In the face of the overwhelming epidemic of fentanyl overdose deaths, the San Bernardino County Sheriff’s Department has instituted a policy of outfitting all of its patrol units with Narcan.
Narcan is the brand name of an opioid counteractant known as Naloxone.
Taken in time, Nalaxone/Narcan will effectively reverse or reduce the effects of opioids. Most notably, the medication is used to counter decreased breathing that comes with opioid overdose. When given intravenously, the substance can go into effect within two minutes. Narcan also be injected into a muscle, but the effect in such cases can be delayed up to five minutes. The medicine can also be administered by aerosol spray, predominantly into an overdose victim’s nose.
Fentanyl was first synthesized in 1960 and made available for medical use in the United States in 1968. It is on the order of 50 times more potent than heroin by weight and 100 times more potent than morphine by weight. So powerful are its effect that Fentanyl can prove deadly in very minute quantities. The strict standardization applied by pharmaceutical companies in its processing into usable forms and protocols relating to its prescription by physicians was intended to prevent the substance from proving fatal.For some three-and-a-half decades it was used, primarily beneficially, in the medical world and became accepted as an essential medicine in the arenas of obstetrics, the management of pain and chronic pain, and as both a regional/transdermal/palliative anesthetic and general anesthetic and for patients with an intolerance or allergies to natural opioids.
Roughly a decade and-a-half ago, illicit chemists/drug manufacturers discovered that the production of Fentanyl could be an extremely profitable undertaking, as it could be used in a highly diluted form when blended with buffers to replicate heroin, morphine, oxycodone, Vicodin, Norco or percoset. Moreover, drug dealers began mixing it with other narcotics such as cocaine, methamphetamine and benzodiazepines for a variation on those popular street drugs.
At issue is the poor quality control often involved in such manufacturing or assembly efforts.
The drug most closely comparable to Fentanyl is heroin, known scientifically as diacetylmorphine and diamorphine. The quality of heroin varies, as the traditional names of the substance – black tar, Mexican brown or China white – can indicate. Making it ever more complicated is that the unregulated and illegal market in heroin results in typical heroin bought on the street varying in purity anywhere between 30 percent to 70 percent. Thus, a heroin user who has adjusted to having a habit will use about 10 to 20 milligrams of pure heroin for each dose or fix. The estimated lethal dose of heroin ranges from 30 mg in an uninitiated adult user to 500 mg in those who have built up a tolerance for the substance, although there is indication that an uninitiated adult user with no opiate tolerance can, in rare circumstances, suffer a fatal overdose on as little as 15 milligrams of heroin.
As deadly as heroin is, fentanyl is far more dangerous. According to the best research available, in half of the adult population, ingesting 2 milligrams of fentanyl would prove lethal. For illustrative purposes, fentanyl and salt are similar in weight. Each grain of salt weighs approximately .0585 of a milligram. Thus there are roughly 17.094 grains of salt in a milligram. In this way, consuming as little fentanyl in a quantity comparable to about 34.2 grains of salt will kill the average adult.
Illicit manufacturers in recent years have taken to pressing minute quantities of fentanyl into counterfeit representations of valium, Xanax, oxycodone or Percoset by finding a binder, i.e., a buffer, that is similar in color and all other respects to the binders used by licensed pharmaceutical companies in their production of those aforementioned drugs. The pills are then stamped with the markings of those various drugs.
In some cases, quality control with some pirate editions of these drugs is more exacting and sophisticated than in others.
More sophisticated operations use a methodology of blending the fentanyl in a way that it is evenly distributed within the binder. In some cases, the fentanyl is encased in mini-gel capules that break down at differing rates when they come into contact with stomach acid to provide a time-release effect, stretching the effectiveness of the drug gradually over as many as eight hours.
In less sophisticated operations, the pills are pressed from a binder gruel into which the fentanyl has been sprinkled as opposed to having been blended. Those pills can have clumps of fentanyl in quantities that approach or exceed a lethal fentanyl dose. If two or more such clumps are found in a single pill, the outcome for the person who takes that pill can be fatal.
The method of using or ingesting the fentanyl that comes in this pill form can vary. It appears that the lion’s share of those who purchase fentanyl-containing pills, be they colored and stamped to replicate Valium, Zanax, Oxycodone, Vicodin, Norco or Percoset, are ingested orally. That is not always the case, however. Some grind the pills into as fine of a powder as they can and snort, that is inhale, the pulverized particles, including the fentanyl and the binder, allowing the drug to be absorbed by the mucus membranes of their nasal tissue, their sinuses or through eventual passage to their throats and clear down their esophaguses to their stomachs. Others disassemble or crush the pills, loading them into a spoon and using heat from a torch, candle or match to separate, as best they can, the fentanyl from the medium in which it is contained and then use a syringe with a retractable plunger to siphon the melted fentanyl with its different relative density, leaving the binder in the spoon to then slam, that is inject, the fentanyl into a vein or artery.
Growing up around the fentanyl culture, indeed intrinsic to it, is a means of distribution that is as newfangled and inventive as postmodern life permits. Whereas in generations past, drugs were sold to end users by drug dealers and drug pushers who quite often worked the streets and had immediate contact with their customers, that is no longer necessarily the case.
The stereotypical imagraphy of an addict scoring a packet of dope in sleazy alleyway that would be common among the parents or grandparents of today’s younger crop of fentanyl users is hardly applicable when it comes to purchasing fentanyl. Those selling the drug today typically make use of social media to communicate with or even advertise to or recruit possible customers and make or close deals. There yet exist small time dealers, limited to a confined geographical location. There are traffickers, as well, with business of immense proportion, operating regionally or across multiple states, indeed in some cases, from coast to coast.
One can purchase fentanyl from an entrepreneur without knowing him or her, ever meeting or seeing or talking directly with the supplier or even as much as knowing his or her identity or real name.
Arrangements for such sales are typically done by means of social media – Facebook, Instagram, Snapchat or forums of that nature. Snapchat is considered particularly suited to making such interactions because of its encryption and a feature that allows for the erasure/disappearance of previously sent or received messages.
In some cases, a deal for the sale of fentanyl or some type of drug is explicitly dealt with and laid out in the exchange. In others, a code is used, one that uses terminology that those who are not involved in the culture would be unlikely to understand. One example of this is the reference or name used to describe a fentanyl dealer or supplier: plug. Another is the way Xanax is identified: bars.
In 2019, authorities in San Bernardino County became aware of a substantial increase in the presence of fentanyl in various communities.
In 2021, there were 317 fentanyl-related deaths documented by the San Bernardino County Coroner’s Office.
The following year, sheriff’s department deputies responded to the scene of over 100 fentanyl overdose deaths.
In July 2022, the department formed within its ranks an overdose response team. Those deputies, trained in the means of effectively responding with lifesaving measures upon encountering an individual experiencing a fentanyl overdose, in turn have been training other deputies.
Last month Narcan was approved by the U.S. Food and Drug Administration for over-the-counter, non-prescription purchase and use so that it can be used in critical situations by laypeople. Injecting Narcan directly into a vein or artery is the most efficacious way of arresting an overdose. Injection into a muscle is less effective. Deputies are learning that time is of the essence when dealing with a fentanyl overdose.
With Narcan available in every sheriff’s vehicle, the department is shifting its priorities with regard to fentanyl, if only slightly.
Whereas previously the department’s focus was on making arrests when they encountered any sort of situation in which fentanyl was involved, deputies have now gone to a footing where they will not necessarily arrest and charge a citizen who comes forward to report a suspected overdose, instead administering Naxolone to the victim and seeking immediate medical assistance. Investigations into how the deadly substance became available to the individual who overdosed is deferred until a later date.
-Mark Gutglueck