Robert Morin, 49,has used heroin and methamphetamine ever since he tried the drugsbehind bars when he was24 years old. He says he always had a good handle on how much heroin his body could handle, and he hadneveroverdosed.
Until this year.
After finding his drug use deepened during the COVID-19 pandemic, he had tried getting clean. Hespentmore than two monthsat Bella Monte Recovery Center in Desert Hot Springs and a sober living facility in Orange County.
Three hours after leavingthesober living facility, he met up with a couple of friends andrelapsed on heroin — and this time, he overdosed. Morin remembers going into a bathroom with his friend and doing heroin, taking"a little extra because I didn't want to be up," he said. Soon after,he lost consciousness.Afriend had to useNarcan,a nasalthat canreversethe effects of opioidsduring an overdose, to save his life.It took two doses, he said, to bring him back.
He re-enrolled at Bella Monte and a toxicology report came back positive for several drugs, he said.Aseparate fentanyl test also came backpositive. Fentanyl isa synthetic opioid that is inexpensive to produce andis 80 to 100 times more potent than morphine and about 50 times more potent than heroin.
"I thought Iwas just doing heroin," Morin said.
Morin is not alone.Morepeople are taking fentanylunknowingly as it's mixed with other drugs.Since 2016, there has been an extraordinary increase infentanyl-related deaths in Riverside County, according to county data. There were686 overdose deaths in 2020, and 279 werefentanyl-related —an increasefrom just two in 2016.
There have been 158 deaths to datethis year where fentanyl was either the primary cause of death or a significant factor, according to data from the Riverside County Coroner. Based on the current trend, Riverside County District Attorney MikeHestrin believes the countyis on track to hit 500 to 600 deaths related to fentanyl this year.
Approved by theU.S. Food and Drug Administration for medical use, fentanyl is often prescribed to individuals who suffer from chronic pain. It's also used and distributed illegally.Drug traffickersare mixing fentanyl with other drugs, includingheroin, cocaine, methamphetamine and MDMA, because it takes little to produce a high, which makes it a cheap option for them.
Nationwide, overdose deaths from synthetic opioids, such as fentanyl,were nearly 12 times higher in 2019 compared to 2013.It only takes about 2 milligrams offentanylto bepotentially lethal, explainedHestrin.
"It's now in everything," Hestrin said, and he, and many others, fearnumbers will only continue to rise. That's whyRiverside County recently established acommittee composed of health, social services and law enforcement officialsto combat the crisis andreview currentpractice with Narcan.
The Riverside County District Attorney’s Office has also cracked down on enforcement, being the first in Southern Californiato file a murder charge against a drug dealer after a person died from fentanyl-laced narcotics.
Read more:Points on map tell stories of tragic overdose deaths. You can add a loved one, too.
‘Russian roulette’
Black marketfentanyl is produced primarilyin China and is being smuggled into the U.S. mainlyvia Mexico,explained Hestrin.
A kilogramblockof the drug— about 2.2 pounds —can potentially kill500,000 people.It's not unusual for law enforcement to find a quantity of that size during interdiction efforts. In April,El Centro Sector Border Patrol agentsat the Highway 86 immigration checkpoint in Borrego Springsseized three packages of suspected narcotics that tested positive for fentanyl, according to a press release. The total weight of the fentanyl was approximately 6.72 pounds, but officials estimated its street market value at just$97,600.
"Drug trafficking organizations — cartels, local gangs, drug dealers and the middlemen— they're usingfentanyl because it makes them more money," Hestrin said.
Drug traffickers are not just cutting heroin and cocaine with fentanyl.According to Hestrin, drug traffickersare using pill-making machines to create counterfeit drugs that look like prescription medications but actually contain fentanyl.
If a person is handed a pill that their friend says isOxycodone —aprescription pain medication —and it has machine stamped markings on it,"it gives the impression it's a real pharmaceutical, and nothing could be further from the truth," he said.
Drug traffickersdon't have the sophisticated technology to accurately dose pills with non-lethal quantities of fentanyl,he added,essentially leading to a game a "Russian roulette."
"They put in a little bit of fentanyl, they're mixing it up by handand then it goes into the pill machine," Hestrin said. "It's just like any of us who make a chocolate chip cookie: You can mix all you want, but there's no way to know how many chocolate chips end up in each cookie."
"They're not trying to kill their clients," Hestrin said. "They just don't care if they do."
‘Your brain is screaming at you’
Five years ago,Tessa Voss, executive director of the Betty Ford Center in Rancho Mirage, said she had barely heard about fentanyl when she was a mental health and addiction counselor. But today, she said, it's added "another level of safety and concern" for those with substance use disorder.
According to Vahida Tanovic-Lechuga, director of nursing at Bella Monte Recovery Center, between March to June of this year, 30% of patientstested positive forfentanyland did not know they had taken it.
Among them is 26-year-old Jon Foreman. He had what he called the "normal high school experience," which he saidincluded drinking on the weekends and partying with friends. But when he broke his ankle ina skateboarding accident, he became addicted toHydrocodone, a prescription opioid used to treat severe pain.
"It felt like something clicked when I tried them, like the world made sense," Foreman said. "I wanted to feel like that all the time."
Foremanbegan buying prescription pain medication fromfriends and his addiction kept growing.
When he was 21,the pills he was buying looked"really impure and not like a prescription pill, not what I was used to."Foremandidn't really care what they were at the time— "as long as it was an opioid, I was OKwith it," he said— but they had an intense effect on him:He began sleeping all the time, started failing in school and not showing up to work.
When he decided to get clean and checked into Bella Monte Recovery Center earlier this month,hetested positive for fentanyl.
As of Wednesday, Foreman wasseven days sober at Bella Monte Recovery Center and describedthe detox from fentanylas "brutal."
"When you're releasing all that poison, your body is screaming at you, your brain is screaming at you, you just want to run. The anxiety, youfeel likeit’s hard to breathe," he explained. On top of that, he's had restless nights and has only slept forthreehours most nights.
Tanovic-Lechuga said people cravefentanyl "intensely" once their withdrawalbegins. One patient wanted it so badly, Tanovic-Lechuga said, that shejumped the gate surrounding the recovery center in the middle of the night just to find some.
COVID-19 compounds problem
The COVID-19 pandemic has made a difficult situation even worse.Overdose deaths from synthetic opioids, mainly fentanyl,increased 38.4%in June 2019 to May 2020 compared toJuly 2018 to June 2019,according to the CDC.
Though he's been using drugs for more than 20 years, Morin said the pandemic allowedhim to become a "hardcore drug addict." He wasn't taken to jail for violatingprobation or parole, mainly because jails and prisons tried to reduce COVID-19 outbreaks, and that led to more time around "the wrong people."
On top of his overdose, he had to useNarcanon at least four of his friends this last year. In all of these instances, they all thought they were doing pure heroin.
Tanovic-Lechuga has also experienced a tough year. She'sbeen to six funerals this year due to overdoses, and one was a peer from high school.
"It was just like, oh my gosh, this is hitting home. My high school friends are dying,"Tanovic-Lechuga said.
Betty Ford Centerexecutive director Voss noted many people havelost health insurance and been in "financial despair trying to access treatment" during the pandemic.
"Some have other financial strains, job loss, family, grief and lossdue to losing loved one in the pandemic, and it's just leading to another level of desperation and fear, which can actually promote continued substance use," Voss added.
County-wide campaign
There's no easy solution to curbing fentanyl overdosesand death rates. ThoughHestrin remains hopeful that numbers will go down, he also believes "it’s going to take a lot more pain before we wake up as a society."
Riverside County has tried to crack down withenforcement and awareness campaigns this year.
The Riverside County District Attorney’s Office in February became the first in Southern California to file a murder charge against a person suspected of selling or providingfentanyl-laced drugs resulting in someone’s death, Hestrin's office said.There are at least five current pending murder prosecutions, Hestrin said.
Based on the 1981California Supreme CourtcasePeople v. Watson, if a driver under the influencekills an individual, the driver can be charged with second-degree murder if they have hadat least one prior DUI conviction, and they have previously been warned about the dangers of drunk driving. Thisallows prosecutors to use implied malice, which is "when no considerable provocation appears, or when the circ*mstances attending the killing show an abandoned and malignant heart," according to California Penal Code 188.
The same can be applied to individuals dealing drugs, explained Hestrin.
If prosecutors can prove drug dealers "have the knowledge that what they're dealing is deadly to human life,disregard the danger to human life and continue to deal, and they kill someone, that's how we're charging them with second-degree murder," he said.
Hestrin said his office is looking at all fentanyl deaths potentially for such prosecution.
"These families who lose a son or daughter or loved one, I've having waytoo many of those conversationswhen I'm at events," he said. "These are real people,not just statistics, and it's hitting our county hard."
The Riverside County Board of Supervisors also approveda fentanyl-abuse awareness campaign on June 29 to establish a countywide multi-disciplinary committee dedicated to combating rising overdoses and deaths.
The committee will providequarterly reports on the county’s efforts, identify gaps inresponse,recommend solutionsandseek grants forfentanylabuse awareness and education, according to a press release.The committee will consist of representatives from Behavioral Health, Emergency Management, Probation, Public Health and Public Social Service and Sheriff's departmentsand the District Attorney’s Office.
The committee will also review current practice regarding naloxone, also known as Narcan.
Having easier access to Narcanand fentanyl test strips, which can determine if drugs have been laced with fentanyl,is crucial, said Tanovic-Lechuga. A two-pack of Narcan can be purchased in pharmacies, but without insurance it can cost around $120, she said.
Bella Monte Recovery Center gives its clients Narcan and fentanyl test stripswhen they are discharged, butTanovic-Lechuga would like to see hospitals do the same.People who come in with overdoses at hospitals are discharged after they're stable, but there is no discharge plan made with referrals to treatment, she said.Those two itemsshould be sent home withpatients,Tanovic-Lechuga stressed, since both can potentially save lives.
The CDC andthe Substance Abuse and Mental Health Services Administration announced in April that federal funding can be used to purchase rapid fentanyl test strips.
Education, particularlywithyouth, is alsonecessary.Hestrinsaid he's already hadconversations with his children about not taking pills that their friends may offer them, and that they should assume they're fatal.
"As a parent, you have these conversations and you just never know how muchreally gets through," Hestrin said."In the end, we just have to trust that they're going to make the best decision."
If you need help with substance use
There are a number of hotlines and treatment programs available to those who need help in the Coachella Valley
Substance Abuse and Mental Health Services AdministrationNational Helpline:800-662-4357;free, confidential and available 24/7
ABC Recovery Center: 44374 Palm St., Indio;760-342-6616
Banyan Palm Springs: 67580 Jones Road,Cathedral City;760-642-1112
Bella Monte Recovery Center:68111 Calle Las Tiendas, Desert Hot Springs; 800-974-1938
Betty Ford Center: 39000 Bob Hope Drive, Rancho Mirage;844-611-6934
Desert Comprehensive Treatment Center: 1330 N. Indian Canyon Drive Suite A, Palm Springs;760-601-5062
Palm Desert Recovery Center: 74350 Alessandro Drive suite a-1, Palm Desert;760-550-0613
Phoenix Rising Recovery Center: 35450 Pegasus Court, Palm Desert;760-919-4741
Ema Sasic covers health in the Coachella Valley. Reach her at ema.sasic@desertsun.com or on Twitter @ema_sasic.
