressive," Jessica Seaman, a program nurse at Hill Alcohol and Drug Treatment, said. "If you think you're taking Oxy, but you're actually getting more of the opiate, it's going to create more opiate sites and you're going to become addicted and develop tolerance faster.

"Now they have a client who, maybe, before was only able to just take a couple of pills here and there, but with fentanyl, the unknowing client is getting something that's getting them hooked faster," she said. "So, now they have a client that needs more, and they're going to get more. They're going to be coming to the dealer more often."

Hill said a lot of addicted individuals in treatment often believe they have full knowledge of what they are taking.

"We see a lot of kids, even adults will come in with the attitude of, you know, 'my dealer would never do that to me,'" Hill said. "'They would never give me fentanyl. I know what I'm taking.' There's a lot of built-in denial patterns in there. And once they see that, no, they are in fact getting fentanyl, it's a bit of a wake-up call and they open their eyes to the fact that they're not invincible and they can die."

And children and young adults are specifically at risk for overdosing on these drugs. Remember, the people producing these drugs are not doctors or scientists; they are illegal producers.

"The problem comes in because I'm talking a top of a pin or a needle's worth (of fentanyl) over and you're getting overdosed," Seaman said. "Where we're really seeing that happen is with the children, with adolescents, because adolescents are still at a pediatric level as far as medicine goes because it goes based on weight and height.

"They may think they're an adult and talk like an adult, but what we're really looking at is metabolic and all of that stuff. These people are trying to play scientists and doctors and that one little bit over ... and these kids are dropping and it's happening a lot."

The type of drugs that the sheriff's department warned were laced with fentanyl are opiates, described as an epidemic in the county and all over the nation.

According to the U.S. Department of Health and Human Services, 10.3 million people in America misused prescription opioids in 2018 and 2 million people had an opioid-use disorder. The Department of Health and Human Services said 130 people died from opioid-related overdoses every day.

Hill said 30 to 40% of the people they treat at the center are addicted to opiates, second only to alcohol.

"The opioid addiction is tremendous," Hill said. "I mean, we get people from kids, we're getting scholars, athletes, Boy Scouts to attorneys to nurses. It doesn't discriminate. It affects everybody. Unfortunately, there was a period of time where doctors, many doctors were handing out opiates like candy, and if you have that addictive propensity, you take a substance long enough, you're going to become physically addicted.

"It just has taken off," she said. "I don't think you can meet any three people without at least having one of them that's been affected by opiate addiction in one form or another."

Hill said opiates are big with young athletes who suffer injuries.

"They get injured, and they get prescribed medication and they get hooked," she said. "You can become hooked in as little as a week of opiates, and they like the way it makes them feel and they want more. Once you're addicted, in order to keep from being sick, that's where a lot of people that switched to heroin also because it's cheaper, it's more pure and it is ultimately going to keep them from getting sick, keep them from getting in trouble with their parents, from anybody finding out. At that point, not using it to get high. They're using it to feel normal."

Even someone severely addicted to opiates may not even show signs of the addiction.

"I think that's what makes opiate addiction more common too and harder for loved ones to realize what's going on because they even function pretty well as an opiate addict," Hill said. "Alcohol and methamphetamine, many other substances, you can tell right away somebody is under the influence. Opiates, somebody can maintain and look relatively normal while having that euphoria. But once they become physically dependent, even the euphoria goes away. They're just normalized.

"Many people become opiate addicts through, no, they never set out to get high," she said. "They set out to take care of their pain. But with that, because it's a physical dependency, increased tolerance, it snowballs from there.

"There's a big difference between becoming chemically dependent because you still have pain," Seaman said. "When you have pain and you take pain medication, the pain medication goes to the pain. When you take a pain medication and you don't have pain, you get high. That's where the difference really comes in. You kind of have to look at the two differently. There's also a point where you become chemically dependent and then you have physical withdrawal. So you keep taking it because you don't want that physical withdrawal; that's different from taking it to get high even."

The grip that those addicts are under can seem insurmountable, Hill said.

"A lot of people have all the best psychological intention in the world to stop using, but they don't know how to combat the physical piece of it, which is a very real piece of it," she said. "The majority of people do need to work, they do need to go to school. The acute phase of opiate withdrawal is 72 hours, and it can be up to two years of what's called the post-acute withdrawal."

Hill said opiates change the receptor sites more than any substance.

"We used to see our success rates anywhere from 10% to 15% for opiate addicts until we started using a medication-assisted treatment in the form of buprenorphine or Suboxone. Back in 2004 is when we started using it, and since then, we've just seen our success rates for opiates just skyrocket because that medication addresses the physical piece. It allows us to do our job to work on the emotional aspect of what was driving the addiction in the first place."

Because opiate addiction has entered the national spotlight, doctors are now more careful in prescribing and overprescribing the drugs.

"When the opiate epidemic first started, we saw the majority of patients were coming in with these huge scripts, these unlimited scripts," Hill said. "You have a tooth pulled and you get a script for 90 Oxycontin. We don't see that nearly as much as we used to.

"There's always going to be the dirty doctors, but I think doctors now have a better understanding of opiate addiction with the attention that's come to it in light of the opiate epidemic. They are looking at other alternatives."

Seaman said that has driven demand for the drugs to the streets.

"Because they were so overly prescribed and now what happened is now we have the opposite," Seaman said. "Now there's a big crackdown on benzodiazepines and controlled substances. So that's where the fentanyl trend is also coming in because you can't get regular pills. So you have to make them."

Hill said she would tell people struggling with addiction that "there's hope."

"Don't become a statistic. People are dying left and right, and there's help out there for them, not just for the emotional piece, but for the physical piece," she said. "Because I really think that physical piece is what scares a lot of people away from getting help. They just don't see a way out from that three days of hell that comes with opiate withdrawal. From what people describe, it's the worst flu you've ever had, times 10.

"A lot of times people will try to get through that withdrawal, that acute withdrawal phase, and they're just not able to do it. They just need to work. They just physically can't handle it. They're so miserable; they end up going back with the Suboxone. We want to offer the introduction of the Suboxone as soon as they're able to start and within 45 minutes, 95% of people's first response is, I feel normal."

Ultimately, they said, at the very least, using the Suboxone in treatment means addicts won't need to use street-purchased drugs that can include fentanyl.

Editor's note: This is the second in a series of stories pertaining to fentanyl and the fatal risks associated with the drug and its effects on the community. Village News will be speaking to people on the front lines of this epidemic.

Jeff Pack can be reached by email at [email protected].