The Ripple Effect, Part Eight: The Fight Against Fentanyl — Examining the Response to the Crisis

Written By Safer Sacramento
 
 

The fentanyl crisis has emerged as one of the most severe public health and safety challenges in the United States, with synthetic opioids like fentanyl responsible for a staggering number of overdose deaths. The Centers for Disease Control and Prevention (CDC) reported 73,838 deaths involving synthetic opioids – primarily illicitly manufactured fentanyl – in 2022. Between 2000-2023, California was hit hard, with communities like Sacramento County experiencing a significant surge in overdose cases. But, there is good news: Recent data indicate that overall overdose deaths are finally going down. The CDC shows overdose deaths in the United States fell 17% between July 2023 and July 2024, and in California, the rate dropped by over 14%. The DEA reports that 5 in 10 counterfeit pills now contain a potentially lethal dose of fentanyl, down from 7 in 10 in 2023. Finally, according to the Sacramento County coroner’s report, fentanyl-related deaths dropped more than 47% from 2023-2024. All this is to say that the combination of law enforcement, harm-reduction programs, public awareness and outreach campaigns focused on prevention and education, expanded treatment and recovery options, and policy initiatives are having a real impact. This momentum bolsters hope and reinforces the idea that building on current efforts and continuing to refine and improve strategies is paramount. In this installment of our documentary blog series, The Ripple Effect, we’ll examine the response to the illicit fentanyl crisis, focusing on California and, more specifically, Sacramento County. 

 
 

Harm Reduction 

One of the most critical tools for saving lives lost to fentanyl-related overdoses is harm reduction. Harm reduction efforts aim not to punish or stigmatize drug users but rather to minimize the risks associated with drug use. Although harm reduction doesn't eliminate the use of drugs, it can significantly decrease the chances of fatal outcomes. Several harm-

Naloxone Distribution 

Narcan | Safer Sacramento

One of the most prominent harm reduction strategies in the face of the opioid crisis has been the widespread distribution of naloxone, commonly known by its brand name Narcan, which can reverse opioid overdoses. Programs at both the state and local levels aim to provide naloxone to first responders, schools, and community organizations. Mobile outreach teams distribute naloxone kits to high-risk areas, saving countless lives. Community initiatives that provide education on properly administering naloxone have also empowered residents to administer it in emergencies. Between 2018 and March 2024, California’s Naloxone Distribution Project (NDP), spearheaded by the Department of Health Care Services (DHCS), distributed more than 3,947,000 kits of naloxone, which were used to reverse more than 249,000 overdoses.

The Sacramento County Department of Health Services, the Sacramento County Opioid Coalition, and other community-based providers have Narcan distribution programs in place in addition to having Narcan available at community outreach events and upon request by the community. Mobile medical teams also offer Narcan to the 

Fentanyl Test Strips 

Image credit: CDC

Fentanyl test strips (FTS) are another harm reduction tool that makes a difference. These strips are a low-cost tool that allows individuals to test their drugs like cocaine, methamphetamine, heroin, pills, powders, and injectables for the presence of fentanyl, providing a way to avoid unintentional ingestion of the potent opioid and reducing the risk of overdose. 

FTS are widely distributed by organizations in many cities and states. In March 2024, California’s Department of Health Care Services (DHCS) expanded its Naloxone Distribution Project (NDP) to include free fentanyl test strips (FTS), which can be obtained by eligible organizations throughout the state. However, test strips do have limitations: they may not detect all fentanyl analogs (e.g., carfentanil) and can be less effective when large amounts of certain substances are present (like methamphetamine or MDMA). Additionally, fentanyl test strips indicate only the presence, not quantity, of fentanyl in a given sample. When testing drugs, the entire drug should be tested. For example, if someone is testing a pill, the pill should be crushed, and the entire substance tested for the most reliable results. 

Additional Harm-Reduction Strategies 

In tandem with naloxone and fentanyl test strips availability, health service organizations are working to communicate other harm-reduction messaging:

  • Never use drugs alone so that someone is available to intervene in the event of an overdose

  • How to recognize the signs of an opioid overdose, including knowing when to call emergency services

  • Amnesty policies, such as California’s 911 Good Samaritan Law, that offer limited protection against arrest, charge, and prosecution for people who seek emergency medical assistance at the scene of a suspected drug overdose.

  • Dangers of polysubstance use

Prevention and Education 

Sacramento has launched a series of community-based programs and secured partnerships aimed at reducing fentanyl exposure and providing support. Nonprofits, healthcare organizations, and local government agencies are working together to provide resources and support for individuals and families affected by fentanyl. In addition, the Sacramento County District Attorney's Office, Sacramento County Crime Lab, Department of Health Services, Substance Use Prevention and Treatment (SUPT), and Arrive Alive CA are organizations that work closely with schools and community partners to raise awareness about the dangers of fentanyl, offer treatment and resources, and encourage open conversations about mental health and substance use. 

Outreach Programs 

Sacramento and other California cities have launched programs that provide resources, support, and substance use education. These programs aim to create a more stable environment for individuals at risk of substance use or misuse, reducing stressors that may lead to substance use and misuse. Sacramento’s outreach programs focus on connecting individuals with resources such as housing, medical care, mental health services, and substance use disorder treatment. These programs aim to meet individuals where they are – often in vulnerable communities – and offer the support they need to begin their recovery journey. 

Additionally, education campaigns in Sacramento County aim to have a wide-reaching impact on those at risk of substance use and misuse, those who are currently struggling, and those who care for individuals who are impacted. 

  • SACCounty Healthy Beginnings is an innovative new project focusing on prenatal substance exposure. The project includes education, screening, prevention, and intervention for prenatal substance exposure. 

  • Safer Sacramento provides educational multimedia resources that guide individuals in making healthy choices to avoid or reduce the potential harm from the use or misuse of substances. The goal is to help create a safe community, free of the dangers of substance use and misuse, with equal access to behavioral health, prevention, and treatment services. 

  • See Her Bloom Campaign was funded by the California Department of Health Services’ MAT Expansion Project and focuses on support and resources for Black women struggling with opioid use disorder. 

  • Between July 2023 and June 2024, Arrive Alive CA was able to impact nearly 18,000 people through a combination of in-person and virtual assemblies, classroom activities, town hall events, parent meetings, and teacher/administration training. 

Many other county and community programs provide valuable resources, education, and support. 

Stigma Reduction 

One of the most significant barriers to addressing the fentanyl crisis is the stigma surrounding substance use and mental health. People struggling with substance use disorders often face judgment, making it difficult to seek help. This stigma can prevent individuals from accessing treatment and recovery services, prolonging their struggles and increasing the risk of overdose. Stigma is particularly harmful in healthcare settings. People with opioid use disorder may avoid going to the doctor out of fear of being judged, which delays potentially life-saving treatment. 

Breaking down stigma requires community-wide efforts. Sacramento has made strides in promoting open dialogue about addiction, with peer-led programs and mental health initiatives that help reduce the shame associated with substance use. Sharing stories of recovery and providing non-judgmental spaces where people can seek support are critical steps in this effort. By reframing addiction as a chronic illness rather than a moral failing, these campaigns hope to encourage more individuals to seek treatment and support. 

Youth-Focused Efforts 

The rise in fentanyl-related overdose deaths among teens and young adults in the nation, including Sacramento County, underscores the need for robust prevention and education campaigns. Evidence suggests campaigns that empower youth with fact-based information and neuroscience, acknowledge their sense of agency and desire for safety, and reinforce their decision-making skills rather than those that lecture, stoke fear, and preach abstinence are most effective. Prevention efforts that shift from “Just say no” to “Just say know” show promising results. Acknowledging and understanding why young people choose to use substances – to experiment and have fun, to fit in socially, to deal with mental health struggles – is an important first step. Research suggests that many teens and young adults who die of an overdose did not have a known opioid use disorder, but many had a history of mental health struggles. 

Sacramento County has been proactively working to meet youth where they are, integrating comprehensive supports and resources in impactful ways.

  • The Department of Health Services, DA’s Office, Arrive Alive CA, and grieving parents spearheaded the Future Focused Fentanyl Education and Awareness in schools. 

  • Additional youth prevention efforts include partnerships with the Sacramento County Office of Education and Center for Collaborative Planning as well as Omni Youth and PRO Youth and Families. 

  • Safer Sacramento Youth is a multi-agency county partnership working to provide a welcoming and inclusive online space for all things related to mental health, well-being, and substance use. The goal is to empower youth, parents, and caregivers with support, guidance, and research-based resources and information utilizing multimedia tools. While social media contributes to risk, it also offers opportunities to meet youth where they are. Tailored programs that leverage social media and peer-to-peer education can effectively reach young people. 

Expanded Treatment and Recovery Services 

Offering wrap-around services and a comprehensive continuum of care promotes healthy communities free of the harmful consequences associated with alcohol misuse and drug use. Sacramento County Department of Health Services and its state, county, and community partners have been instrumental in raising awareness about the dangers of fentanyl through education and harm-reduction resources while continuing to expand and improve its treatment services. 

Addressing Co-Occurring Disorders 

SUD frequently presents alongside additional mental health conditions such as depression, generalized anxiety, and trauma-related disorders. These co-occurring mental health and substance use disorders – sometimes called "dual diagnoses" – represent a significant health concern. This intersection presents unique risks, as untreated mental health issues can fuel substance use, while substance use can exacerbate mental health symptoms, creating a vicious cycle. 

Peer Support Programs 

Peer support programs play a crucial role in the recovery process. They provide a safe space for individuals to share their experiences, offer advice, and receive emotional support from others who understand what they’re going through. In 2020, California passed a law (Senate Bill 803) that allowed certified peer support specialists to become Medi-Cal providers eligible for Medi-Cal reimbursement through county mental health plans and substance use disorder plans (behavioral health plans). California Medi-Cal Peer Support Specialists play many roles in supporting people living with mental health conditions and/or in substance use/misuse recovery. They facilitate educational groups and peer support groups and may connect people to services as they transition from hospitals or jails into the community. They also work one-on-one as role models, mentors, coaches, and advocates to support people in developing individualized wellness plans. 

Medication-Assisted Treatment (MAT) 

Medication-assisted treatment programs combine FDA-approved medication with counseling and behavioral therapies to provide a whole-person approach and are a cornerstone of opioid use disorder treatment. Medications such as buprenorphine and methadone help manage withdrawal symptoms and reduce cravings, providing a more stable pathway to recovery. 

Sacramento’s facilities are expanding to meet demand, with additional paths for treatment in its correctional facilities, including the Sacramento County Main Jail, and telemedicine initiatives improving access for rural areas. Sacramento Metro Fire and Sacramento Fire Department have mobile medical teams who provide buprenorphine and engage in Naloxone Leave Behind Programs for the community. 

Cognitive-behavioral therapy (CBT) and contingency management are evidence-based approaches often combined with medication that help individuals address the underlying behaviors and thoughts that contribute to substance use disorders. CBT helps individuals identify triggers, manage stress, and develop healthier coping mechanisms. Contingency management offers tangible rewards for meeting treatment goals, such as vouchers or cash. 

Culturally Responsive Care 

Tailoring treatment to incorporate a person or community’s culture into the design and delivery of substance use programs increases effectiveness. Considering factors such as race, socioeconomics, language, sexual orientation, family history and structure, and gender improves outcomes, especially in diverse communities and among vulnerable populations. 

Sacramento County is actively working to improve and expand the scope of substance use and mental health services to incorporate additional culturally sensitive approaches. These improvements include community-defined evidence practices (CDEPs) that draw on local community residents’ unique knowledge, experiences, and needs to develop programs, interventions, treatment protocols, and prevention strategies. 

Prosecution, Legislation, and Deterrence 

Enhanced Prosecution of Traffickers 

At the federal and state levels, interagency partnerships between law enforcement and health service organizations are proving effective in comprehensively addressing the illicit fentanyl crisis. Federal efforts focus on dismantling international smuggling networks responsible for bringing fentanyl into communities. Through partnerships with countries like China and Mexico, the U.S. works to dismantle fentanyl production and trafficking networks. Key efforts include China's 2019 ban on fentanyl production, recent sanctions against Chinese companies, and the establishment of a Global Coalition to Address Synthetic Drug Threats. Federal agencies leverage digital evidence from encrypted platforms and the dark web to convict traffickers. These technological advances have been instrumental in securing convictions against those facilitating the distribution of fentanyl. Domestically, agencies like the U.S. Customs and Border Protection, the DEA, and the Treasury Department collaborate with state and local agencies to detect, intercept, and investigate fentanyl trafficking. 

State Legislation 

States nationwide are introducing bills to improve deterrence and facilitate effective prevention and treatment. In 2023, Governor Newsom launched his Master Plan for Tackling the Fentanyl and Opioid Crisis, which provides a comprehensive framework to address the opioid and fentanyl crisis, including steps to support overdose prevention efforts, hold the opioid pharmaceutical industry accountable, crack down on drug trafficking, and raise awareness about the dangers of opioids, including fentanyl. In November 2024, California voters passed Proposition 36, which toughens the punishment for drug possession. Prop 36 offers individuals opportunities to enter a treatment program and have their charges dropped instead of receiving a jail or prison sentence.

In the last few years, California has passed several laws that address the fentanyl crisis specifically for youth: 

  • Senate Bill 367, known as the Campus Opioid Act, signed into law in 2022, requires that every public college campus in California distribute a federally approved opioid overdose reversal medication like naloxone and include information about opioid overdoses in their orientation process. 

  • In October 2023, Senate Bill 10 passed, mandating that every public school that serves 7th-12th grade students develop a protocol to address instances where a student is experiencing an opioid overdose. The protocol is part of a school’s existing Comprehensive School Safety Plan, or CSSP. The bill also establishes a state framework to ensure all students understand the growing risk of fentanyl exposure and have access to the resources needed to prevent and respond to fentanyl poisoning and overdoses. The law is known as Melanie’s Law, named after Melanie Ramos, a 15-year-old girl who died of fentanyl poisoning in her high school bathroom.

  • Assembly Bill 2429 was signed into law in July 2024, mandating existing health classes include comprehensive lessons about the dangers of fentanyl, including risk factors, identification of lacing, and response to overdose. 

Law Enforcement, Deterrence, and Rehabilitation 

Federal and state law enforcement agencies throughout the nation, including in California, have been working to target the source of fentanyl by prosecuting those involved in its distribution. California has seen an increase in prosecutions of individuals involved in the sale of fentanyl, particularly when the drug has led to fatal overdoses. In July 2023, a 21-year-old man was convicted of second-degree murder and sentenced to 15 years to life for the fentanyl-related death of 15-year-old Jewels Wolf, establishing the first-ever guilty verdict in a fentanyl-related homicide trial in the state of California. Other states are pushing legislation that increases penalties for involvement in fentanyl-related deaths. 

Prevention and harm reduction remain key priorities, with local law enforcement working alongside health officials to curb fentanyl distribution and educate communities about the dangers of this deadly drug. Additionally, considering alternative sentencing for nonviolent drug offenders as well as treatment opportunities to reduce dependency can be less costly and more effective in reducing recidivism and long-term substance use problems. 

In Sacramento County, the DA’s office put together a Sac FORCE (fentanyl overdose response criminal enforcement) team that investigates fentanyl overdose deaths through collaboration with local, state, and federal partners and aims to hold drug suppliers responsible for fentanyl-related deaths while promoting public health awareness and community safety. 

Legal Action Against Pharmaceutical Companies 

Over the past few years, several lawsuits have been filed against pharmaceutical companies that aggressively marketed opioid painkillers while downplaying their addictive potential. These lawsuits have resulted in multi-billion-dollar settlements, with funds directed toward addiction treatment and prevention programs at both the state and federal levels. 

In 2022, four of the largest corporations in America – Johnson & Johnson, Cardinal Health, AmerisourceBergen, and McKesson – agreed to pay roughly $26 billion in a settlement that resolved thousands of civil lawsuits filed against the corporate giants by local and state governments and Tribal communities across the United States. The settlement funds are used to bolster treatment and prevention efforts. In addition, Purdue Pharma, the maker of OxyContin, is facing thousands of lawsuits for falsely marketing OxyContin as non-addictive and contributing to the devastating opioid crisis. In June 2024, the Supreme Court overturned Purdue’s settlement plan that included filing for bankruptcy and paying out $8 billion to state and local governments on the grounds that the Sackler family, who own Purdue, should not be immune from future lawsuits. 

Sacramento County invested $4 million of these funds into the community for programs and services to address the fentanyl crisis, focusing on prevention campaigns, harm reduction, youth services, and mobile medical teams. 

Moving Forward 

The fentanyl crisis is a pressing public health and safety emergency that requires urgent and sustained action. As fentanyl continues to proliferate in the illegal drug market, coordinated efforts to implement comprehensive strategies are more important than ever. 

While Sacramento County has made significant strides in addressing the fentanyl crisis, the work is not finished. To effectively combat the fentanyl epidemic, Sacramento County will continue to collaborate with federal, state, and local partners to protect the community from the devastating effects of illicit fentanyl and to save lives – through broad and sweeping support systems that include prevention education, accessible treatment options, and harm reduction resources. 

 
Safer Sacramento
Next

The Ripple Effect, Part Seven: Illicit Fentanyl’s Devastating Toll on Teens and Young Adults