.Just one pill: fentanyl deaths on the rise in Marin and Sonoma counties

Trevor Leopold would have turned 22 on Jan. 30. Instead, he’s “forever 18,” his mother says.

When Greenbrae resident Michelle Leopold received the news that her 18-year-old son died in his Sonoma State University dorm room, she didn’t need to wait for the coroner’s report to know what had killed him.

Although it was November 2019, before most parents had heard of the fentanyl crisis, there was no doubt in Michelle Leopold’s mind that this powerful synthetic opioid was the culprit. Sadly, she was well aware of the dangerous drug because her son’s close friend had succumbed to a fentanyl overdose the previous year.

Indeed, toxicology results confirmed that Trevor Leopold died after ingesting a pill laced with fentanyl. One pill.

He thought he was taking the prescription drug oxycodone, Michelle Leopold said. As it turned out, the fentanyl-laced pill contained no oxycodone at all. Similarly, Trevor Leopold’s friend, who died of a fentanyl overdose in 2018, believed he was consuming Xanax, a prescription benzodiazepine.

“One of the scariest things about this is that so many who end up overdosing don’t know they’re taking something with fentanyl in it,” Dr. Matt Willis, Marin County’s public health director, said in an interview. “It’s kind of like drinking punch that’s been spiked at a party—hard to call it abuse when it’s unintentional. More like a poisoning.”

Melissa Struzzo, manager of the Sonoma County Substance Use Disorder & Community Recovery Services, has the same concern as Willis. 

“There are naive users, who think they’re getting Vicodin or Percocet,” Struzzo said. “They’re not active users and have no tolerance built up for fentanyl. This group has a higher potential for overdose.”

Marin and Sonoma counties, like the rest of the United States, are experiencing a dramatic surge in drug overdoses. Grim statistics reveal the gravity of the crisis, driven by fentanyl.

Overdoses in Marin County have more than doubled since 2018, said Willis. Today, fentanyl is associated with over 50% of OD cases.

The number of fatal ODs in Marin has also increased significantly—more than 100% in the last three years. Every five days, someone dies of an overdose in the county. During 2021 and 2022, 60% of those deaths were linked to fentanyl.

Sonoma County is faring worse, with someone dying every two days from an overdose death, according to the Sonoma County Department of Health. Even more astounding is that deaths involving fentanyl increased by 2,550% from 2016 through 2021.

This increase is responsible for Sonoma County ranking 14th out of 58 in California for the highest drug overdose death rate. Sonoma County is second in the Bay Area for the greatest increase in the OD death rate, while San Francisco has the dubious distinction of landing in the top spot.

Exactly how did fentanyl, a powerful legal synthetic opioid developed in 1959, cause this nationwide crisis? Fentanyl, used as an analgesic during surgery and as a prescription drug to treat severe pain, is easily produced and affordable. 

Unfortunately, fentanyl’s characteristics also make it attractive to the illicit drug market. In recent years, the supply of fentanyl has grown swiftly, with most of it manufactured outside of the United States. The drug’s effect is similar to heroin, and it’s extremely addictive.

“Fentanyl is up to 100 times more potent than morphine,” Struzzo said.

Drug dealers bank on fentanyl’s addictive quality to keep their customers coming back for more. But just two milligrams of fentanyl—a few grains—can kill a person, according to the Drug Enforcement Agency, which prompted the agency to issue a health alert: “One pill can kill.”

Without access to the sophisticated and expensive scientific weights and measures used by a pharmaceutical company, it’s almost impossible for dealers to calculate how much fentanyl they’re putting into a pill or powder. 

And the guy or gal next door may be making those pills, with pill presses for all budgets just a few keystrokes away on Amazon. The presses allow dealers to pump out counterfeit pills that look almost identical to prescription drugs, such as Ritalin, Adderall and oxycodone.

“Fentanyl is now present in most illicit pills and powders,” Willis said. “People overdose from the presence of fentanyl in what’s sold on social media as prescription pills, cocaine or other powders.”

The opioid drug epidemic affects people of all ages, either through intentional or unintentional use. Even infants are brought to emergency rooms with fentanyl ODs.

The issue is daunting and complex; however, Marin and Sonoma have countywide collaboratives to attack the crisis from all sides.  

OD Free Marin has five teams, including intervention, treatment and recovery; youth action; education and outreach; equity action; and the justice system. The Sonoma County Prevention Partnership works on drug policy and advocacy efforts.

Both counties agree that a harm reduction approach is beneficial. For example, many pharmacies in Marin and Sonoma sell Narcan, a medication that can reverse the effects of fentanyl, without a prescription. Schools have Narcan, and staff have been trained to administer it. Some experts recommend that every first aid kit contain the life-saving medication. Substance abuse programs are also key to addressing fentanyl use.

Law enforcement agencies are working on getting dealers off the streets, but it can be difficult when social media platforms make it easy for them to hide. For example, Snapchat, a messaging app, allows users to determine how long their messages remain visible. In addition, dealers use different emojis for each drug they have available, negating the need to write anything incriminating. 

The illicit drug business, especially with inexpensive fentanyl readily available to dealers, is quite lucrative. There’s always a dealer ready to fill the void when another is arrested, according to Willis.

“Public health and law enforcement agree that we aren’t going to arrest our way out of this problem,” Willis said. “Instead, we partner with the justice system using all of the tools at our disposal, including diverting people with low level drug offenses to assessment and ensuring people who are incarcerated have access to addiction treatment.”

Willis, Struzzo and Michelle Leopold say it’s imperative that people understand the dangers of just one pill.

Leopold plans on educating as many people as possible about what happened to her son, with the goal of preventing fentanyl deaths. “People just don’t know,” she said.

Last year, Leopold and her husband hosted Narcan training sessions at the six Ace Hardware stores they own. Although Leopold admits it’s hard, she makes herself available to the media and speaks  at numerous public forums.

“When we got the phone calls about Trevor, I turned to my husband and said, ‘We can’t be quiet about this,’” Leopold said. “There are a lot of us speaking out on behalf of our dead, poisoned children. Hopefully, it’s making a difference.”