Fentanyl, a potent opioid already responsible for thousands of deaths nationwide, is increasingly showing up in drugs like cocaine and methamphetamine in California, officials say.
The white powder, a lethal substance 50 times stronger than heroin, is sometimes mixed into other opioids to produce a stronger high. Now its presence in non-opioids has public health experts worried that California may be staring down a new dimension of the deadly epidemic.
Officials suspect that three men who died in downtown Los Angeles late last month had snorted cocaine laced with fentanyl, an incident that has further galvanized fentanyl fears.
"We don't know whether this is an anomaly, or whether it's a bellwether of something that's about to hit," said UCLA professor Steve Shoptaw, who studies substance abuse.
Although California has avoided the worst of the opioid epidemic, the drug market here is dominated by stimulants, he said—the very drugs that have just started to be mixed with fentanyl.
Indeed, fentanyl deaths in California tripled between 2016 and 2017, according to the state health department.
Fentanyl, which can kill even in small doses, is dangerous for experienced opioid users, and even more so for people with no tolerance for opioids. Experts say they don't know whether dealers are purposely or accidentally tainting drugs with fentanyl, but that it's a concern regardless.
"We need to think of fentanyl being used with a wide range of drugs," said Jane C. Maxwell, a professor at the University of Texas at Austin who studies substance abuse. "We're so concerned about heroin and fentanyl, people aren't really looking at other uses of fentanyl and other problems that might occur."
About 11:30 p.m. on April 25, Maynor Garcia's phone buzzed with a text from his older brother, Gabriel Dirzo.
Dirzo wanted to know whether Garcia would host a birthday barbecue for him the following month.
"Yeah bro no problem," Garcia texted back.
The two had hung out the day before with Garcia's young daughters and vowed to spend more time together.
Hours later, Dirzo was found dead in his apartment in downtown Los Angeles, along with two other men. Police identified them as Gilbert Valenzuela Jr., 41, of Los Angeles and Robert Ramirez, 36, of Alhambra.
That night, the men had been drinking and eventually began doing what they believed was cocaine, according to reports from the L.A. County Department of Medical Examiner-Coroner.
Officials suspect the men died because the cocaine was actually fentanyl, or was cocaine laced with fentanyl, said Dr. Gary Tsai, medical director of the county health department's substance abuse prevention and control division.
"Cocaine, while it can be life-threatening, generally doesn't result in instantaneous overdose deaths like that," Tsai said.
Toxicology tests that provide an exact cause of death could take up to two months, said Ed Winter, a spokesman for the coroner's office.
Fentanyl has been prescribed as a painkiller for cancer patients since the 1960s. But an illicit version is being manufactured and can be easily mixed with other drugs without being noticed.
Several people in San Francisco have recently died from consuming fentanyl with methamphetamine, counterfeit Xanax or crack cocaine. There have been reports elsewhere of fentanyl in the rave drug MDMA.
"We aren't seeing the volume or the impact that … is happening on the East Coast, but we know that could change," said Rachael Kagan, spokeswoman for San Francisco's Department of Public Health. "We're really on high alert."