By Grace Toohey
Los Angeles Times
LOS ANGELES — Fentanyl has continued to tighten its deadly grip on Los Angeles, with the synthetic opioid causing the majority of fatal overdoses countywide in 2022.
For the first time in recent years, fentanyl surpassed methamphetamine as the most common drug listed as a cause of overdose deaths, according to a recent report from the L.A. County Department of Public Health. Fentanyl was blamed in almost 60% of all accidental drug or alcohol overdoses in 2022, the report said, and has continued to disproportionately kill Black Angelenos.
Overdoses in general increased again in almost every measure from the prior year, further escalating a crisis fueled by the opioid epidemic, which has devastated communities across the nation.
“It’s absolutely heartbreaking,” said Amanda Cowan, executive director of Community Health Project Los Angeles, which provides services to people who use drugs. The project’s harm-reduction approach tries to minimize the risks of drug use, for example by providing clean-needle programs or education on responding to overdoses.
“These communities are just being decimated,” she said.
County and academic leaders echoed Cowan’s concern — and none were surprised by fentanyl’s growing influence on drug deaths.
“We’re still amid the worst overdose crisis in history, and that’s obviously an emergency situation,” said Dr. Gary Tsai, director of the county’s Substance Abuse Prevention and Control program. “We’re doing a lot of work to improve our system, but there’s obviously still a lot of work that we have to do.”
In 2022, the county recorded 3,220 accidental overdoses, of which more than 1,900 were caused at least in part by fentanyl, county data showed. (Multiple drugs can be listed as the cause of an overdose death.) Since 2016, overdoses in L.A. County have increased almost threefold, and there were about 200 more overdose deaths in 2022 than in 2021.
The largest number of fentanyl overdose deaths were recorded among white Angelenos and in affluent areas, but when accounting for population, Black people and those living in higher-poverty areas died of fentanyl overdoses at significantly higher rates. The fatal overdose death rate for Black residents was more than three times that of Latinx Angelenos in 2022, and almost two times that of white residents — disparities that have continued to widen over the last few years. However, the rate of hospitalizations for fentanyl overdoses were similar among white and Black Angelenos.
“In the case of race/ethnicity, Black people account for 8% of the [county] population, and disproportionately accounted for 21% of fentanyl overdose deaths in 2022,” the report said.
Ricky Bluthenthal, a professor of population and public health sciences at USC’s Keck School of Medicine, called the disparities in deaths by race worrying, especially as they’ve only worsened in recent years. But he said that it’s not a problem unique to L.A., and that it requires targeted strategies to ensure resources are reaching those in most need.
“It speaks to a national challenge that we have in the United States, related to making sure that both medication for opiate use disorder and naloxone is readily available for people who live in predominantly African American and Latino neighborhoods,” Bluthenthal said. Naloxone — most commonly used as a nasal spray under the brand name Narcan — is the life-saving medication that can block the effects of opioids, reversing overdoses.
Tsai said the disproportionate effect of fentanyl on Black Angelenos may be partly compounded by other issues, including the fact that Black people are disproportionately experiencing homelessness in L.A., and fatal overdoses are the leading cause of death for unhoused people.
He also said that a major risk factor of overdose death is using drugs alone, which can occur more frequently when living on the street.
The report also found that areas where more than 30% of residents lived in poverty had overdose death rates almost double those of groups with lower poverty rates.
“The widening inequities between under-resourced and more affluent groups underscore the need to target prevention efforts to those at highest risk,” the report said.
Experts agree that Los Angeles County has made significant strides on this issue in some ways, most notably with efforts to distribute naloxone in the last few years, giving thousands of doses to community groups, jails, healthcare providers, and especially those who work with people experiencing homelessness or who may use or be around drug use. The overdose reversal spray has even been put in public schools and been handed out to those leaving prison.
But Cowan said there are still many gaps and shortcomings, including a need to put more focus on harm reduction, treatment, housing and mental health — all issues that intersect with substance use.
“You feel like you’re screaming into a void a lot of time,” Cowan said. “We keep forgetting that all of this intersects with so many different things, and we keep Band-Aiding our way through this. It’s a piecemeal approach, and that’s never going to work.”
She would like to see officials treat the problem like the crisis it is, but doesn’t see that happening unless people start seeing drug use not as an “individual failing, but a structural and societal issue.”
Fentanyl has only been routinely tested for in L.A. County since 2016 — when 109 deaths were caused by the synthetic opioid. In 2022, fentanyl caused more than 1,900 overdoses, an almost 1,700% increase in just six years, according to the report.
“We are facing this really dramatic change in the illicit drug supply; looking at the figure over time, it sort of makes you want to cry,” Bluthenthal said.
His research found that heroin in L.A. has been largely replaced by fentanyl, which is 50 times more potent.
“This transition is wreaking havoc on people,” he said.
Bluthenthal also called for more harm-reduction programs, like one that provides oxygen in Skid Row to help stabilize people who overdose, and more accessible treatment for those with substance-use disorders.
“Our capacity to provide methadone to the people who want it and could benefit from it is much less than the demand for it,” he said, noting that methadone clinics — which provide medication for people with opioid-use disorders — remain too strict and limited.
He said he would also like to see the expansion of “contingency management programs” that provide financial incentives to people who stay off stimulant drugs like methamphetamine. Such programs have launched across the state in two dozen counties, including L.A., under a new pilot program funded by Medi-Cal reimbursements.
“You can make treatment more readily available to people. You can make sure when people use, there’s naloxone available, or there are these hotline services,” said Bluthenthal, who praised the work of one such hotline recently featured on WBEZ Chicago’s “This American Life” whose operators call 911 if someone using drugs stops responding to them.
Tsai said there’s some reason to remain hopeful. Overdose deaths among children fell for the first time in two years in 2022, and the rate of year-to-year increases in overall fatal overdoses dropped significantly — which Tsai hopes may signal a plateau in overdose deaths, though it’s too soon to say.
“On the fentanyl front, we might be slowing down, just looking at the numbers, but there’s still so many things that can happen between now and when we get the 2023 data,” he said. “All it takes is another more potent substance to come into the drug supply for that number to then shoot up.”
In just six years, fentanyl has become the prominent driver of opioid overdose deaths, going from causing about 20% of fatal opiod overdoses in 2016 to causing almost all of them — 92% — in 2022.
Officials have already warned about other synthetic opioids even more potent than fentanyl that have been linked to overdose deaths across the nation.
Another concern is xylazine, which is not an opioid but is still dangerous. Earlier this year, law enforcement officials in Los Angeles confirmed the flesh-eating drug was found in at least 4% of seized fentanyl and had been linked to at least one 2021 death.
“Every one of these deaths is someone’s mom, dad, son, brother, uncle, lover. … Every one of them is a tragedy,” Bluthenthal said. “And we can do things, more things, to prevent them — and we should, so that we have fewer of these tragedies next year.”
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