# California opioid crisis

Since 2017, the number of fatalities in California attributable to synthetic opioids has increased by 1,027%. Fentanyl has caused 20% of deaths among California's teenagers and young adults. California has made legal efforts to tackle the opioid issue, including patrols, assistance grants, and education.

## Background

In 2014, drug possession in California was reduced to a misdemeanor, rather than a felony, with the passing of Proposition 47. In response, San Francisco law enforcement reduced their efforts against drug possession and use. San Francisco has not been able to develop a comprehensive and consistent approach to drug use and overdoses; the San Francisco Department of Public Health and local nonprofits tend to argue for harm reduction strategies, while law enforcement agencies have argued for increased penalties for drug possession, use, and dealing.

## Fatal overdoses

Over 80,000 Americans may have fatally overdosed on opioids in 2021, with more than 11,200 of those fatalities occurring in California, as reported by the U.S. Centers for Disease Control and Prevention. Fentanyl is responsible for the death of 20% of teens and young adults in California (15 - 24). According to California Health Policy Strategies statistics, drug overdoses are now two to three times more fatal than state car accidents. The number of California state fatalities linked to synthetic opioids has climbed by 1,027% since 2017.

## Fentanyl crisis in San Francisco

Synthetic opioids, most notably fentanyl and drugs laced with it have seen increasing usage in the American city of San Francisco, California since 2019. In 2023, 810 people died from accidental drug overdoses, a majority containing fentanyl, in San Francisco, with overdoses per 100,000 people being more than double the national average. From January to July 2024, 412 people died from unintentional drug overdoses.

### Background

In 2014, drug possession in California was reduced to a misdemeanor, rather than a felony, with the passing of Proposition 47. In response, San Francisco law enforcement reduced their efforts against drug possession and use. San Francisco has not been able to develop a comprehensive and consistent approach to drug use and overdoses; the San Francisco Department of Public Health and local nonprofits tend to argue for harm reduction strategies, while law enforcement agencies have argued for increased penalties for drug possession, use, and dealing.

### Sources and pricing

According to the U.S. Drug Enforcement Administration, fentanyl is also substantially cheaper on average in San Francisco - around $100 cheaper per ounce - compared to cities like New York City and Philadelphia, and the California cities of Los Angeles and Sacramento. This cheaper pricing has been blamed for the higher overdose rate in San Francisco. As of January 2023, lower-grade fentanyl was being sold in the streets of San Francisco for $150 to $200 per ounce, while higher-grade fentanyl went for between $500 and $550 per ounce. Some fentanyl users reported that they obtained the drug for free by doing favors with fentanyl dealers.
Members of the DEA have said they believe fentanyl's price is cheaper in the city due to "soft drug policies". Local users have reported they believe the price is cheaper because San Francisco fentanyl has been diluted with other substances, pointing to the more expensive price of fentanyl in previous years. The DEA has reported that "regular" fentanyl sold in the city ranges on average between 5% and 10% purity. Another theory, held by some of those involved with drug policy, is that the saturation of the market in the city has driven down prices.
Authorities have reported that fentanyl from San Francisco is the source of fentanyl in Sacramento and that users and dealers from across California have traveled to San Francisco to purchase the drug more cheaply, although this latter assertion has been challenged by local nonprofits.

### Reactions

In mid-2022, arrests of drug dealers and users increased again, with the appointment of a new district attorney.
In December 2023, the city of San Francisco began testing wastewater for fentanyl, other drugs such as amphetamine, cocaine, methamphetamine, and xylazine, and naloxone. The testing was part of a larger study by the National Institute on Drug Abuse, which was also testing wastewater in 70 other U.S. cities, and is scheduled to continue until August 2024.
Between May 2023 and January 2024, law enforcement in the city seized 145 pounds of fentanyl. In early 2024, the California Highway Patrol recovered 42 pounds of fentanyl within a ten-mile radius of the Tenderloin neighborhood in San Francisco. In the same period, the CHP issued more than 6,000 drug-related citations, leading to nearly 500 arrests.

### Deaths per year

| Year | Deaths |
| 2017 | 222 |
| 2018 | 259 |
| 2019 | 441 |
| 2020 | 726 |
| 2021 | 642 |
| 2022 | 649 |
| 2023 | 810 |
| 2024 | 589 |

## Legal actions

Senate Bill 10, also known as "Melanie's Law", was a bill heard by the California Senate in 2023. The bill was named after 15-year-old Melanie Ramos, a student at Hollywood's Helen Bernstein High School who passed away at school in September 2022 from what was thought to be a fentanyl overdose. Her body was discovered in one of the campus bathrooms by her friend's stepfather after she had been reported missing for eight hours, according to a lawsuit filed by her family. By expanding resources, the bill attempts to prevent fentanyl overdoses on campuses across the state. As part of a school safety plan, the legislation would compel schools to devise an action plan for student opioid overdoses. This can entail educating staff on how to give medicines like Narcan to alleviate the symptoms of an opioid overdose.
From the beginning of May through the middle of June, California Highway Patrol (CHP) officers seized in San Francisco as much fentanyl as it could be the direct cause of more than 2 million fatal overdoses. The governor's office stated that the quantity, being over 4 kilograms, was sufficient to kill the population of San Francisco three times over. The seizure was conducted as a part of Gavin Newsom's plan, which combats the spread of fentanyl and bright and tries to enhance public health and safety in San Francisco.
Attorney General Rob Bonta stated on 9 June 2023 that Walgreens, CVS, and two pharmaceutical companies would have to pay a total of $17.3 billion to the state of California as part of a settlement for their involvement in the opioid crisis. Despite the drug issues in the San Francisco city, community-led harm-reduction initiatives have been stopped by Newsom and some local officials. Tenderloin Center, designed as a temporary harm-reduction measure, will be replaced by 12 smaller "wellness hubs" around the city. These hubs were designed to offer "health and shelter services", besides allowing "supervised drug use" so that overdose deaths are prevented.
Legislation that would have permitted controlled drug-use facilities in three Californian cities, including San Francisco, was vetoed by Newsom in 2022 summer. Consequently, the plan for the wellness centers came to a standstill after San Francisco's city attorney objected that the city would end up being held heavily liable, a decision which made the non-profits seek a means to finance the overdose preventive components of their activities without receiving financing from the city.