Drop in deaths is small glimmer of hope in San Diego’s fentanyl crisis

In less than a decade, fentanyl has gone from a little-known synthetic opioid to one of the leading causes of death in San Diego County.

In 2015, health officials in the region recorded 22 fatal fentanyl overdoses. That number rose to 468 in 2021, and then to 814 in 2022.

“We have made the fight against fentanyl a priority because we are the epicenter of the fight against fentanyl,” said San Diego District Attorney Summer Stephan.

But a small glimmer of hope has emerged amid the devastating numbers: Fewer people died from fentanyl overdoses in 2023 than in 2022. It was the first time the number of fentanyl deaths fell since region health authorities began tracking them.

Still, Stephan can’t exactly celebrate, as 749 people died from fentanyl last year.

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 North America’s busiest land border, is “a transportation hub.”

“We are a transition point for fentanyl to come in,” McGrath said. “The fentanyl comes through the Mexican border and then it’s transferred to distribution centers like Los Angeles and Las Vegas. Then it’s distributed to the rest of the country.”

One of the election year talking points that McGrath and other law enforcement officials are quick to debunk is the claim that fentanyl is being smuggled across the border by illegal immigrants.

The reality is that most fentanyl is sold through legal border crossings in San Ysidro and Otay Mesa, usually concealed in vehicles or large trucks.

While San Diego is primarily a transportation hub, it is inevitable that some supply will remain in the region to meet local demand.

Unfortunate accidents

Prosecutors and drug treatment experts say Mexican drug cartels have created a generation of fentanyl users by secretly adding the addictive opioid to other drugs.

During the early years of the crisis, nearly all overdose deaths were described as “accidental,” because people were unaware they were taking fentanyl. They were taking drugs and pills laced with it.

Over time that started to change.

“In 2019 and 2020, we never saw cases where someone was seeking or asking for fentanyl,” Stephan said. “Now, in 2024, we have a lot of cases where the victims are asking specifically because they are now addicted.”

It’s a trend that treatment experts at A NEW Path in San Diego have noticed, too. April Ella is the director of operations and runs the naloxone distribution program.

“They might try to get Xanax, but it has fentanyl in it,” she said. “Now they realize it has fentanyl in it. They might get a little more addicted to it, drop the whole Xanax and go to fentanyl.”

Ella attributes some of the decline in fatal overdoses to the increased availability of the overdose-reversing drug naloxone, marketed under the brand name Narcan. But she cautions that fewer deaths does not necessarily mean fewer overdoses.

It is very difficult to detect non-fatal overdoses, Ella says.

“If they don’t go to the hospital, or don’t get arrested, or don’t get any kind of care or even call the hotline, there’s no way to track how many people are overdosing every day,” she said.

Despite the lack of reliable data, A NEW Path has seen increased demand for naloxone — suggesting that more people are overdosing or at least concerned about overdosing. Ella said she encounters people in the field asking for multiple naloxone kits.

“They say, ‘I used three of those kits on my brother, on my roommate, on whoever,'” she said. “But that doesn’t mean it’s being reported anywhere.”

According to the Public Prosecution Service, increased cooperation between various agencies has also contributed to the decrease in the number of fatal fentanyl overdoses.

McGrath’s office works closely with the San Diego District Attorney, the FBI, Drug Enforcement Administration, Homeland Security Investigations and various local agencies. Everyone has a role to play, she said.

“Identifying and dismantling the cartels is what the U.S. Attorney’s Office does,” she said. “That’s our unique piece of the puzzle.”

District Attorney Stephan says tougher penalties for drug possession are also needed. Meanwhile, advocates like Ella say it would be a return to the failed policies of the war on drugs.