San Diego Saw Sharp Increase In Fentanyl Deaths Throughout Pandemic Lockdowns

Speaker 1: 00:00 After more than a year of pandemic lockdowns and anxieties signs are emerging, that the stress has taken a toll on mental health and personal behaviors. One of the worst examples of that is the increase in San Diego county of drug overdose deaths from fentanyl abuse county statistics show that deaths from the synthetic opioid more than doubled in the past two years, while seizures of the drug along the San Diego, Mexico border, continue to rise county health officials, project the number of deaths due to fentanyl overdose. This year, we'll reach a staggering 700 people joining me to explain more about this drug and its lethal potential is Dr. Carla Marian Feld, a board certified addiction psychiatrist at UC San Diego who specializes in the treatment of substance abuse, Dr. Marian felled, welcome to the program. Speaker 2: 00:52 Thank you for having me now, how Speaker 1: 00:54 Is fentanyl related to heroin and other opioid Speaker 2: 00:58 Drugs? Opioids are any class of medicines that can act on the opioid receptor in the brain. And some of them are derived from natural sources like the poppy plant. So things like morphine and heroin, and to some extent, coding fentanyl is a synthetic opioid. So its structure is different, but it still acts on the same receptor in the brain. The difference with fentanyl versus some of the naturally derived opioids, is that it's much more potent. So you just need a very, very small amount to achieve a high or a pleasurable effect. And you just need a tiny, tiny bit more to actually overdose or have a very negative effect. Is it cheaper than say heroin? It's cheaper in the sense that you need much less to have a similar effect. So in many ways it ends up being a cheaper product to have a more effective, efficient high, but with greater risks is Speaker 1: 01:55 The reason that there are so many overdoses is because people are unfamiliar in how to use this as opposed to heroin. Speaker 2: 02:02 I think that there's greater public knowledge about the risks of fentanyl, but there's also a mix of people who are using it. So for some people in the community, there is a preference for fentanyl because it is potent and it's a preferable high. They end up using it without really knowing or recognizing that it's in the supply of heroin or other opioids that they might be obtaining or increasingly where we're seeing it as in the supply of methamphetamine that people are using. But for some they're not necessarily aware, does fentanyl have any legitimate use? It's been around for a long time as a very helpful analgesic for patients with cancer pain, or other types of chronic pain. It wasn't till about 2013 that somebody realized the cheaper, more potent high that you could get with fentanyl. And it started coming into our illicit drug supply. And that's where we really saw this rise in opioid overdoses that had been steadily increasing since the early two thousands with oxycodone and with heroin, but just dramatically increased with the introduction of fentanyl to the illicit supply in 2013. What kinds of Speaker 1: 03:13 Challenges does fentanyl addiction present when treating someone for substance abuse? Speaker 2: 03:18 It actually makes things a lot more complicated. Unlike many other addictions, we actually have really good medications to help people with opioid use disorders with opioids. We have methadone, we have buprenorphine and we have once monthly injectable naltrexone. And these are all three medications that have dramatic benefits to reducing opioid cravings, reducing opioid overdoses, reducing mortality, improving life functioning, et cetera. So the challenge with fentanyl is that it's much harder to get patients started on these medications. Doctor, Speaker 1: 03:53 What are you finding out about the pandemic's effect on opioid addiction? Speaker 2: 03:57 We've had signals since early on in the pandemic of worsening rates of substance use across all substances. Particularly alcohol has made a lot of press, but we've seen it with opioid use disorder as well. The pandemic has done many things. It's interrupted drug supplies. So people are more likely to have disruptions in their use, which can lead to some desperate behaviors or trying to obtain things that are more risky. For example, in addition with all of the stressors that everyone in our society is facing isolation, mental health, et cetera, those things are already things that exacerbate substance use disorders and were just intensified and increased during the pandemic. As you mentioned, Speaker 1: 04:41 Fentanyl is new in terms of opioids. And when we know about heroin, we know about Oxycontin, but fentanyl is basically the new drug on our streets. Are we still catching up in terms of how we go about addressing this problem in our community? Speaker 2: 04:57 So fentanyl is newer to San Diego because we have some interesting dynamics in San Diego where methamphetamine has been such a prevalent substance of misuse. And there's been a lot of access to that because fentanyl is so potent, you need just a small amount of it. So it's actually easier to distribute and smuggle into the country as opposed to the quantities you would need for heroin. And so that's changed what's available in San Diego. So fentanyl was really a big problem in the United States, starting in the early 2010s, particularly around 2013, but we're sort of touching up in San Diego now that it's easier for it to be coming here. And we are seeing these change in what people are using in our community. And now I think we're just seeing a continuing legacy of that. That's been exacerbated by the pandemic. I've been speaking Speaker 1: 05:51 With Dr. Carla Marian Feld, a board certified addiction psychiatrist at UC SD and Dr. Marian Feld. Thank you very much. Thank you for that.