In 2020, in the midst of the coronavirus pandemic, Phoenix witnessed a sharp rise in fatal drug overdoses, many with fentanyl as the cause. Addiction treatment expert Robert Castan explains why.
Will* was doing well - he was winning against his heroin addiction, and working his recovery after leaving an initially successful program at a Phoenix rehab center. The 26-year-old supermarket grocery worker (a menial job for an intelligent young man, but he liked it), was regularly attending group recovery meetings around the city, sharing his story on occasion, but mostly feeling grateful at being part of this inspiring and supportive recovery community.
Then, out of nowhere, the coronavirus pandemic hit the shores of the U.S., and Will, who was doing so well now, much to the relief of his family, subsequently lost his job.
He started staying home alone in his Phoenix apartment, and, according to his family, he was becoming depressed, regardless of what they tried, and he was desperately missing his recovery support groups, his community lifeline that could no longer gather in-person.
Sadly, within a month of his job loss, a family member found Will dead in his apartment - from a heart attack caused by an opioid overdose.
*With respect to his family, Will is not his real name.
Long before the coronavirus ever reached the shores of the U.S, drug overdose deaths were actually reaching near-record highs by the end of 2019. However, the opioid epidemic was still a national health crisis that was alive in the public’s consciousness, federal resources were still being readily made available, and the long-term prognosis looked better than it had for years.
Subsequent data-driven research demonstrated that the majority of these overdose deaths were opioid-related, and had been triggered by the sudden rise of synthetic opioids, eg. fentanyl, which were now being found in a range of illicit drugs, such as other opioids (like heroin), cocaine, ecstasy, methamphetamine, and blackmarket prescription drugs, like fake OxyContin and Xanax.
And then the coronavirus pandemic arrived.
Everything changed - especially for people like Will and other recovering drug addicts, as well as active addicts, recreational drug users, those with mental health disorders, and those with co-occurring disorder (also known as dual diagnosis, where a substance addiction is simultaneously presenting with a mental health disorder.
The opioid epidemic quickly lost its place in the public consciousness, and its regular frontpage updates simply disappeared, pushed out by the new pandemic. Its funding, at both federal and state level, took a direct hit as resources had to be diverted to fight the new health crisis.
Experts had warned that the pandemic was likely to temporarily worsen the opioid epidemic and its associated overdose deaths, with their concerns centered on economic disruption, increased social isolation, and reduced access to substance addiction treatment.
They have been more than proved right.
In Phoenix, the DEA and local police have made a series of massive fentanyl busts over the past year, seizing thousands and thousands of illicit pills. Sergio Armendariz, a street outreach worker with the Phoenix Rescue Mission, an accredited charity (501c3 non-profit organization), says those drug busts haven’t affected local supply, though.
He stated that people living in Phoenix's homeless camps, where addiction is sadly far too common, offer a growing market for Chinese and Mexican fentanyl. "It's huge over there. Everyone's talking about the fentanyl on the street. When I come up to camps, you see the foils," he added.
Clearly, since fentanyl started appearing in the western U.S., where it actually used to be rare, It’s made major profitable inroads for the drug manufacturers and dealers alike. Chelsea Shover, an epidemiologist at Stanford University, reported, "Up through 2018, the vast majority of synthetic opioid overdoses occurred east of the Mississippi River."
However, her research data demonstrated that, in late 2019, fentanyl had begun killing far more people in western cities, like Los Angeles, Seattle and Phoenix. Shover added, "You think you're using heroin or you think you're using Ecstasy or Xanax or what looks like an Oxycontin pill, but it's actually fentanyl."
Fentanyl is a powerful synthetic opioid, similar to morphine, but 50 to 100 times more potent. It is a regulated prescription drug; however, fentanyl is also manufactured and used illegally. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.
On the flipside, according to the DEA, the street names for illicit fentanyl include Apache, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash. According to the National Institute on Drug Abuse (NIDA), synthetic opioids, including fentanyl, are now the most common drugs involved in fatal overdoses in the U.S.
Furthermore, it is not just fentanyl that is being cut into other illicit drugs, such as heroin, meth, and cocaine. Fentanyl analogs (substances with a similar chemical structure to fentanyl) are appearing more and more in the autopsy findings of county coroners.
Recently, DEA agents from the Minneapolis / St. Paul District Office reported significant increases in counterfeit fentanyl-based pills entering Minnesota from drug trafficking organizations (DTOs) in California, Arizona, and Mexico.
In fact, during the first 7 months of 2020, they recovered over 46,000 counterfeit pills, nearly 4 times the amount seized in all of 2019. These counterfeit pain pills and sedatives are now flooding the illegal drug supply, causing their own fair share of fatal drug overdoses.
Supplied via Mexican drug cartels, or direct from China, the pills look identical to legitimate medications, such as hydrocodone, Xanax or other medications, often prescribed for pain or anxiety. Omaha Division Special Agent in Charge Richard Salter Jr., said, “There is no quality control in these counterfeit pills. A lethal dosage of fentanyl is two milligrams, equivalent in size to a few grains of salt, as compared to a lethal dose of heroin at 30 milligrams. Each time someone takes a counterfeit pain pill, they are playing Russian roulette with their life.”
Along with the DEA, Maricopa County, where Phoenix is located, is currently warning their community about a new, more addictive and more dangerous form of fentanyl - para-fluorofentanyl (pFF). Authorities believe pFF, considered to be extremely strong and powerful by the DEA, is synthetically manufactured in illegal production labs run by Mexican drug trafficking organizations.
The Chief Medicolegal Death Investigator, with the Maricopa County Office of the Medical Examiner, reported this month (December, 2020) that 11 recent suspected overdose deaths had tested positive for the fentanyl analogue pFF.
Cheri Oz, Special Agent in Charge of DEA in Arizona, stated, “Para-fluorofentanyl is yet another dangerous and lethal drug produced by Mexican drug cartels. The drug cartels continue to sell synthetic opioids like pFF in order to get rich while thousands of Americans die every year. DEA and our law enforcement partners are tirelessly fighting to stop this poison from entering our communities, and ending up in the hands of our loved ones.”
The local supplier of the pFF remains unknown at present, but DEA agents believe para-fluorofentanyl could well be present in other regions in Arizona.
Earlier in the year, Dr. Elinore McCance-Katz of the Substance Abuse & Mental Health Services Administration (SAMHSA) stated, “Our mental health system, our substance-use-disorder treatment system has been virtually shut down. We often don’t have facilities that can do 6-foot social distancing.” She added that there has been a “complete lack of concern or any ability of government officials to contemplate any other health risk except for COVID-19.”
As much as the Arizona Department of Health Services (ADHS) has tried to respond to these opioid-related overdose deaths, its fiscal hands have continually been tied by the coronavirus pandemic. Furthermore, the private addiction treatment industry in Arizona, responsible for saving the lives of many desperate drug addicts and chronic alcoholics across the state, is still a business, like another. It has suffered financially, too, during the pandemic. Many had to shut their doors for way too long.
The pandemic has heavily impacted the range of substance addiction recovery services that all rehab facilities, like our own, can offer, but we have slowly adapted and modified, as the year has progressed. This includes:
· New operational COVID-19 protocols and regulations · Provision and better utilization of “telemedicine” technology for clients · Clients being educated in accessing their treatment, care and support online, and · As regulations have been relaxed, the wider use of Medically Assisted Treatment (M.A.T.), eg. the provision of methadone and other opioid replacement drugs
Just like the rest of Arizona, we pray and yearn for a better year ahead, one where we can fully rejoin and engage in the fight against the opioid epidemic, and where those in need of substance use treatment - people just like Will - are able to access their services far more freely, in a more traditional person-to-person setting, and finally receive the potentially life-saving professional assistance that the coronavirus has so cruelly denied them this past year.
Author Bio: Robert Castan, Springboard Recovery
Robert is a member of the Executive Leadership Team at Springboard Recovery, in Scottsdale, AZ., recently featured in a live online special - “Surviving Addiction” - from the virtual Facebook studios of Arizona’s Family.
Robert, an Arizona resident, began his professional career as a house manager, and has become both an industry leader, and an expert and trusted voice in the treatment world. He has been walking his own path of recovery for over 10 years, which has driven his ambition to help make effective treatment available to others who are struggling with substance addiction.