A Stanford University sophomore found unresponsive in a campus fraternity house in January died from an accidental overdose of fentanyl, a powerful narcotic, the Santa Clara County Medical Examiner-Coroner's Office confirmed on Tuesday.
The confirmation comes amid reports of accidental fentanyl overdoses on college campuses across the country and an uptick in overdoses in Santa Clara County.
Eitan Michael Weiner, the son of a university professor and Stanford associate vice president, was found by paramedics inside the Theta Delta Chi fraternity house on Jan. 17. The coroner's office said his cause of death was fentanyl toxicity and the manner of death was accidental.
Later that day, the Stanford Department of Public Safety issued a warning to the campus community about counterfeit prescription pills containing fentanyl that have been smuggled into the U.S. from Mexico. The legally required warning provided information about fentanyl, including signs and symptoms of overdose.
In a "critical" message to students in late January, Vice Provost for Student Affairs Susie Brubaker-Cole shared information from three administrators about "counterfeit prescription painkillers that look like Percocet and OxyContin, but contain fentanyl." Local law enforcement agencies have seized a large number of counterfeit 30-milligram Percocet pills containing fentanyl, wrote Ralph Castro, associate dean and director of the Office of Alcohol Policy and Education, Mona Hicks, senior associate vice provost and dean of students, and Jim Jacobs, associate vice provost and executive director of Vaden Health Center. (The university did not make the administrators available for an interview.)
"As many of you know, young people are dying in record numbers after consuming drugs containing fentanyl. We need your help determining how we can keep Stanford students safe," they wrote.
Neither the Department of Public Safety nor the administrators' statement made a connection to Weiner's death.
Weiner's parents, Amir Weiner, an associate professor of history, and Julia Erwin-Weiner, an associate vice president for medical center development and former senior associate dean for external relations of Stanford Law School, did not respond to an interview request for this story.
"We are deeply concerned by Eitan's cause of death," the university said in a statement. "We are increasing our drug and alcohol prevention and education programs, enhancing screening and assessment of students who have engaged in substance abuse, and working with national experts in college substance abuse to develop a comprehensive plan to promote and support student health and well-being."
More powerful than morphine
Fentanyl is an opioid drug that is 80 to 100 times more powerful than morphine. Exposure to even amounts the size of crumbs can cause overdose or death, according to a health advisory issued by the Santa Clara County Public Health Department in September. The advisory was specifically directed to schools, after-school programs, parent and teacher organizations and other organizations that serve young adults because two teenagers died from fentanyl overdoses in the county in 2019.
There were 27 fentanyl-related deaths in Santa Clara County in 2019, including the 15- and 16-year-olds, according to the public health department — and that number could continue to rise because some cases from last year remain open. Some of the deaths were due to overdoses on fentanyl alone or in combination with alcohol or other drugs. Several of the deaths had been linked to fake pills that are made to look like 30-milligram oxycodone prescription pills but contain fentanyl, the county said. There was a "strong uptick" in fatal overdoses in August 2019, according to the county District Attorney's Narcotics Unit.
"People who took these pills thinking they were taking oxycodone were unaware that they were taking lethal doses of fentanyl," the county said.
The pills are circular, light blue to light green in color and have an "M" inside a square stamped on one side and a "30" stamped on the other side, according to the District Attorney's Office. They are called "M30s" or "blues" because of the stamps and color.
Fake pills are not prescribed, stolen or resold by or from verified pharmaceutical companies, and there is no connection between their appearance and their ingredients, Public Health Director Dr. Sara Cody wrote in a September update.
"No one should take a pill that was not obtained directly from a pharmacy," she wrote. "Pills given by a friend or bought from others also should not be taken. Doing so could have deadly consequences."
Nationally, overdose deaths involving synthetic opioids, which include fentanyl (though not methadone), increased almost 47% from 2016 to 2017, according to the Centers for Disease Control and Prevention (CDC). Reports from law enforcement indicate this increase may be due to illegally or illicitly made fentanyl: seizures of fentanyl increased by nearly sevenfold from 2012 to 2014, according to the CDC.
How Santa Clara County is responding
The Santa Clara County District Attorney's Office and multiple law enforcement agencies across the county have seized large quantities of fake 30-milligram Percocet pills that contain fentanyl as their sole active ingredient, according to the county.
Prosecutions in Santa Clara County surged in 2019, Brian Buckelew, supervising deputy district attorney of the District Attorney's Office Narcotics Unit, said in an email on Tuesday. His office prosecuted a few dozen defendants for selling fentanyl in 2019, and local county law enforcement agencies seized more than 10,000 fake-pharmaceutical fentanyl pills in 2019, including in Palo Alto, he said.
The District Attorney's Office also conducts fatal overdose reviews in fentanyl cases to try to identify supply sources and criminal liability for those who sell or furnish to someone who fatally overdoses. (The San Mateo County District Attorney's office on Monday sentenced a drug dealer in a fentanyl overdose case to three years in county jail and over three years of mandatory court supervision.)
The "great majority" of fentanyl-laced pills in Santa Clara County are manufactured in Mexico, Buckelew said. His unit also sees fake Xanax, Valium, Vicodin and other opiates and benzodiazepines that contain fentanyl. Santa Clara County law enforcement agencies and the narcotics unit have also seen fentanyl in powder cocaine and methamphetamine.
The drugs containing fentanyl are "killing people across the country in alarming rates," he wrote.
The U.S. Drug Enforcement Administration has told Buckelew that in a special laboratory that tests the amount of active ingredients in fake drugs, 26% of pills come back positive for fentanyl in fatal dosages — more than 2 milligrams of fentanyl per pill.
The District Attorney's Office is also working with the Public Health Department and other agencies to create a rapid response team for the issue. The county also joined a statewide initiative by the California Health Care Foundation, which formed the California Opioid Safety Network, to address the problem. In 2015, the county started the Santa Clara County Opioid Overdose Prevention Project to improve strategies for prevention, treatment and education related to opioid abuse.
Signs and symptoms of fentanyl overdose may include nodding off, falling asleep in class, droopy eyes, pinpoint pupils, appearing "zoned out," barely being able to stay awake and constipation, the county said. A person who has these symptoms from stress or sleep deprivation will be able to wake up, the county said, while a person who has overdosed will not.
Naloxone, which is also known by its brand name, Narcan, can reverse the effects of an opioid overdose. The state allows pharmacists to prescribe naloxone without a prescription and pharmacists are required to provide counseling and education for anyone trying to obtain naloxone. First responders serving Stanford also carry Narcan.
The Santa Clara County Opioid Overdose Prevention Project also offers free naloxone training and kits every Friday from 1 to 2 p.m. at three locations:
• Central Valley Clinic, 2425 Enborg Lane, San Jose.
• Alexian Health Clinic, 2101 Alexian Drive, Suite B, San Jose.
• South County Clinic, 90 Highland Ave., Building J, San Martin.
Stanford: Community is 'at-risk'
Earlier this month, Stanford's undergraduate student government considered but ultimately tabled a resolution asking the university to put Narcan kits in student residences, which some colleges across the country have started to do in response to the opioid epidemic.
Stanford has directed students to drop counterfeit drugs off, with no questions asked, at public disposal locations for controlled substances that can be found through this link. (Stanford's ZIP Code is 94305.)
University leadership warned students against using test strips to check for fentanyl in drugs.
"These tests won't tell you how much nor how strong the fentanyl is. Even worse: The testing process can result in enough fentanyl absorption to hurt or kill someone," the administrators wrote in January.
"Our community continues to be at-risk for acute alcohol and drug related harms," they said. "Alcohol, marijuana, hallucinogens and vaping products are examples of drugs that create student emergencies every week at Stanford. At this moment, we must confront this dangerous concern head on."
They pointed to initiatives Stanford has launched in response, including adding an online educational module on prescription drugs, hosting forums with students about drug use and improving student drug screening.
They invited anyone interested in addressing this issue at Stanford to contact Senior Associate Vice Provost and Dean of Students Mona Hicks at firstname.lastname@example.org.
The Santa Clara County Sheriff's Office is continuing to investigate Weiner's death, according to Stanford.
Anyone with information about the case is asked to contact the Sheriff's Office at 408-808-4500 or the Sheriff's Office Investigative Services anonymous tip line at 408-808-4431.
Reporter Sue Dremann contributed to this story.