Retired Santa Cruz physician Helen Nunberg spent decades treating people with addictions and can’t understand why Rep. Jimmy Panetta recently voted for the HALT Fentanyl Act. The act, she says, will lead to harsher criminal penalties for possession of small amounts of fentanyl-related drugs and makes the same mistakes we have been making for decades. “Obviously, what we are doing isn’t working,” she writes. She encourages you to write to your senators and keep President Joe Biden from signing it into law.
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On May 25, the U.S. House of Representatives passed H.R. 467, the HALT Fentanyl Act, and our representative, Jimmy Panetta, voted in favor. I don’t know why.
H.R. 467 will lead to harsher criminal penalties for possession of small amounts of fentanyl-related drugs because they will be permanently classified as Schedule I and, therefore, illicit.
This is not the course we need to take as a community deeply concerned about use and overdoses in our community — particularly among youth.
Several years ago, then-Supervisor Ryan Coonerty asked me, as a physician treating people with addictions, why Santa Cruz has more overdose deaths than San Mateo, Santa Clara and Monterey counties despite our spending more on harm reduction and residential treatment.
I replied that, obviously, what we’re doing isn’t working.
I’d like to share a bit of the history I learned about in my 40 years treating people with addictions and in the research I did for presentations to physician assistants and sociology students about treating addiction during the current opioid crisis.
Heroin has been around since the late 1800s, early 1900s, when the Bayer pharmaceutical company marketed it for cough suppression and said it wasn’t addictive. With a U.S. population at that time of around 75 million, one in 300 people became addicted to heroin.
Fast forward to the 1970s, and there has been an increase in heroin use and 5,000 overdose deaths annually.
In 1986, the Anti-Drug Abuse Act legislated mandatory minimum sentences for possession of small amounts of Schedule I illicit opioids such as heroin. It led to a startling increase of incarceration, especially of Black men, with no reduction in addiction or deaths.
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In the 1990s and 2000s, Purdue Pharma marketed long-acting oxycodone for chronic pain relief and said it wasn’t addictive. In the 2010s, people addicted to OxyContin — Schedule II, not illicit — found heroin was cheaper and easier to buy.
Before 2014, more overdose deaths were due to prescription opioids such as OxyContin than were due to heroin. Together OxyContin and heroin were responsible for 30,000 overdose deaths annually.
In 2014, fentanyl and fentanyl-related drugs entered the heroin and counterfeit pill markets. Fentanyl is 50-100 times more potent, and a lot cheaper to produce than other opioids.
No one has to grow opium poppies to manufacture fentanyl.
Last year, with 333 million people, the rate of addiction in the U.S. was, remarkably, the same as 100 years ago, but deaths numbered 110,000.
Think about that. Think how little progress we have made, how ineffective our policies have been. How damaging.
Those who voted for H.R. 467 — including our own representative — seem to have forgotten the long-term harm and failure of the Anti-Drug Abuse Act.
Why else would they believe we need the HALT Fentanyl Act?
Most of the provisions of the HALT Fentanyl Act were enacted temporarily, as an emergency measure under the Trump administration in 2018. Since then, fentanyl‐related overdose deaths increased from roughly 47,000 to more than 81,000 annually.
H.R. 467 has not yet passed in the Senate. President Joe Biden has not yet signed it. Many people and groups are urging them not to.
I hope they listen. I hope you join me in writing to our senators to urge them not to support it.
In August 2022, Gov. Gavin Newsom vetoed Senate Bill 57, legislation that would have legalized a few supervised consumption sites as a pilot program. Again, I don’t know why.
Whom did he listen to?
Safe consumption sites are places where users bring their own drugs, where trained workers recognize when a user has unknowingly taken a too-potent dose and their breathing is about to stop, administer Narcan and save a life. New York City has opened two supervised drug consumption sites, also known as overdose prevention centers, and Rhode Island legalized them.
Why don’t we?
The $6 billion for addiction treatment and prevention programs from the Purdue Pharma Sackler family settlement has recently moved one step closer to being delivered to states and communities.
I hope my elected officials will fund what works, not more of what doesn’t work.
So far, we know of a few methods that seem to work to prevent overdoses. Incarceration is not one. Only medication treatment with methadone or buprenorphine, both drastically underprescribed, and safe consumption sites have been shown to reduce the risk of overdose death and recidivism.
An overdose prevention center in Santa Cruz is possible. We can do this, we should do this.
We can save these lives.
Helen Nunberg is a retired physician and 41-year Santa Cruz resident. She has degrees in biology from University of Rochester (New York), an M.D. from Mount Sinai School of Medicine, and a master’s in health care policy and management from UC Berkeley. She practiced medicine for 40 years in county clinics, community health centers, group and solo practices. She conducted a study of medical marijuana users in 2006, with results published in 2011, and has guest lectured on substance use and the opioid crisis. A child of Holocaust survivors and native of the Bronx, she feels incredibly fortunate to live in Santa Cruz, to travel the world, to have her children and grandchildren close by, and help where she can.