Fentanyl pills seized by federal officials in Los Angeles in 2021. (Photo by Jonah Valdez, San Gabriel Valley Tribune/Southern California News Group)

A single sugar packet’s worth of fentanyl packs 500 lethal doses.

More than 100,000 lives were consumed by drug poisonings and overdoses last year in the United States, the equivalent of 10 Boeing 737 jets crashing every week — for an entire year.

The synthetic opioid was responsible for just 4% of drug-related deaths in 2013, but more than 70% in 2021. It’s now the leading cause of death for children 17 and under

“The fentanyl epidemic is our most significant long-term health crisis,” Orange County Sheriff Don Barnes said at a public hearing Thursday, March 3. “Our resources are outmatched by the sheer quantity of what is being trafficked.”

Orange County Supervisor Katrina Foley hosted the three-hour hearing to focus on what can be done to stem the tragic tide, which killed a South County 15-year-old last weekend.

“Users often don’t even know it’s in the drugs,” Foley said. “Just one pill can kill.”

Constructing a crisis

The wheel was sent in motion decades ago, when doctors began over-prescribing potent opioids for pain relief, officials said. It’s euphoria in a bottle, and addiction was swift for many. When doctors were pressured to cut back on those prescriptions, pill addicts turned to street heroin, and a new class of addicts was born.

But fentanyl turns out to be much cheaper and more powerful —  50 times more potent than heroin, and 100 times more potent than morphine. Anyone with a pill press can make it look like prescription oxycontin or Xanax or myriad other prescription drugs masquerading as the real thing. It’s also showing up in street drugs like cocaine, meth, even marijuana.

Profit margins with fentanyl are much greater, and moving product is much easier than it’s ever been, thanks to social media that give dealers direct access to drug seekers, including children, Supervisor Doug Chaffee said.

The size of a penny compared to a lethal dose of fentanyl (Photo courtesy of the Orange County Sheriff’s Department).

Things grew vastly more dire, Sheriff Barnes said, after well-meaning Californians passed criminal justice overhauls in 2014 and 2016. Proposition 47 reclassified some felony drug and theft offenses as misdemeanors, virtually eliminating the threat of landing behind bars. Proposition 57 overhauled the parole system, increasing credits for good behavior so prisoners could be released sooner.

“The social science experiments … reduced and decriminalized and in some ways incentivized drug use,” Barnes said. “The experiment is failing. It’s creating addicts at an exponential rate.”

Reducing the likelihood that drug and property-related crimes could result in jail time has had perverse outcomes, he said. Before Prop. 47, drug users might face one year in a treatment program, or many years behind bars. “There were tremendous incentives to get into programs, sobriety, participate in their own treatment,” Barnes said. “Those don’t exist anymore.”

That must change, he said. Costa Mesa Police Chief Ronald Lawrence agreed.

“It’s an inhumane way to deal with drug addition,” Lawrence said.

Constructing a solution

Parents who’ve lost young, curious children to the scourge say addiction is not the only thing at play. Experimentation and recreational use — common and relatively safe a few decades ago — can now be deadly.

Solutions, then, span everything from test kits so users can check for fentanyl to new laws cracking down on those peddling it to a far more robust public education campaign warning of its dangers, speakers said.

Drug cartels take full advantage of a porous border to transport their deadly wares, Barnes said, and securing it would be one of the most significant steps toward controlling narcotics trafficking.

But one of the greatest travesties, he said, is when people get medical treatment for addiction and sober up while in jail, only to be released and fall back into old habits because there’s no post-custody, sustainable treatment system, Barnes said.

Orange County District Attorney Todd Spitzer announcing that drug dealers can now face murder charges if someone dies from fentanyl poisoning in November. Pictures of victims show the real-life toll. (Photo by Mindy Schauer, Orange County Register/SCNG)

In Sacramento, Assemblywoman Cottie Petrie-Norris, D-Laguna Beach, and Sen. Pat Bates, R-Laguna Niguel, have been working on legislative fixes for years.

A Petrie-Norris bill would target traffickers and add sentencing enhancements of 20 years to life for distributing drugs resulting in death. There’s an understandable reluctance in the Legislature to support penalty enhancements right now, given the lessons learned from mass incarceration, she said. But her bill targets not addicts, but “the traffickers and dealers killing our kids. … We need to strike the right balance. Firm, decisive penalties for bad and evil actors who traffic these deadly drugs.”

Bates has bills pending in the Senate that would expand education about risk and impose an additional 10- or 20-year term on dealers who repeatedly sell drugs that result in great bodily injury or death.

Criminals involved in this must face real consequences, she said, but she has seen bills like this die again and again. “You never ever give up,” she said. “You have to be warriors.”

The Orange County District Attorney’s Office has started to warn offenders that if they keep selling drugs that kill people, they could be charged with murder.

A personal connection

Matt Holtzman, chair of the County of Orange Behavioral Health Advisory Board, lost his daughter to an overdose last year. He also has a stepdaughter in recovery who went through more than a half-dozen treatment programs. “I have a dog in this hunt,” he said, calling for mandatory overdose awareness events at schools; a mass communication blitz on TV, radio, billboards, bus shelters and buildings; overdose-reversing Narcan in homeless shelters, schools, college dorms and nightclubs; and accessible addiction treatment that actually works.

Orange County Sheriff’s Department forensic scientist Terry Baisz shows fentanyl pills masking as real pharmaceuticals  (File photo, MICHAEL GOULDING, ORANGE COUNTY REGISTER)

“You’ve been right in the forefront of this, but we need more,” Holtzman told officials. “This plague affects all of us. If we want to get to the heart of the matter, we need better treatment and treatment on demand. When people are ready to go, there has to be a place for them. We can’t wait two weeks, or we’ve lost them.”

Studies have shown that people have a much better chance of getting sober in public treatment programs, which are required to take a medical approach to addiction, than they are at the private programs so ubiquitous in Southern California. Orange County has earned the moniker of America’s “Rehab Riviera,” and federal officials say it’s now the nation’s ground zero for addiction fraud. 

Programs that treat people for the 28 days private insurance will pay for, then let them go, “are a multibillion-dollar farce,” Holtzman said. “We need to do better. As long as there is demand, there will be supply.”

Dr. Clayton Chau, director of the Orange County Health Care Agency, offered some hope. “Addiction is a medical condition,” he said. “Treatment works, and recovery is possible.”