Exactly what is fentanyl and what does it do?

Sadly it sometimes takes a tragedy to create awareness, and this week's tragic deaths of four people in South Lake Tahoe are bringing out questions.

Why?
What is Fentanyl?

While the "whys" are not answerable, the rest of the questions are.

The message of the dangers of fentanyl is not new, and has filled headlines for years - and especially over the last couple of years as the results hit more families, more young people, and more communities. The South Lake Tahoe Police Department (SLTPD) responds to fentanyl overdoses weekly, almost daily. Between Feb. 12 and Feb. 14, they responded to seven overdoses (three were nonfatal).

"Fentanyl is in everything," said SLTPD Sgt. Nick Carlquist.

Some people in the region have shared their tragedies to raise awareness. In Placer County, the family of 17-year-old Zach Didier took their story to the public after his 2020 death after taking one pill. Zach thought he was getting a prescription of Percocet through a drug dealer on Snapchat, that one fake pill contained fentanyl and Zach died.

"We need to talk about this. We need to talk about what's happening,” said Zach’s parents, Chris and Laura Didier. “We can't protect Zach now, but hopefully we can protect someone else’s child.”

The “1 Pill Can Kill Placer” campaign came from that tragedy (see story here).

So what is fentanyl and why is it used by drug dealers?

According to the Centers for Disease Control and Prevention (CDC), pharmaceutical fentanyl is a synthetic opioid approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse. Illegally made fentanyl is sold through illegal drug markets for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge—to increase its euphoric effects, said the CDC. Most casual users never know fentanyl is part of what they believe they are using. Fentanyl can be cut into a variety of drugs due to its ability to increase the potency of the drug. How much fentanyl is in an illegal drug is unknown, increasing the danger to the user.

While heroin is still around, fentanyl is taking over as the cause of overdose. It is found in pills, marijuana, cocaine, vaping ingredients, and more.

The Drug Enforcement Agency (DEA): 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose. Drug trafficking organizations typically distribute fentanyl by the kilogram. One kilogram of fentanyl has the potential to kill 500,000 people.

Naloxone/Narcan

Naloxone is a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. As SAMSA (Substance Abuse and Mental Health Services Administration) explains, it is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of opioid overdoses from fentanyl, heroin, morphine, and oxycodone. It is sold under the names Narcan and RiVive, with the Narcan nose spray the most common.

Pharmacies offer Narcan over the counter for sale, but in South Lake Tahoe groups are trying to get it into the hands of the public. For the past several years, the Tahoe Alliance for Safe Kids (TASK) has spearheaded efforts to get Narcan to the people who need it, and has had it at Drug Take Back days, helped facilitate getting it to school nurses, the Tahoe Homeless Coalition and other agencies. After Monday's tragedy, they have worked collaboratively with El Dorado County and Barton Health to get the word out and help increase supplies. On Wednesday they delivered two cases to Tahoe Blue Event Center ahead of this weekend's music festival, and more outreach is being planned.

At this time there are free doses of Narcan at Barton Community Health Center, Barton Urgent Care & Barton Primary Care at Stateline, Barton Emergency Department, Tahoe Coalition for the Homeless- Red Lodge, El Dorado County Behavioral Health Services.

The pharmacies that carry does are:
Safeway at Bijou - available without a prescription, about $40.
Safeway at Roundhill - Available with a prescription (pharmacist can write), and they will bill insurance.
Tahoe Valley Pharmacy - Does not carry Narcan
Raleys - Available but needs a prescription (which a pharmacist can write) and can bill insurance.
Both CVS pharmacies - available over-the-counter for $45.

While Narcan can save a life, 911 still needs to be called as a dose that only lasts in a person's system for about 90 minutes. People may see it as a green light that all is okay, but a follow-up with a medical professional is still needed. Many times, more than one dose is needed per situation as nobody knows what dosage of what drug caused the overdose, and not all fentanyl is created equal.

Carlquist said every home they search with a warrant, and every car they search has empty Narcan canisters. Narcan comes as a nasal spray.

One current situation that is growing more dangerous each day is the prevalence of "tranq" or xylazine mixed with fentanyl. While the fentanyl portion can be reversed by Narcan, the xylazine cannot since it is not an opioid. According to the DEA, xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Milgram. “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23 percent of fentanyl powder and seven percent of fentanyl pills seized contained xylazine.”

Tranq” is a powerful sedative that the U.S. Food and Drug Administration has approved for veterinary use. People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis, the rotting of human tissue, that may lead to amputation. That gives the drug another nickname, the "zombie drug."

Fentanyl test strips

Fentanyl test strips (FTS) are available in multiple places. They are small strips of paper that can detect the presence of fentanyl in all different kinds of drugs (cocaine, methamphetamine, heroin, etc.) and drug forms (pills, powder, and injectables). FTS are a harm reduction strategy designed to reduce the negative consequences of drug use, including the risk of fatal and nonfatal overdose. Part of the drug needs to be destroyed to test, and there is no guarantee that the results would match the rest of the batch of drugs.

What can you do?

There is only one thing a person can do to avoid a fentanyl overdose, and that is to not use drugs.

"There is no such thing as a bad batch of drugs, all drugs as bad," said Carlquist.

Several groups and agencies around Lake Tahoe are working to increase knowledge and awareness about drug overdose risks and harm reduction strategies to help prevent overdoses and deaths.

TASK works to prevent and reduce youth substance use and related harm while keeping kids safe in collaboration with community partners. They have a website, support youth clubs and programs, use a texting network for both kids and parents and use a plethora of other avenues to support the community's needs. For more information, visit HERE.

The Speedy Foundation is a non-profit named after 3-time Olympian, Jeret "Speedy" Peterson of Boise, Idaho, and Park City, Utah who was lost to suicide. They have a Truckee office, and while their main focus is suicide prevention, they have overdose prevention programs and education. For more information, visit https://knowoverdosenc.com/, https://www.thespeedyfoundation.org/, and https://www.mentallycovered.org/collections/resources/Substance-Use.

The El Dorado County COPE (Coalition for Overdose Prevention and Education) https://www.eldoradocope.org/fightingfentanyl works county-wide to address the overdose epidemic.