With its port on the Pacific and its proximity to the Mexican border, San Diego is on the front lines of the War on Drugs. Just this past April, federal drug enforcement agents seized over a ton of cocaine from an 800-yard tunnel running from Tijuana, Mexico to San Diego, CA. However, while illicit drug trafficking and the violence of the cartels associated with it garner most of the media attention, problems associated with prescription drugs in San Diego often get overshadowed.

America is in the grips of an opioid addiction epidemic. The CDC reports that from 1999 to 2014 opioid overdose deaths in America nearly quadrupled. Over that same time period, sales of prescription opioid painkillers in the U.S. also nearly quadrupled, however Americans did not report any change in the amount of pain they experience. In 2014, more people died from drug overdoses than any other year for which data has been recorded. More than sixty percent of those deaths involved opioids.

San Diego is not immune to this epidemic. According to the California Department of Public Health, in 2013, the most recent year for which numbers are available, 7,810 people died of health consequences related to drugs or alcohol, including 775 in San Diego County.

Many of the opioid overdose deaths are from accidental overdoses. Those have become increasingly more common with the rise of fentanyl. Fentanyl is a highly addictive and highly dangerous opioid. It was a major factor in the overdose deaths of several celebrities, most recently, Prince. Fentanyl is a powerful opioid. It is up to 50 times more potent than heroin. The estimated lethal dosage of fentanyl is only two milligrams.

Because of its low manufacturing cost relative to its potency, fentanyl circulation continues to increase. Between 2013 and 2014 fentanyl drug busts more than tripled. Trying to stretch their profits, drug manufacturing and trafficking organizations increasingly use fentanyl to cut or lace other drugs, including other opioids.

The fentanyl-in-disguise phenomenon once again thrusts San Diego to forefront of the drug trade, this time where prescription drugs and illegal trafficking meet. In April, law enforcement officials confiscated 1,183 tablets of fentanyl that were labeled as oxycodone. After noticing an unusual bulge on a man passing through the Otay Mesa Port of Entry on foot, a Customs and Border Patrol Agent directed the man to a secondary inspection. The suspicious man, Sergio Linyuntang Mendoza Bohon of Tijuana, Mexico, turned out to be concealing the fentanyl tablets in his underwear.

Similar counterfeit pills have already killed more than 10 people in Sacramento, CA. The pills in the Sacramento case were labelled as the painkiller Norco, a mix of hydrocodone and acetaminophen. But, like in the San Diego case, the pills actually contained fentanyl.

As if the dangers of tainted pills, addiction, and death weren’t enough to worry about, another recent story highlighting the dangers of prescription drugs in San Diego is a cautionary tale about trusting doctors too readily.

On August 30, San Diego Drug Enforcement Administration agents arrested Physician Naga Raja Thota. They charged Thota, a pain specialist in El Cajon, with distributing addictive drugs, including oxycodone, without medical cause. But, that was just the beginning of his wrongdoing. Thota allegedly distributed the drugs in exchange for sex acts.

The complaint filed against Thota stated he gave opioid prescriptions to at least two young women on multiple occasions in exchange for sex acts. The complaint also alleges Thota and the young women exchanged sexually-explicit text messages prior to him writing the prescriptions. This allegedly establishes a pattern of behavior. Sadly, this story gets worse.

According to one 20-year-old victim’s statement in the complaint, Thota met her while she was hospitalized for hydrocodone and alprazolam withdrawal symptoms. Although she did not, have any condition associated with long-term, chronic pain, Thota, the pain specialist agreed to treat her. Allegedly his documentation for the treatment said he treated her for pain, despite her lack of need for such treatment. The victim’s complaint continued, claiming Thota exposed the woman to higher and higher dosages of opioids. She said she felt she would not get additional opioid prescriptions if she did not perform sex acts with Thota. Eventually her tolerance for prescription opioids grew to the point she started using heroin.

This sobering story shows the evils someone can face when they get hooked on a particular substance, but the news in San Diego regarding the prescription drug problem isn’t all bad. In April, San Diego and Imperial counties participated in the 11th National Prescription Take-Back Day. The DEA and other organizations involved set up 43 prescription drug return locations in San Diego County and three more such locations in Imperial County. In total, they collected 5.4 tons of drugs in just four hours.

San Diego faces a unique challenge in the battle against substance abuse. Just like most of the rest of the country, it has to battle prescription drug abuse, but San Diego is fighting drug abuse on two fronts. Its geographic location makes it pivotal in any strategic approach to disrupting illicit drug trafficking. With that additional threat, people can easily overlook the prescription drug problem. Stories like finding fraudulently labeled fentanyl and doctors taking advantage of patients’ addictions remind us to stay vigilant on both fronts of the War on Drugs.

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In San Diego, the War on Drugs Has Two Fronts