The Fentanyl Crisis in California - Deaths, Stats, and Analysis

The Fentanyl Crisis and California's Unique Position

The ongoing fentanyl crisis in the USA, particularly in California, is one of the most devastating public health emergencies of our time.

It began with the overprescription of medications like Oxycontin and Percocet in the 1990s, which led to the first wave of opioid overdose deaths. A rise in the illegal use of heroin (another opioid) in the early 2010s brought on the second wave of the opioid crisis. An alarming use of synthetic opioids like fentanyl set off the third wave - which saw the most dramatic spike in overdose deaths since 2013.

California’s unique susceptibility to the fentanyl crisis comes down to several reasons. For one, the state’s porous border with Mexico - a country that accounts for 90% of all fentanyl that makes its way into the US.

Then there are demographic reasons, such as vulnerable groups like immigrants and agricultural workers.

Finally, social attitudes and stigma surrounding drug use prevent certain sections of Californian society from seeking medical help at the county or state levels.

The following five sections of this report explore the trends of the fentanyl crisis in California, its economic and human impacts, preventative efforts, and alternative sentencing norms for fentanyl-related offenses.

The Fentanyl Crisis by Numbers

There were an estimated 107,543 drug overdose deaths reported in the US in 2023, according to provisional data from the CDC’s National Centre for Health Statistics. Overdose deaths involving synthetic opioids, primarily fentanyl, were responsible for 74,702 of them.

That’s 69.46% of all drug overdose deaths in the US.

Between May 2023 and May 2024, 12,835 people died of drug overdoses in California - the highest across all 50 states. Its closest competitor, Florida, recorded 7,852 deaths over the same period.

Overdose Trends

The lone silver lining in this national tragedy comes from a modest 3% decline in the number of drug overdose deaths between 2022 and 2023. This is the first decrease in drug overdose deaths since 2018.

Overdose deaths involving opioids (both synthetic and natural) fell from an estimated 84,181 in 2022 to 81,083 in 2023.

Polydrug Usage

In the context of this report, polydrug refers to the mixing of fentanyl with either prescription drugs and alcohol or illegal drugs like methamphetamines and cocaine.

While polydrug deaths involving fentanyl accounted for just 0.6% of all drug overdose deaths in 2010, that figure grew to 32.3% by 2021.

The alarming rise in overdose deaths due to fentanyl polydrug usage is being called the ‘fourth wave’ of the opioid crisis.

Youth Impact

Overdose deaths among the youth have spiked in recent years, mostly due to their experimenting with prescription drugs and counterfeit pills laced with fentanyl.

Overdose deaths among 15 to 24-year-olds skyrocketed 49% between 2019 and 2020. An average of 22 high school-age adolescents died each week in 2022 after overdosing on pills containing fentanyl.

In terms of racial and ethnic disparities, American Indian and Alaskan Indian youth account for the highest fentanyl-involved overdose deaths, followed closely by Latinos.

Recidivism in Addiction Recovery

The relapse rate for people addicted to fentanyl is remarkably high, a factor that contributes directly to the severity of the opioid crisis.

While overall relapse rates among people with substance use disorder (SUD) hover between 40% and 60%, that rate could be as high as 80% to 95% for individuals with fentanyl dependence.

Relapse Statistics by Substance

Data compiled by the US Substance Abuse and Mental Health Services Administration between 1994 and 2004 indicate a wide variance of relapse rates according to the substance used.

Here are the findings in a nutshell:

[fs-toc-h3]Impact of Treatment Modalities

There are essentially three different modes of treating fentanyl abuse and addiction. The best results are often achieved when all three are applied simultaneously.

Medication for Opioid Use Disorder: Medications like Buprenophrine, Methadone, and Naltrexone are used to normalize brain chemistry, relieve cravings, and prevent withdrawal symptoms. This is the first line of treatment for people addicted to fentanyl.

Outpatient Counseling: It enables individuals to make behavioral and lifestyle changes to support a sober life. It also helps them understand their triggers and the reasons behind their drug use. It is most effective when paired with medication treatment.

Inpatient Rehabilitation: Users committing to a controlled environment receive treatment without distractions or temptations. Some Inpatient environments are hospital-like, while others are akin to spas and hotels. It provides a more supportive environment and a higher rate of success.

[fs-toc-h3]Success Stories and Challenges

The grim statistics of the fentanyl crisis would be hard to bear without the occasional light of success stories.

One such story comes from journalist Kathryn Kemp, who details her struggle with, and eventual victory over prescription fentanyl in the book ‘Painkiller Addict: From Wreckage to Redemption’.

A similarly inspiring story comes from Gwinn Taylor, who dug her way out of living on the streets as an addict to graduating from the University of Louisville.

What these stories show, more than anything, is the insidious nature of fentanyl addiction. The primary challenge of this crisis is that people who are prescribed fentanyl strips or lozenges, like Taylor, often slip into addiction unwittingly.

The second challenge is its potency: people who stop using it can suffer debilitating withdrawal symptoms within hours. There’s no going cold turkey with a fentanyl addiction.

Economic Impact of the Fentanyl Crisis

The ongoing fentanyl crisis has widespread implications for the US economy. A significant chunk of the economic burden is due to reduced quality of life because of fentanyl addiction and the value of lives lost to fatal overdoses.

The total estimated cost of the opioid crisis on the US economy reached $1.02 trillion in 2017, the last year for which we have credible data. The cost of opioid use disorder on the economy of California topped $36.5 billion that same year.

Costs at both state and national levels are expected to have grown significantly in the years since.

Healthcare Costs

Analysis by the healthcare improvement company Premier found that opioid overdoses cost hospitals across the US an estimated $11 billion annually. That amounts to 1% of all hospital expenditures.

Hospitals spent an average of $11,731 on overdose patients who were treated and admitted, and $20,500 for those who needed ICU care.

The analysis also found that 14% of all opioid overdose patients were uninsured.

Workforce Impact

Princeton economist Alan Krueger suggests the rise in opioid prescriptions between 1999 and 2015 accounts for a 43% decline in men’s labor force participation during the same period. The corresponding fall in women’s labor force participation was 25%.

Other researchers have found that the US economy suffered $92 billion in lost productivity due to opioid addiction and overdose deaths in 2017.

Community Burden and Revitalization

The fentanyl crisis has ripped through American communities from coast to coast. But some have borne the brunt of it more than others.

1. Opioid overdose deaths per 100,000 people was 28.6 in urban counties, against 26.2 in rural counties.
2. The rate of drug overdose deaths in urban counties was twice that of rural counties for non-Hispanic Blacks.
3. From 2010 to 2021, Hispanic overdose deaths rose from 5.6% to 21.7%, an increase of 287.5%.
4. Among Native Americans, fentanyl-involved death rates are 210 per 100,000 of the population, against 30 per 100,000 of the general population.

These disparities in fentanyl addiction and mortality call for the revitalization of efforts to develop community-centered solutions. Due considerations must be made for the unique cultural attitudes and socioeconomic circumstances that exacerbate the effects of the fentanyl crisis on certain communities.

Youth Addiction Trends and Prevention Efforts

A majority of adults who develop substance use disorders start using them during their adolescence or early adult years. This puts some youth at a higher risk of drug abuse and dependence.

Trends in Youth Addiction

According to a 2019 CDC survey, one in seven high school students reported misusing prescription opioids at least once in their lifetime.

Fentanyl deaths as a share of all adolescent drug overdose deaths shot up from 32% in 2018 to 65% in 2020. That was the first year ever that adolescents accounted for more fentanyl-involved deaths in the US than adults.

In California, the extent of the crisis can be gauged from the fact that the Los Angeles Unified School District (LAUSD) is one of the state’s largest when it comes to stocking naloxone in schools.

Naloxone is a medicine that rapidly reverses the effects of opioid overdoses.

[fs-toc-h3]Risk Factors

Opioid use among the youth corresponds with a higher incidence of behaviors that lead to negative health outcomes, such as substance abuse.

1. According to the CDC, youth opioid use is directly linked to sexual risk behaviors.
2. Students using prescription drugs without a doctor’s advice are more likely to be the victim of physical or sexual violence while dating.
3. Drug use among youths is also associated with mental health conditions and suicide risks.

[fs-toc-h3]Current Prevention Efforts

Preventing fentanyl dependence among the youth requires a thorough understanding of the factors that influence individual choices and behaviors.

As such, current efforts to prevent fentanyl use are centered around three key strategies:

1. Primary Prevention: Tiered and multidisciplinary prevention efforts that range from population-wide strategies to targeted interventions for high-risk individuals.
2. Surveillance and Risk Identification: Preventing opioid misuse through active surveillance and risk identification based on social determinants and health equity of at-risk groups.
3. Tailored Approaches: Understanding substance use behaviors among specific communities and tailoring prevention responses according to their unique needs and strengths.

Drug Courts and Alternative Sentencing

Punishments for drug-related offenses in the US are typically harsh. Many such crimes are charged as felonies and carry mandatory minimum sentences.

Some states do make it possible to obtain alternative sentencing options to avoid incarceration, especially for first-time and non-violent offenders. It’s worth noting, however, that alternative sentencing is a privilege based on judicial discretion and not an automatic right.

Alternative sentencing can include probation, supervised work release, unpaid work, community service, curfew, and other options.

Comparing Drug Court Outcomes

Long sentences for serious crimes, especially drug-related crimes, have inherent appeal. Yet, most research shows that higher incarceration rates do not reduce drug problems, either at the level of the community or the individual.

On the other hand, proponents of alternative sentencing argue it reduces recidivism and is more cost-effective.

Let’s compare the outcomes of mandatory minimum sentencing against alternative sentencing:

Mandatory Minimum Sentencing

• Denies court discretion to consider a person's history, culpability, or family responsibilities.
• Prosecutors can use the threat of mandatory minimum sentences to get guilty pleas for lesser offenses.
• Takes the offender out of the community and into an environment that can exacerbate criminal or drug use tendencies.
• Leads to prison overcrowding that condemns inmates to psychologically harsh and physically dangerous living conditions.

Alternative Sentencing

• Judges have a chance to consider what is fair and equitable under the circumstances and the law.
• First-time and non-violent offenders can expect less punitive sentences that help them overcome addiction.
• Let’s the offender stay connected to the community and engage in self-improvement programs while caring for dependents, if any.
• State resources can be better spent on an offender’s treatment, rehabilitation, education, and mental health improvement.

Economic Benefits for Municipalities

The direct economic benefits of alternative sentencing for local municipalities are hard to quantify. An indirect idea can be gained, however, from the estimated loss to annual GDP as a result of incarcerated people being out of the workforce - which is between $78 billion and $87 billion.

Another indicator of the economic benefits of alternative sentencing comes from Avenues for Justice (AFJ), one of the country’s first alternative-to-incarceration programs that offers education, mentoring, and life skills training.

AFJ spends $6,300 to keep an individual out of jail when incarcerating that same individual would have cost the state more than $500,000. The money thus saved can be cycled back to the municipality to pay for more pressing development programs.

Accessibility Challenges

Despite the wide-ranging benefits of alternative sentencing on individuals and communities, it is not as frequently applied in cases as could be expected.

A 2015 report by the United States Sentencing Commission (USSC) found that alternative sentences were pronounced on only a small percentage of federal offenders. Many of them were rendered ineligible for leniency because of their conviction under serious statutes.

The USSC also found that alternative sentencing was disproportionately applied to different race categories. Black and Hispanic offenders received such sentencing at lower rates than White offenders.

[fs-toc-omit] Conclusion

The fentanyl crisis continues to ravage individual lives and communities across the US at unprecedented rates. Drug overdose deaths involving fentanyl reached 74,702 in 2023, which was almost 70% of all drug-related fatalities that year.

With 12,835 drug overdose deaths between May 2023 and May 2024, California is by far the hardest hit among all 50 states. Its vulnerability to the fentanyl crisis stems from its unique demographic composition, the reluctance among certain sections to seek medical help, and the state’s proximity to Mexico - the source country for 90% of all fentanyl that reaches the US.

Aside from its impact on individuals and communities, the fentanyl crisis exacts a tremendous cost to the economy. In 2017, the estimated cost of the opioid crisis on the US economy topped $1.02 trillion. The cost to the California economy was over $36 billion.

Part of the challenge with fentanyl is its high potency. While relapse rates for substance addiction are 60% or lower in general, fentanyl users relapse at a much higher rate of up to 95%. The youth are particularly at risk of slipping into fentanyl addiction. In 2018, more adolescents died due to fentanyl use than adults.

A combination of medication, counseling, and inpatient rehabilitation is therefore necessary to treat fentanyl abuse.

Finally, there is a judicial aspect to the fight against fentanyl. Alternative sentencing options like supervised work release, probation, and community service show better outcomes than mandatory minimum sentencing. Allowing first-time drug offenders to remain connected to the community while overcoming their addiction.

It’s imperative that individuals, communities, and institutions come together to raise awareness of the fentanyl crisis and help those who fall victim to it recover and regain sober, healthy, and productive lives.

Hollywood Hills Recovery is an exclusive substance abuse treatment and recovery center committed to making a dent in the fight against fentanyl. Our expert team provides customized treatment plans to help individuals achieve lasting sobriety.

Reach out to us today to learn more about treatment options.

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