Pubdate: Sat, 09 Apr 2016
Source: Sacramento Bee (CA)
Copyright: 2016 The Sacramento Bee
Contact: http://mapinc.org/url/0n4cG7L1
Website: http://www.sacbee.com/
Details: http://www.mapinc.org/media/376
Author: Erika D. Smith

HOW PUBLIC POLICY CONTRIBUTED TO FENTANYL OVERDOSES

Pills Have Led to Overdoses Across Sacramento, Central Valley

Authorities Suspect Traffickers From Mexico Are to Blame

With Legal Weed Flourishing in U.S., Cartels Focusing on Opioid Addicts

Dr. Angella Barr spends her days in East Sacramento, talking to an 
ever-growing group of people who are "sick and tired of being sick 
and tired." Opioid addicts who have hit rock bottom.

She helps housewives who've developed a tolerance to prescription 
painkillers, but are terrified by heroin. She helps college students 
who have already turned to the illicit drug. And the IV drug users 
who wear long-sleeves because they don't want to be judged by their 
track marks.

But no fentanyl addicts. Just like everybody else, she has followed 
the spate of overdoses in the Sacramento region, all linked to a 
counterfeit version of the opioid painkiller. As of Friday, that 
number was 48. Ten have died.

"That's really one of the scarier things. I don't get one of those 
people in my outpatient clinic saying, 'I took one of those fentanyl 
pills and I'm addicted,' " said Barr, an addiction specialist at 
Chemical Dependency Treatment Associates Inc. "They're dying."

Yet, she doesn't seem as lost as the rest of us about how we got 
here. How we got to a point where a guy like Jerome Butler, a 
28-year-old father of three, can one minute be hanging out drinking 
beer with friends, and the next minute be unconscious and never wake up.

How we got to where chemists working for Mexican drug cartels are 
cooking up deadly doses of synthetic fentanyl and pressing them into 
pills designed to look like the prescription painkiller Norco. And 
how, despite the apparent risks, people continue to take them.

Natasha Butler, told The Bee that her son "can't just die and no one 
is accountable for what happened to my baby."

The truth is, in addition to whoever is producing this stuff and 
selling it, there are lots of people to hold accountable. What's 
happening with fentanyl, meth and other synthetic drugs, such as 
spice, is partly the result of a series of public policy decisions by 
state and federal governments and private industry over several 
years. Think of it as a perfect storm of good intentions and 
unintended consequences. One that created a demand and an incentive 
to supply a new era of drug use.

Think about it.

In the United States today, we have a vast and growing market of 
opioid addicts. Addicts, in many cases, who won't even admit to 
themselves that they are addicts because of the stubborn stigma of 
addiction, lingering tendency of our laws to criminalize it and the 
notion that "addicts" are fiends wandering the streets in a zombie-like daze.

Dr. Melody Law ran headfirst into that line of thinking when she took 
a job as an addiction specialist at a clinic in opioid-ravaged Lake 
County. Her new bosses had expected a flood of people seeking help 
when she arrived. It didn't happen.

Asked why, Law lamented: "Patients do not like to be labeled addicts. 
Addicts in society are not treated very kindly," she said. "To 
understand addiction as a chronic disease would be helpful."

Also in the United States today, we have a medical profession that is 
largely just coming around to the idea that it must cut back on 
prescribing opioids so it doesn't create even more addicts.

The American Medical Association and the Centers for Disease Control 
and Prevention have issued updated guidelines. Doctors in many states 
have expressed a willingness to follow them, although political battles remain.

The initial push to prescribe more medication for pain came from a 
good place. For years, doctors had downplayed patients' complaints 
about pain. That thinking began to change in the 1990s, when the U.S. 
Food and Drug Administration approved the slow-release opioid 
OxyContin. The motto became "pain management" to reduce suffering. A 
noble cause, for sure.

Of course, that mindset has changed again. Because of the current 
epidemic of opioid abuse largely driven by prescription drugs, it 
went on under the radar for far too long. Now, everyone wants to talk 
about it. People running for president. Pastors. Police. Baristas. 
Newspaper columnists. Pushy editorial boards.

The statistic you're most likely to hear about opioids is that more 
Americans die of overdoses than car crashes. And that, in one year, 
doctors prescribed enough opioids for every American adult to have a bottle.

Most people now agree that doctors need to rein it in - and rightly 
so. Good intentions again. But a lot of damage is already done. Some 
patients who have been taking opioids for years are grumbling about 
how new limits on prescriptions are making it harder to get the drugs 
they say they need.

How many of those Americans will turn to the black market when they 
get cut off by their doctors remains to be seen, but I'm not 
optimistic. It has been happening for years, as evidenced by the 
rising rates of heroin use.

Not surprisingly then, another thing we have in the United States 
today is a rising rate of heroin seizures being trafficked here from 
Asia and South America. The Drug Enforcement Administration, in its 
2015 National Drug Threat Assessment Summary, also notes that 
"Mexican traffickers are making a concerted effort to increase heroin 
availability in the U.S. market."

Although plenty of marijuana is still seized at the border, there has 
been a decline over the last few years. Some say the Mexican cartels 
are changing their tactics, shifting their business model from 
marijuana to heroin, meth and synthetic drugs, including fentanyl.

The why is pretty obvious. Not only is there a demand for it in the 
United States, but with more states legalizing marijuana and allowing 
Americans to grow it, there's not as much of a market for it.

That's not to say voters shouldn't vote to legalize cannabis for 
recreational use in November. It's about time California had some 
certainty on that front. But we need to be realistic about what we're 
doing, too. We're not, as experts once predicted, killing the 
cartels' business. We might instead just be giving it an unintended, 
final push in a more dangerous direction.

But what of fentanyl?

Authorities say they suspect the fake Norco pills that caused so many 
overdoses in Sacramento County are coming from traffickers, probably 
from Mexico using materials they got from China. And last week, 
heeding warnings from police about fentanyl being the new go-to drug 
for cartels, a Senate committee passed SB 1323 to stiffen penalties 
for traffickers.

The idea of the drug ripping through Sacramento's homeless 
population, for example, is terrifying.

Barr doubts it will happen, though. Many addicts, she says, don't 
think like that. Some will take anything, chasing an even higher high 
despite the risks, but most addicts - the housewives, the college 
students - will stay away from mysterious pills for a while.

The cartels are another story.

"Drugmakers, they're very smart chemists. They evaluate and 
re-evaluate what their purpose is and see how their products have 
affected people," she predicted. "They'll wait a few months and 
change the formula to something (not as deadly). Then they'll put it 
back out there, and then it will really be scary."

I hope she's wrong - that fentanyl won't take root in California the 
way it has on the East Coast. But either way, there's something 
rather troubling about knowing that thanks, in part, to years of 
unintended consequences from incremental public policy decisions, the 
very possibility is there.
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MAP posted-by: Jay Bergstrom