In Los Angeles County  

• The number of fentanyl overdose deaths in Los Angeles County has risen every year since routine testing of fentanyl began in May 2016.
• In 2021, fentanyl-related overdose deaths increased to 1,504, a 1,280% jump from 2016 and a 31% increase from the previous year.

Sources: SafeMed LA, 2022; California Department of Public Health, 2022

Unintentional Fentanyl Poisonings

• Powdered fentanyl looks like many other drugs and is commonly mixed with substances like heroin, cocaine and methamphetamine, and can be made into pills that resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs contain fentanyl.
• Since fentanyl is colorless and odorless, drugs may contain deadly levels of this highly potent synthetic opioid, resulting in unintentional overdose and death.
• Criminal drug networks are mass-producing counterfeit pills and falsely marketing them as legitimate prescription pills to deceive the American public.
• Fake prescription pills are easily accessible and often sold on social media and e-commerce platforms, making them available to anyone with a smartphone, including minors.

Drug Enforcement Administration Fact Sheet
Source: DEA, 2022

What is Xylazine?

Xylazine is a non-opioid veterinary tranquilizer NOT approved for human use that has been linked to an increasing number of overdose deaths nationwide. Also known as “tranq,” xylazine is a central nervous system depressant that increases the risk of life-threatening overdose when taken in combination with other substances like alcohol, benzodiazepines and fentanyl.  

• Xylazine comes in a clear liquid that is cooked down into a powder form and is mixed with illicit opioids such as heroin or fentanyl, or pressed into counterfeit pills (e.g. Norco, Percocet, Xanax) as a cheap additive to increase the effects of these drugs. 
• Xylazine can cause drowsiness and amnesia and slow breathing, heart rate, and blood pressure to dangerously low levels. 
• Repeated xylazine use is associated with skin ulcers, abscesses and related complications, especially for those administering intravenously. 
• Experts are concerned that a growing prevalence of xylazine in the illicit opioid supply may render the emergency opioid reversal medication naloxone less effective, nonetheless naloxone should be administered in the event of a suspected overdose in addition to alerting emergency medical services. 
• There is NO test to determine if illicit drugs contain xylazine, therefore the Los Angeles Department of Public Health recommends the safest course of action is to avoid using illicit drugs as the supply has been commonly and unpredictably contaminated with lethal substance such as xylazine and illicitly manufactured fentanyl. 

Source: NIDA; LACDPH

Recent News

• The Los Angeles Department of Public Health issues an alert on June 20, 2023 warning residents that fentanyl and other illicit narcotics have been found in legitimate pharmacies in Mexico. It is recommended that residents avoid using pills from any sources besides those that come from an FDA-licensed pharmacy or are prescribed by your healthcare provider.
• On March 29, 2023, the Food and Drug Administration approved Narcan, the nasal spray version of the opioid reversal medication naloxone, for over-the-counter use. This is the first naloxone product approved without a prescription in the wake of the drug overdose epidemic that is being fueled primarily by synthetic opioids like illicitly manufactured fentanyl. Read more about the timeline for availability here. 
• The Los Angeles Department of Public Health issued an alert on March 8, 2023 to warn residents that xylazine has been detected in drug samples obtained in both San Francisco and San Diego, indicating that it is now likely present within the drug supply in Los Angeles. Most people who are purchasing or being given illicit drugs are not seeking xylazine and likely do not know that it may be present in the drugs they are trying to obtain. 
• The Drug Enforcement Agency (DEA) released a public safety alert on December 21, 2022 warning about the growing threat of xylazine and its mixture with illicit drugs like fentanyl, cocaine and heroin with approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 containing xylazine.
• The California Department of Public Health issued an alert to California County and District Superintendents and Charter School Administrators on September 21, 2022, warning about a concerning trend identified by the Drug Enforcement Agency about brightly colored fentanyl (referred to as Rainbow Fentanyl) used by drug traffickers with the intent to appeal to children and young people.
• The Los Angeles Department of Public Health issued a health alert on September 15, 2022, warning the community about counterfeit pills contaminated with fentanyl after four adolescents were found dead from an overdose after purchasing counterfeit narcotic pills.
• The Drug Enforcement Administration recognized the first ever National Fentanyl Awareness Day in 2022, which will take place annually on May 10th. This day is an effort to educate individuals around the danger fentanyl poses to the safety, health and national security of the American people.

What are the signs of an overdose?
Sometimes it can be difficult to tell if a person is heavily under the influence or experiencing an overdose. If you’re having a hard time telling the difference, it is best to treat the situation like an overdose – it could save someone’s life.

The following are some symptoms of being under the influence of opioids or benzodiazepines:

• Pupils will contract and appear small
• Muscles are slack and droopy
• Speech may be slurred
• They appear to be falling asleep but will respond to outside stimuli like loud noise or a light shake

The following are signs of an overdose:

• Loss of consciousness
• Unresponsive to outside stimulus
• Awake, but unable to talk
• Breathing is very slow and shallow, erratic or has stopped
• Vomiting
• Body is very limp
• Face is very pale, clammy
• Fingernails and lips turn blue or purplish black
• Pulse (heartbeat) is slow, erratic or not there at all

What should you do if you suspect someone is overdosing?

• Shout loudly, “Are you okay? Can you hear me?” to make sure the person is conscious. Apply painful stimuli like rubbing the knuckles against the sternum or applying a fingernail to the nail bed.
• If there is no immediate change in their condition, call 911 immediately. Tell the 911 operator, “I believe this person is overdosing.”
• California’s 911 Good Samaritan Law provides protections for any person experiencing a drug-related overdose, or a person who seeks medical assistance for a person experiencing a drug-related overdose. For more details, read AB 472 here.

Naloxone
Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

For more information on naloxone and how to obtain this potentially lifesaving medication, please visit the California Department of Public Health’s Opioid Prevention Initiative here. 

Types of Naloxone:

• Injectable: Liquid form, injectable naloxone is commonly used by paramedics, emergency room doctors and other specially trained first responders.
• Auto-injectable: EVZIO® is a prefilled auto-injection device that makes it easy for families or emergency personnel to inject naloxone quickly into the outer thigh. Once activated, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators.
• Intranasal: NARCAN® Nasal Spray is a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while patients lay on their back. Anyone can be trained to use NARCAN®.