Fentanyl Epidemic: First responders discuss seriousness of the problem

First responders know better than anyone the threat that fentanyl poses to the public. From law enforcement like the Riverside County Sheriff's Department to the Cal Fire Riverside County Fire Department paramedics tasked with trying to save the lives of people who have overdosed on the drug, they mince no words.

"(The numbers of people dying from fentanyl) are staggering is what they are, they're staggering," Battalion Chief Gad Amith of the EMS Bureau of Cal Fire Riverside County Fire Department said. "It's just scary. It scares me. If you haven't done so, go to the CDC, go to the DEA, look at their website, they've got outstanding data that tells you the numbers much better than I can ever share with you globally. Particularly here in the U.S., the numbers are truly frightening."

According to the U.S. Drug Enforcement Administration's 2019 National Drug Threat Assessment report, "Fentanyl and other highly potent synthetic opioids – primarily sourced from China and Mexico – continue to be the most lethal category of illicit substances misused in the United States. Fentanyl continues to be sold as counterfeit prescription pills as traffickers – wittingly or unwittingly – are increasingly selling fentanyl to users both alone and as an adulterant, leading to rising fentanyl-involved deaths."

The report indicated that the Centers for Disease Control and Prevention reported a 47% increase in synthetic opioid-involved deaths from 19,413 deaths in 2016 to 28,466 deaths in 2017. "Synthetic opioids were present in more drug-involved overdose deaths than any other illicit drug for the second consecutive year," according to the report.

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," the report reads. "The Medical Examiner has continued to see more fentanyl accidental overdose deaths and the county is on track to exceed last year's statistics."

While overdose numbers caused in part, at least, by fentanyl are higher in the Midwest and eastern states, California's rate is 1.2 to 2.6 people per 100,000 residents and rising. The problem is even troubling in states such as Ohio and West Virginia where the rate reaches the 20s.

"Riverside County, for the most part, continues to be predominantly a rural county and at its southern edge, we border both Imperial County in the desert and San Diego County in the west and those counties border the border of Mexico," Amith said. "Whereas maybe 10, 15 years ago, the only place you can get illicit fentanyl was from China or from Mexico, today most of the fentanyl that arrives in the U.S. arrives from China and there are approximately 100 factories in China that are involved in production of raw materials and the various materials needed to produce fentanyl. So the fact of the matter is fentanyl has become readily available and for the most part, it's at low cost at the street level for your typical drug user."

The Drug Threat Assessment reported that the availability of fentanyl at California DEA field divisions has risen from 2017 to 2018 and there is no indication that its growth will slow down anytime soon.

"It's more complicated than that, it isn't just fentanyl, it's opiates in general," he said. "Heroin and Oxycontin are opiates that we encounter and in many times we don't know what we're encountering other than the symptoms. As I said, when you take a pill on the street and you ingest it and then you become unresponsive and you stop breathing, it's going to be very difficult for anybody to tell you what you took other than the symptoms are always the same. And it's subsequent blood tests in the hospital that confirmed that it was opiates."

Amith said at the end of 2019, Cal Fire Riverside County Fire Department took more than 170,000 calls countywide.

"That is the huge number of calls that's about, we average about 500 calls per day," And this is at a time when we have, relatively speaking, the same number of stations, the same number of firetrucks and our call volume is increasing exponentially. We're trying to make ends meet and trying to keep up with the demand for service. There's no doubt that opiate overdoses played a part in those responses."

At the time of this interview, Amith was working on obtaining data pertaining to Riverside County cases involving fentanyl.

"I will qualify that by saying I don't think there's a day goes by that we don't see it," he said. "It's very hard to associate demographics to it. We see it in Temecula and in Blythe and in Palm Desert and in Indio and in Beaumont and Coachella and Moreno Valley and Perris and Elsinore.

"The problem with fentanyl and opiates, in general, is that it transcends socially economical lines. It is not true to say that fentanyl is a street drug, not at all. Fentanyl can be seen in people's homes. Some of them are affluent and well-off as well as our transient homeless population and everything in between. There are no boundaries.

"Nobody's immune from it. I don't think there's a state in the nation or community in the nation that can claim that they're immune from this because nobody is. It transcends any demographic bank boundaries or social demographic boundaries. That's because of the relatively low cost and the ease of being able to get it. And it's really sinister in that respect."

Amith reiterated that from where he sits, the epidemic is affecting people from all walks of life and said it's foolish to place the blame on any segment of the population.

"Homeless people are not the problem that's causing fentanyl dissemination and addiction and an epidemic of use in no way, shape or form," he said. "I live in the city of Indio and we have a very large transient population there and the homeless population. Although Indio has got some beautiful neighborhoods and very opulent enrich neighborhoods in the United States, it also has some of the poorest neighborhoods anywhere in Riverside County. And I can tell you lots of homeless people downtown, particularly the next to the railroad tracks, but they're not to be blamed for the opiate epidemic in no way, shape or form. Those that choose to do so are simply blind to what is occurring out there."

He continued.

"Even if you try to dissect it through ethnicity and racial lines, it affects African Americans and Asians and Hispanics and Caucasians and Samoans and Pacific Islanders. Whether you're Jewish or Muslim or Sikh or Christian or Lutheran or Southern Baptist, it makes no difference."

Amith said all Cal Fire Riverside County Fire Department are trained consistently on dealing with the threats associated with treating overdose cases.

"They all practice it all the time," he said. "And they understand that it's done to protect their lives. This is not a joke. Whether you come across a homeless person on the street corner or you're in somebody's $2 million home, the end result may be very much the same.

"A lot of their training involves the use of personal protective equipment or PPE, which they're required to wear on every call period for medical assistance. They wear protective gloves, medical gloves that will protect them from having direct skin contact. And in addition to that, they are trained in the recognition of overdoses and opiates.

"In addition to that there are those types of calls where if our personnel encounter large quantities of unknown powders or substances that they have any inkling or suspicion that that may be fentanyl, it may rise to the level where we may have to call in the Hazardous Materials Team to identify the product and we do so jointly with the Riverside County Sheriff's department. And then the handling of that product, particularly in large quantities, has to be done very, very carefully."

As we reported in previous stories in this series, 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, 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," the bulletin reads, 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," it reads. "Multiple overdoses have already occurred in the Temecula Valley."

Newly-appointed Temecula Chief of Police, Captain Zach Hall reiterated the threat for this story.

"Fentanyl is very dangerous," he said. "Taking an unknown-origin pill can be fatal as there is no way to know whether it is a legitimately manufactured pill or a counterfeit made with fentanyl. It is equally dangerous to use legitimately manufactured pills other than prescribed.

"You should not take medication which is not prescribed to you and ensure you procure your prescription medications through legitimate traditional means, i.e., pharmacy, doctor's office or hospital. No opiate-based medications are legally sold via the internet and you should not use medication purchased on the street."

Hall said all deputies have been trained specifically in dealing with calls that could possibly involve fentanyl. He said the majority of Temecula deputies have enhanced personal protection equipment are carrying Narcan and have been trained to administer it.

"Our residents need to understand the items they purchase on the street are unregulated," Hall said. "This means prescription pills are likely fake or labeled incorrectly. This applies to consumable products as well such as food, tobacco, vape oils and marijuana. These items could also be counterfeit, contaminated or laced with something dangerous."

Amith agreed.

"They're cutting (fentanyl) into a variety of pills that are even nameless that have all kinds of illicit street names," he said. "The bottom line, you as the end-user, when you buy at a street corner or you buy it at your local school or you buy it from a friend, you don't really know what you're getting, and the danger is severe."

Amith also warned of another drug that he said is just beginning to hit the United States that is truly frightening.

"It's called carfentanil," he said. "Carfentanil is a drug that's been used in veterinary medicine for many years to put down large games, specifically elephants, lions, giraffes, rhinos. And this particular drug is 10,000 times more potent and he takes a very minute amount of it. Even carfentanil has found its way toward illicit drug use. And there have been quite a few fatalities, particularly in the Midwest.

"It doesn't take somebody with a lot of know-how to be able to change a substance by either putting it through a chemical process or changing or adding another molecule and change something into something else. And that can become catastrophic from a public health point of view.

"There are YouTube videos that will show you how to do this. That's how bad it is."

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

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