PD Editorial: Congress can’t wait on fentanyl bill

The third wave of the United States' opioid addiction crisis is lapping at California's shores. The state can avoid the worst of this phase of a deadly epidemic, but only if political and public health authorities give the problem the urgent attention it deserves.

The third wave comes in the form of fentanyl, an opioid 10 to 100 times more potent than morphine. Fentanyl is also a chemical trickster. Tweaking the drug's molecular formula create analogues that are every bit as addictive as fentanyl but remained technically legal on the street.

The federal Drug Enforcement Agency responded in 2018 by imposing a classwide ban on all fentanyl analogues. That's worked, but the agency's authority for such action expires on Feb. 6 unless Congress acts.

The U.S. Department of Justice, supported by the attorneys general of 52 states and territories, including California's, has asked Congress for an indefinite extension of the DEA's classwide fentanyl ban. The House and Senate, despite being embroiled in impeachment, should approve such legislation without delay.

Opposition to an extension comes from opposite corners of the ideological landscape - the American Civil Liberties Union on the left and FreedomWorks on the right. Both argue that an effective response to the opioid crisis must focus on treatment and prevention, not law enforcement and incarceration.

They're right - or they would be, if robust treatment programs were up and running and if prevention programs alone could stanch the flow of fentanyl and its analogues.

Despite state and federal governments' welcome turn away from harsh prison sentences for drug users, the opioid epidemic demands action on all fronts, including a robust law-enforcement element.

America's opioid epidemic began in the 1990s, when too many physicians, with the encouragement of pharmaceutical companies, began overprescribing addictive painkillers. The second wave rose a decade later, when a crackdown on prescription opioids led many addicts to switch to a cheaper and more readily available drug: heroin.

Fentanyl, the third wave, arrived in 2013. It's cheap, potent and, until the DEA curbed analogues flowing from overseas drug labs, was quasi- legal. According to the federal Centers for Disease Control and Prevention, fentanyl overdoses accounted for 28,466 deaths nationwide in 2017 - 39% of all opioid-related fatalities.

Western states have dodged the worst of the fentanyl scourge so far. The CDC reports that in 2017, fentanyl caused only 7% of overdose deaths west of the Mississippi. One reason is the prevalence of black-tar heroin in the West, which doesn't combine with fentanyl as easily as the powdered heroin more commonly found in the East and Midwest.

That's changing. According to the California Department of Public Health, statewide fentanyl overdose fatalities rose to 743 in 2018, nearly double the number the year before. The San Francisco Chronicle reports that 234 San Franciscans died of fentanyl overdoses in 2019, up from 90 in 2018.

California and its communities must do all they can to arrest and reverse this alarming trend as well as help those who already suffer from substance use disorders. An important part of that effort involves supporting legislation to give the DEA the permanent authority it needs to pursue those who make, import and distribute fentanyl and all its deadly chemical cousins.

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