Editor’s note • This story discusses opioid misuse and substance use disorder. If you or someone you know is at risk of an opioid overdose, visit UtahNaloxone.org or your local public library to obtain free naloxone. If you or someone you know need medical services, visit the Utah Naloxone Wellness Center, aka Andy’s.

Finding fentanyl, Mysti Lopez remembers, was as easy as heading to the Jordan River Trail, a popular spot for deals. Police announced seizures of hundreds of fentanyl pills there this summer.

Lopez had grown up surrounded by relatives with substance use disorder, she said, then turned to heroin herself as she grieved after her uncle’s death. Her fentanyl use quickly followed. “Despite telling myself I’d never be like them,” Lopez said of her family, “I eventually found myself walking that same path.”

Sober for more than three years now, Lopez works to support others in recovery — help widely needed, as fentanyl use has soared in Utah.

Last year, the synthetic opioid became the drug most commonly involved in fatal Utah overdoses, based on data provided by the Utah Department of Health and Human Services. It hit that mark nationally in 2021.

The 290 people who died in Utah last year after taking fentanyl represented a 71% increase in two years, and more than five times the number of such deaths recorded in 2019.

A new state task force held its first meeting last week, as officials promise to fight fentanyl with a comprehensive approach from disrupting drug trafficking networks to reducing demand. The goal, Utah Gov. Spencer Cox said in announcing the task force, is to “make life worse for those who are profiting off this and make life better for those who are suffering.”

To help people get sober, he added, the state will promote prevention, offer treatment — and sometimes pursue temporary incarceration.

But advocates also want the state to boost harm reduction efforts — practical tactics like syringe exchanges and strips to test for fentanyl that help people use substances safely until they’re ready for treatment or other paths to recovery.

The approach works because it protects people as they build a relationship with advocates and get comfortable asking about medication-assisted treatment or other options, said Max Radecky, a harm reduction specialist at Odyssey House.

“The most successful strategy is starting at the individual level,” he said, “and helping people to understand that substance use is a disease just like any other.”

Why is the fentanyl surge happening?

Illegally manufactured fentanyl — a prescription drug up to 50 times stronger than heroin and 100 times stronger than morphine — is fueling the drug’s use in Utah, officials say. In the state’s illegal drug market, it’s often mixed with other drugs, made to look like the authentic pharmaceutical version, or even pressed to look like Flintstones vitamins.

Dustin Gillespie, the assistant special agent in charge of the U.S. Drug Enforcement Administration’s Salt Lake City District Office, said that’s because fentanyl is cheap to produce.

Drug cartels — mostly the Sinaloa and Jalisco cartels in Mexico — can produce fentanyl at cents per pill and make huge profits, Gillespie said.

“They kill a few customers in the process,” he said. “That’s just an acceptable collateral damage for cartels who are seeking money.”

As long as there’s demand, cartels will find a way to generate supply, Gillespie said.

The DEA works to seize pills before they hit the streets and has been doing so in record numbers, he said.

In 2018, law enforcement seized 15,000 fentanyl pills in Utah. That number surged to about 2 million last year.

But there’s still an “oversupply” of pills in Utah communities, Gillespie said, and it’s in every community. “Our investigations take us to the most affluent neighborhoods and to some of the poorest,” he said.

And it could take just one pill to cause a fatal overdose, he said, as agency lab tests have shown that 70% of the pills contain a potentially lethal dose of two milligrams or more. One pill might have no fentanyl, Gillespie said, and another might have five times the potentially lethal dose.

The majority of drug overdoses involving fentanyl also involved at least one other drug, according to the state. Methamphetamine — which was involved in just a dozen fewer deaths than fentanyl in 2023 — was the most common. Gabapentin, alcohol, heroin and cocaine also were often involved.

How is Utah already trying to help people?

Cox’s announcement of the task force — at a news conference with Lopez and others at Cottonwood Park along the Jordan River Parkway Trail — coincided with the first day Utahns started receiving ballots.

Rep. Brian King, a Democrat from Salt Lake City who challenged Cox’s reelection bid, criticized it as “political theater,” saying fentanyl trafficking and abuse “has been serious for a long time, but suddenly the governor decides to make a show of it.”

Groups have been working together before now, as law enforcement focuses on busting the supply chain, public health officials provide education and resources and harm reduction programs try to keep people out of danger.

“I wish we had a solution because we would have already done it,” said Jessica Serfustini, health promotion director for the Southeast Utah Health Department.

The department covers Emery, Carbon and Grand counties and focuses on education and harm reduction.

Those efforts use evidence-based programs to help decrease the spread of disease and provide a safer route for drug use that’s going to happen either way, she said.

“We understand that with or without this program,” Serfustini said, “drugs are in our community.”

The health department’s work includes education on the dangers of mixing drugs and how to use naloxone, an injectable emergency opioid overdose treatment, and Narcan, a nasal spray version.

The state and Utah Naloxone — founded by state Sen. Jen Plumb — have pushed out hundreds of thousands of doses of the injectable treatment. Most of those have come from Plumb’s organization, but the state’s help is a win, she said, because it took “multiple efforts for Utah to shift its trajectory” to include harm reduction.

Plumb, a doctor and minority assistant whip in the Utah Senate, describes naloxone as a fire extinguisher.

“It’s the way that we keep people alive while they’re hopefully on their path to having better health or wellness,” she said.

The Southeast Utah Health Department’s program also provides strips to test drugs for fentanyl and xylazine, a non-opioid tranquilizer also being laced into illegal drugs.

Someone who thinks they’re using a drug other than fentanyl could still be at risk for an overdose if they unknowingly take one laced with it.

“They don’t know what it is when they get it. They don’t know how strong it is. They don’t know what it contains,” Plumb said. “They don’t know what it’s adulterated with. All they know is they want to stop feeling terrible” from withdrawals.

What else is needed?

These safety efforts also include around 10 syringe exchanges across the state — more than half of which are in the Greater Salt Lake area, said MacKenzie Bray, executive director of The Salt Lake City Harm Reduction Project.

The programs, which take in used syringes and offer new ones, are proven to lead to decreased rates of HIV and hepatitis C and less syringe litter, Bray said. They’ve been around since the 1980s, but they’re “still kind of controversial,” she said, especially depending on the political landscape.

That’s even though they work: “People who access a syringe exchange are three times more likely to access treatment,” she said.

Some advocates would also like to see access to a safe supply and to create spaces to use safely, such as overdose prevention sites in Philadelphia and New York. They’ve existed in other countries for years, said Mindy Vincent, a licensed social worker who founded the Utah Harm Reduction Coalition.

Research has shown the centers are associated with reduced public drug use, lower demand for health care and emergency response resources and increased access to treatment, according to the National Institute on Drug Abuse.

They’re better than having someone die in “a porta potty in Pioneer Park or a Burger King bathroom,” Vincent said, and while Utah needs these kinds of centers, the state “can’t even tolerate talking about it.”

Still, Utah has made a lot of progress and has “just about as many support systems in place as we can at this point,” Vincent said.

The state could expand its supports, she said, like providing more access to naloxone, more clinics where people can access medication-assisted treatment so they can get help when they’re ready in the moment and more places willing to treat people who are actively using.

Harm reduction isn’t specifically mentioned in the task force proposal. But Tracy Gruber, executive director of Utah Health and Human Services, stressed the effort is much broader than law enforcement.

“It’s an all-hands-on-deck approach,” Gruber said.

Harm reduction would fit into the task force’s prevention efforts, she said, and she expects existing syringe exchanges and other programs to continue.

Lead with compassion, advocates urge

As the problem persists, empathy is key, said Radecky, who runs the syringe exchange program at Martindale Clinic. Drug misuse often stems from trauma, he said, so it’s critical to see those with substance use disorders as people first.

“I just want people to know that these are human beings,” Radecky said, “and they’re your neighbors and brothers and sisters.”

Bray of the Salt Lake City Harm Reduction Project was starting a syringe exchange in 2016 around the time her brother died from an opioid overdose, after he returned to using drugs. She remembers him as “kind of too smart for his own good” and funny.

Plumb’s brother died in 1996, which led to “absolute horror” from family and neighbors, she said, when her immediate family would truthfully say he died of a heroin overdose.

Vincent stressed that Utahns don’t need compassion for the behavior, but rather for what’s driving it.

Plumb said she has watched over the decades as people have realized substance use disorder is a tragic disease and “not something that we can value these people less because of.”

But stigma is still a big barrier, people in harm reduction and health emphasize.

“It’s way more common than people think,” Bray said, “and we just don’t really talk about it as much because there’s the shame and stigma associated with it.”

Lopez agrees. People with substance use disorder face shame because “you think you’re not worth it or you’re just another statistic,” she said.

Utahns, like most people, fear what they don’t understand, Lopez said, but she wants them to have a mindset of compassion.

“People just want to be heard and loved,” she said, “and feel they can come back to the society they feel so isolated from.”

Editor’s note • This story is available to Salt Lake Tribune subscribers only. Thank you for supporting local journalism.