The scourge of fentanyl clearly visible on the streets of Los Angeles

In a dirty alley behind a Los Angeles donut shop, Ryan Smith was convulsing under the grip of a fentanyl high, going from moments of sleep to bouts of violent shivering on a hot summer day.

When Brandice Josey, another homeless addict, leaned in and blew out a puff of fentanyl smoke in an act of charity, Smith sat up and slowly parted her lip to inhale the vapor as if it were the cure for her problems.

Wearing a dirty yellow “Good Vibes Only” T-shirt, Smith leaned back on his backpack and slept the rest of the afternoon on the asphalt, unperturbed by the stench of rotting food and human waste that permeated the air.

For far too many people hooked on the drug, the sleep that follows a fentanyl hit is permanent. The highly addictive and potentially lethal drug has become a scourge across the United States and is affecting the growing number of people living on the streets of Los Angeles.

Nearly 2,000 homeless people died in the city between April 2020 and March 2021, an increase of 56% over the previous year, according to a report released by the Los Angeles County Department of Public Health. Overdose was the leading cause of death, killing more than 700.

Fentanyl was developed to treat severe pain from conditions such as cancer. The use of fentanyl, a powerful synthetic opioid that is cheap to produce and often sold as is or mixed with other drugs, has skyrocketed. Because it is 50 times more powerful than heroin, even a small dose can be fatal.

It has quickly become the deadliest drug in the country, according to the Drug Enforcement Administration. Two-thirds of the 107,000 overdose deaths in 2021 were attributed to synthetic opioids like fentanyl, the US Centers for Disease Control and Prevention said.

The toll of drug victims extends well beyond the streets.

Jennifer Catano, 27, has the names of two children tattooed on her wrists, but she hasn’t seen them in several years. They live with her mother.

“My mom doesn’t think it’s a good idea because she thinks it’s going to hurt the kids because I’m not ready to rehab myself,” Catano said.

He’s overdosed three times and been through rehab seven or eight times.

“It’s scary to come out of it,” he said. “Withdrawals are really bad.”

Catano wandered into a subway station near MacArthur Park desperate to sell a bottle of Downy fabric softener and a Coleman camping chair she stole from a nearby store.

Drug abuse can be a cause or a symptom of homelessness. Both can also intersect with mental illness.

A 2019 report from the Los Angeles Homeless Services Authority found that about a quarter of all homeless adults in Los Angeles County had mental illness and 14% had a substance use disorder. That analysis only counted people who had a permanent or long-term serious condition. Taking a broader interpretation of the same data, The Los Angeles Times found that about 51% had mental illnesses and 46% had substance use disorders.

Billions of dollars are being spent to alleviate homelessness in California, but the treatment is not always funded.

A controversial bill signed by Gov. Gavin Newsom could improve that by forcing people with severe mental illness to get treatment. But they need to be diagnosed with a certain disorder like schizophrenia, and addiction alone doesn’t qualify.

Help is available but it is outweighed by the magnitude of the misery on the streets.

Rita Richardson, a field supervisor for the LA Door, a city addiction prevention program that works with people convicted of minor crimes, hands out socks, water, condoms, snacks, clean needles and flyers at the same access points as Monday to Friday. She hopes that the consistency of her visits will encourage people to seek help.

“Then hopefully the light bulb goes on. It may not happen this year. It may not happen next year. It could take several years,” said Richardson, a former homeless addict. “My goal is to bring them from darkness to light.”

Parts of Los Angeles have become scenes of despair with men and women sprawled on sidewalks, huddled on benches, and collapsed in squalid alleyways. Some huddle together smoking the drug, others inject it.

Armando Rivera, 33, blew white puffs to attract addicts in the alleyway where Smith slept. He needed to sell some drugs to buy more. Those who didn’t have enough money to support his habit hovered around him, waiting for a free kick. Rivera showed no mercy.

Catano was unable to sell the chair, but eventually sold the fabric softener to a street vendor for $5.

It was enough money for another stop.