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The silent killer: Fentanyl deaths raise alarm on Guam



By Jayvee Vallejera

 

A description of how a fentanyl overdose kills is quite clinical. A quick Google search reveals some of the symptoms include clammy hands, pinpoint pupils and something called cyanosis, which means your hands and feet are bluish—signs of a severe lack of oxygen. What will kill you, though, is that it robs you of your ability to breathe.


The breathing of people overdosing on fentanyl slows down and eventually stops, since it affects the part of the brain that controls breathing.  This leads to hypoxia, when the brain is damaged due to lack of oxygen.


How potent is fentanyl, then? It is 100 times more powerful than morphine. “These are not mere numbers; they represent lives cut short, families torn apart, and communities left to grieve,” said Gov. Lou Leon Guerrero in a public message on July 28, addressing the fast-growing threat to Guam.


While no stranger to the war on drugs, the community is now dealing with a “silent killer” that “is beginning to cast its dark shadow over Guam.”


The Drug Enforcement Agency summed up the danger of fentanyl in four words: “One pill can kill.”


 “According to the Drug Enforcement Administration, just two milligrams of fentanyl, which is equal to 10-15 grains of table salt, can kill. Fentanyl can be absorbed into the body via inhalation, oral exposure or ingestion, and even skin contact,” said Ike Peredo, director of Guam Customs and Quarantine.


Nationally, fentanyl is responsible for more than 70,000 overdose deaths each year.  That is nearly two-thirds of all opioid-related fatalities in America.


On Guam, there have already been seven fentanyl overdose deaths in the last four years—eight cases, actually, but one was revived, according to Berlyn Savell, spokesperson for the Guam Police Department.


What complicates matters is that fentanyl in and of itself is not an illegal drug like methamphetamine or heroin. It is a controlled substance approved by the Food and Drug Administration for pain medication.


According to the Guam Behavioral Health and Wellness Center, fentanyl is an opioid typically prescribed to patients undergoing chemotherapy, or those experiencing severe post-surgery pain.


 Dr. PJ Ji, a pain management specialist at AC Micro Interventional Pain Clinic on Guam, said some of the patients he sees are dealing with non-cancer pains, such as chronic cervical or lumbar pain and fibromyalgia. He said a few are prescribed fentanyl patches, but he tries to get them off these patches as soon as possible, adding they are not the best option to manage pain.


“They do work, don’t get me wrong, but they do tend to increase tolerance,” he said. “And this will lead to escalation of doses.”


A lot of times, patients want to use these fentanyl patches every two days versus the three days they're prescribed, Ji said. That’s because many patients often replace the patch after the second day, complaining about a loss of effectiveness.


Ji said other analgesics—both opioid and non-opioid—are often better for managing pain, depending on the source of the pain itself.


Ji, who is also an anesthesiologist, said fentanyl is commonly used for surgery, but this is just a one-day dosing for surgical pain.


It is when fentanyl is misused that it can lead to substance use dependence and, in some cases, overdose deaths, according to the Guam Behavioral Health and Wellness Center.


Leon Guerrero, who is a registered nurse, said fentanyl’s potency increases when mixed with illegal substances such as heroin and methamphetamine.


Worse, it has now been found that fentanyl is also being mixed with fake prescription drugs, increasing their lethality. Most victims are not even aware they are taking fentanyl, believing they are taking something far less dangerous like prescription medications such as Oxycodone or Xanax, which are laced with fentanyl.


“Lives have been lost to fentanyl simply because the victim believed he was taking some other drug,” Leon Guerrero said. “Imagine for a moment hearing that your son or daughter took a pill to help with their anxiety—never to wake up again.”


The DEA Laboratory recently found that of the fentanyl-laced fake prescription pills analyzed in 2022, six out of 10 contained a potentially lethal dose of fentanyl, the governor disclosed. 


As to how fake prescription pills make their way to Guam, GPD’s Savella said the illegal trafficking of fentanyl to Guam involves complex networks that often span multiple jurisdictions, including international sources.


“While the precise pathways of fentanyl's entry into Guam can be difficult to trace, we are aware that it is often smuggled through various channels in our borders,” she said.


Peredo has an idea, though. He said the suspected illegal fentanyl intercepted by Customs officers all came from a point of origin within the United States. “However, most illegal fentanyl is believed to come from Mexico and China before it is smuggled into the U.S., where it is further distributed into other states and territories,” he added.


Since 2022, Peredo said, Guam’s Customs agency has intercepted a total of 87.9 gross grams of suspected illegal fentanyl—79.4 gross grams in 2022 and 8.5 gross grams in 2023. An additional 119 tablets suspected to contain illegal fentanyl have been intercepted so far in 2024. 


 “Of these amounts, a total of nine pills from the 2022 seizure yielded positive results for the presence of fentanyl, with a net weight of 0.848 grams. The seizure made in 2023 came back negative for containing illegal fentanyl,” Peredo said. The results of the analysis of the suspected illegal fentanyl seized so far in 2024 are still pending.


 “It is important to note that illegal fentanyl can be mixed with other narcotics and counterfeit medications. Thus, our officers seize such drugs and submit them for analysis of their true contents by federal crime labs abroad, which can take anywhere between one and six months,” he added.


Leon Guerrero has outlined a five-point action plan to enhance Guam’s capacity to combat this growing menace. This includes working closely with Guam and federal law enforcers and Customs to intercept dangerous drugs, including fentanyl; training and equipping Guam police officers and paramedics on how to use Narcan (known by its generic name naloxone), a medication used to quickly reverse the effects of opioid overdoses; boosting Guam’s opioid treatment capacity through the Guam Behavioral Health and Wellness Center; expanding education and prevention measures like the “One Pill Can Kill” campaign that targets public and private schools; and enacting new laws to punish convicted drug kingpins with decades in prison, not months or years.


In line with this,  Leon Guerrero recently signed into law Bill 239, authored by Sen. Chris Barnett, which sets a range on the length of a prison sentence for drug possession, depending on the quantity of drugs intercepted. The lowest prison range is 25 years for large amounts of substances,  while repeat offenders will be punished with 30 years to life.

    The bill, now Public Law 37-113, sends a strong message to the meth and fentanyl dealers “who are poisoning our island,” said Barnett.


The new law also imposes fines mirroring federal penalties for businesses that import meth and fentanyl and lays the groundwork for quantity-based sentencing for fentanyl.


Separately, Sen. William A. Parkinson has introduced legislation to amend the law against illegal drug use and distribution, particularly involving highly lethal substances like fentanyl and methamphetamine.


Currently, Guam law classifies deaths caused by Schedule I drugs like heroin, LSD, and cannabis as aggravated murder, murder or manslaughter. Parkinson’s bill would include Schedule II drugs as well, like meth and fentanyl.


Noting that fentanyl is found in different forms, mixed with other substances, and also disguised as legitimate medicine, Peredo said Customs officers themselves need greater access to regular training to increase their understanding of current trends. 


Customs officers also require updates to certain laws, policies and procedures, as well as increased jurisdiction, to better prevent criminals and criminal enterprises from circumventing the agency’s enforcement efforts, Peredo said. “This ranges from border search authorities to resource management,” he added.


At GPD, Savella said officers receive specialized training to recognize and safely handle fentanyl to reduce the risk of accidental exposure during their duties.


There are other logistical challenges that the Customs office has to deal with, such as a shortage of manpower and resources, Peredo said.


He said Customs requires  250 to 300 officers to adequately man all of Guam’s borders and designated ports and enable them to do their job well, but  the number of personnel falls far short of what is needed. “We currently have only 141 officers,” he said.


Inadequate equipment is another challenge. “Although more narcotics analysis devices are on order, our agency has been operating with access to only one narcotic analyzing device available through a federal task force,” he added.  


Peredo said the devices are important for Customs officers to make quicker decisions and rule out false positives.


“We cannot stress enough how serious it is to locate and remove illegal fentanyl from our community before it becomes a dreadful epidemic,” he said. (With additional reports from Mar-Vic Cagurangan)





 

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