In less than a decade, fentanyl went from an unknown synthetic opioid to a leading cause of death in San Diego County.
County health officials recorded 22 fatal fentanyl overdoses in 2015. That number jumped to 468 in 2021 and then to 814 in 2022.
“We’ve made fighting fentanyl a priority because we are ground zero for it,” said San Diego District Attorney Summer Stephan.
But a small ray of hope has emerged amid those devastating numbers — fewer people died from fentanyl overdoses in 2023 than in 2022. It was the first time fentanyl deaths decreased since county health officials began tracking them.
Yet, with 749 fentanyl deaths last year, Stephan is hardly celebrating.
Instead, her office and public health experts are studying local consumption patterns and the San Diego region’s unique place in the global supply chain.
Tara McGrath, the U.S. Attorney for the Southern District of California, said San Diego, home to the busiest land border in North America, is “a transportation hub.”
“We are a transition point for the arrival of fentanyl,” McGrath said. “The fentanyl comes through the Mexican border and then transfers up to distribution hubs like Los Angeles and Las Vegas. Then it gets distributed to the rest of the country.”
One election year talking point that McGrath and other law enforcement are quick to debunk is the claim that fentanyl is smuggled across the border by undocumented immigrants.
The reality is most fentanyl comes through legal border crossings in San Ysidro and Otay Mesa — usually hidden in vehicles or large trucks.
While San Diego is primarily a transportation hub, it is inevitable that some of the supply will stay in the region to feed the local demand.
Unhappy accidents
Prosecutors and drug treatment experts said Mexican drug cartels created a generation of fentanyl users by secretly introducing the addictive opioid into other drugs.
During the early years of the crisis, nearly all overdose deaths were described as “accidental” because people did not know they were using fentanyl. They were taking drugs and pills that had been laced with it.
Over time that began to change.
“In 2019 and 2020, we never saw cases where somebody was seeking or asking for fentanyl,” Stephan said. “Now in 2024, we have many cases where the victims ask specifically because they’re now addicted.”
It’s a trend that treatment experts at San Diego-based A NEW Path have also noticed. April Ella is the director of operations and runs the naloxone distribution program.
“They start maybe trying to get a Xanax, but it’s laced with fentanyl,” she said. “Now they realize fentanyl is in it. They might get a little bit more addicted to it, drop the whole Xanax portion and go toward fentanyl.”
Ella credits part of the decrease in fatal overdoses to increased availability of overdose reversal drug naloxone, which goes by the brand name Narcan. But she warns that fewer deaths don’t necessarily mean fewer overdoses.
Nonfatal overdoses are extremely difficult to track, Ella said.
“If they don’t go to the hospital, or they didn’t get arrested, or they didn’t get some sort of care or even call the helpline, there’s no way to track how many people are overdosing every single day,” she said.
Despite the lack of reliable data, A NEW Path has seen more demand for naloxone — which suggests more people are either overdosing or at least worried about overdosing. While out on the field, Ella said she runs into people asking for multiple kits of naloxone.
“They say, ‘I used three of those kits on my brother, on my roommate, on whoever,’” she said. “But that doesn’t mean it gets reported anywhere.”
Prosecutors believe increased collaboration between multiple agencies has also contributed to the decline in fatal fentanyl overdoses.
McGrath’s office works closely with the San Diego District Attorney, the FBI, Drug Enforcement Administration, Homeland Security Investigations, and several local agencies. Everyone with its own role to play, she said.
“Identify and dismantle the cartels, that’s what the U.S. Attorney’s office does,” she said. “That is our unique piece of the puzzle.”
District Attorney Stephan says tougher drug sentencing laws are also needed. Meanwhile, advocates like Ella say that would be a return to failed policies of the war on drugs.
