Drug overdoses are rising in many states west of the Mississippi, and dramatically so in California.

This trend has only recently become clear in government mortality data, including new numbers released Feb. 12. The increase in overdoses in the West is an ominous development that comes after a short period of progress in bringing down the overall drug-overdose death toll.

In California, fatal drug overdoses over the previous 12 months increased 13.4 percent between July 2018 and July 2019, the last month for which the CDC has compiled provisional data — an additional 728 deaths.

In contrast, Illinois’ fatal drug deaths were down 8 percent, Pennsylvania’s down 10 percent, Michigan’s down 13 percent and Maine’s down 20 percent.

The overdoses in the West are driven largely by opioids, particularly illicit fentanyl, a synthetic drug that is roughly 50 times as powerful as heroin. Fentanyl has finally arrived in force in the western United States. Because fentanyl is so potent, and its dosage so easily miscalibrated, it is killing people who previously had managed their addictions for years.

Historically, the West Coast opioid market has been dominated by black tar heroin, a gunky substance not easily mixed with white powder fentanyl. That’s the orthodox explanation for why fentanyl first became popular in the eastern United States, where white powder heroin has historically been favored and drug dealers could more easily blend fentanyl and heroin

Fentanyl started becoming more common here around 2015. The medical examiner’s latest, provisional numbers tell an alarming story: Deaths in San Francisco from fentanyl and/or heroin jumped from 79 in 2017 to 134 in 2018, and then more than doubled to 290 in 2019.

People are dying from other drugs as well, with a large spike in deaths linked to the potent stimulant methamphetamine. Efforts to cut off access to meth precursors sold in pharmacies have helped shut down local meth labs like the ones made famous in the TV show “Breaking Bad.” But that opened a new market for the Mexican drug cartels, said Daniel Comeaux, special agent in charge of the Drug Enforcement Administration’s San Francisco division.

He acknowledged that there is rampant drug use right outside his office, but said the federal response has made it harder to buy drugs.

Drug overdose deaths rise in the West

The drug-using population overlaps to a great degree with the homeless population — another relatively new development, according to Alex Kral, an epidemiologist at RTI International, a nonprofit research firm. Kral said that 15 years ago, he rarely saw people on the street injecting drugs, and estimated that only about a quarter to one-third of people injecting drugs were homeless. Now, he said, upward of 75 percent are. And even the most experienced users of heroin can be fooled by fentanyl.

Kral works on harm reduction — an approach that provides people with tools and support to limit the negative consequences of drug use. That’s particularly a problem with fentanyl, which delivers an immediate, powerful high but can also render the user unconscious and unbreathing almost instantly.

Harm reduction advocates emphasize that the overdose crisis is driven by social factors, including economic inequality, the housing crisis that is tied to a rise in homelessness in San Francisco, systemic racism and the criminalization of drug use. They say the overdose epidemic should be treated as a matter of public health and not as a law enforcement issue.

The statistics of drug use and overdoses do little to capture the gritty reality of life on the downtown streets of San Francisco. The use of drugs in public and the burgeoning homeless population are sources of dismay for many of the more affluent residents of the city.

Kristen Marshall, a harm reduction worker who distributes naloxone to drug users, noted that thousands of overdoses have been reversed by peers on the street who were supplied with naloxone as part of harm reduction efforts.

For many years, San Francisco saw a growing population of drug users but had a strikingly low rate of fatal overdoses. But that was before fentanyl showed up.

Source: The Washington Post, by: Joel Achenbach[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]