A1 6 eZ re the washington post.saturday, february 22 , 2020
with fentanyl, which delivers an
immediate, powerful high but
can also render the user uncon-
scious and unbreathing almost
instantly.
“I’ve never seen so many peo-
ple die,” said Chris, a young man
in a hoodie standing near Eighth
and market streets in an area
with open drug use. He did not
want to give his full name because
of concerns about trouble with
law enforcement. He s aid he takes
fentanyl and meth and has been
on drugs for 15 years. He spoke in
a light pre-dawn rain while, just a
few feet away, young people stood
at a bus stop waiting to board
buses to technology companies in
other locations in Silicon Valley.
Chris was engaged in conversa-
tion with a man named Brian, 29,
who had been sitting unsheltered
in the rain, leaning against a
fence. Brian said he lives outside
and prefers to do so. He said he’s
been using meth for 10 years.
Neither Chris nor Brian is inter-
ested in seeking drug treatment.
“It’s like a 24-hour party out
here,” Chris said.
“That’s such a bougie com-
ment,” Brian said.
The use of drugs in public and
the burgeoning homeless popula-
tion are sources of dismay for
many of the more affluent resi-
dents of the city. Harm reduction
activists believe that the law en-
forcement focus on impoverished
and homeless drug users is unfair
given that wealthy people often
use drugs without repercussions.
“People are interested in open-
air drug dealing because it’s visi-
ble to people and makes our city
look bad,” s aid Kristen marshall, a
harm reduction worker who dis-
tributes naloxone to drug users.
She noted that thousands of
overdoses have been reversed by
peers on the street who were
supplied with naloxone as part of
harm reduction efforts. for many
years, San francisco saw a grow-
ing population of drug users but
had a strikingly low rate of fatal
overdoses. But that was before
fentanyl showed up.
The statistics of drug use and
overdoses do little to capture the
gritty reality of life on the down-
town streets of San francisco. The
drug use is in plain sight in the
Te nderloin and the South of mar-
ket neighborhoods. one morning
on market Street recently, a
young man in a hoodie was bent
over at a bus stop in front of a
hotel, injecting himself with a
needle. He h ad slit both pants legs
to improve access to his legs. one
leg was bleeding. He l ooked dazed
as he stood up, and did not re-
spond when asked his name and
whether he needed assistance.
Asked again whether he was
okay, he looked puzzled and said,
“I feel like there’s something alive
in my b ody and I don’t k now what
it is.”
[email protected]this problem,” s aid Eliza Wheeler,
a leader in the harm reduction
community.
Paul Harkin, director of harm
reduction at GLIDE, a multi-
service social center, pointed out
that testing kits, including chemi-
cally treated strips similar to
pregnancy tests, could help users
know what’s in their drugs and
help them avoid overdosing. “Un-
fortunately, America is very puri-
tanical. We have to decriminalize
in the way Portugal did, and we
have to do drug testing so we
know what’s in the drug supply,”
he said.
That’s particularly a problemKral works on harm reduction
— an approach that provides peo-
ple with tools and support to limit
the negative consequences of
drug use.
Harm reduction advocates em-
phasize that the overdose crisis is
driven by social factors, including
economic inequality, the housing
crisis that is tied to a rise in
homelessness in San francisco,
systemic racism and the criminal-
ization of drug use. They say the
overdose epidemic should be
treated as a matter of public
health and not as a law enforce-
ment issue.
“The war on drugs has createdoverlaps to a great degree with
the homeless population — an-
other relatively new develop-
ment, according to Alex Kral, an
epidemiologist at rTI Interna-
tional, a nonprofit research firm.
Kral said that 15 years ago, he
rarely saw people on the street
injecting drugs, and estimated
that only about a quarter to one-
third of people injecting drugs
were homeless. Now, he said, up-
ward of 75 percent are.
And even the most experienced
users of heroin can be fooled by
fentanyl: “If you’re a new user of
fentanyl, you don’t even know
necessarily how much to take.”last year launched a program to
target d rug dealing in the Te nder-
loin district, leading to indict-
ments of more than 100 people.
“If you cause an overdose
death, we will put you in jail for 20
years — federally,” Comeaux said.
He acknowledged that there is
rampant drug use right outside
his office, but said the federal
response has made it harder to
buy drugs.
“Now you might have to walk
three blocks to buy heroin,” he
said. “If we didn’t do what we’re
doing, you would be able to buy
that heroin in one block.”
The drug-using populationence.”
But the provisional CDC statis-
tics released last week, which
include estimated underreport-
ing of deaths by medical examin-
ers, show a slight uptick in fatal
overdoses nationally over the first
half of 2019.
In California, fatal drug
o verdoses over the previous
12 months increased 13.4 percent
between July 2018 and July 2019,
the last month for which the CDC
has compiled provisional data —
an additional 728 deaths.
In contrast, Illinois’ fatal drug
deaths were down 8 percent,
Pennsylvania’s down 10 percent,
michigan’s down 13 percent and
maine’s down 20 percent.
The overdoses in the West are
driven largely by opioids, particu-
larly illicit fentanyl, a synthetic
drug that is roughly 50 times as
powerful as heroin. fentanyl has
finally arrived in force in the
western United States. Because
fentanyl is so potent, and its dos-
age so easily miscalibrated, it is
killing people who previously had
managed their addictions for
years.
Historically, the West Coast
opioid market has been dominat-
ed by black tar heroin, a gunky
substance not easily mixed with
white powder fentanyl. That’s the
orthodox explanation for why
fentanyl first became popular in
the eastern United States, where
white powder heroin has histori-
cally been favored and drug deal-
ers could more easily blend fenta-
nyl and heroin.
fentanyl started becoming
more common here around 2015.
The medical examiner’s latest,
provisional numbers tell an
alarming story: Deaths in San
francisco from fentanyl and/or
heroin jumped from 79 in 2017 to
134 in 2018, and then more than
doubled to 290 in 2019.
People are dying from other
drugs as well, with a large spike in
deaths linked to the potent stimu-
lant methamphetamine. Efforts
to cut off access to meth precur-
sors sold in pharmacies have
helped shut down local meth labs
like the ones made famous in the
TV show “Breaking Bad.” But that
opened a new market for the
mexican drug cartels, said Daniel
Comeaux, special agent in charge
of the Drug Enforcement Admin-
istration’s San francisco division.
“You have no mom and pop
labs anymore because so much is
coming from the mexican car-
tels,” Comeaux said in an inter-
view in his office in the heart of
the Te nderloin district. “A s much
as we’re seizing, they’re produc-
ing.”
Comeaux said the DEA re-
mains aggressive in targeting
i llicit-drug wholesalers.
“Look, we’re putting people in
jail,” Comeaux said. The agency
deaths from a
Fentanyl moves west: ‘I’ve never seen so many people die’
Photos by nick otto for the Washington PostCLOCKWIse FROM tOP: daniel Comeaux, special agent in charge of the dea’s san Francisco division, whose agency last year launched
a program to target drug dealing in the city’s tenderloin district. Paul harkin of GLIde, right, prepares a bag of harm reduction supplies
to hand out to drug users on the streets. a drug user looks at a package of the anti-overdose medication naloxone given to her by harkin.BY CHRISTOPHER INGRAHAMKorean director Bong Joon-ho’s
“Parasite” i s a dark parable about
the yawning gulf between the rich
and the poor in South Korea. It’s a
story of a society where those in
the working class have no hope of
attaining a better life and instead
squabble among themselves for
the l iteral scraps of prosperity cast
off by the wealthy as they move
serenely through their charmed
lives.
The film and its message have
strongly resonated with American
audiences: Last week, it won best
picture at the Academy Awards,
prompting a confused President
Trump to ask “What the hell was
that all about? We’ve got enough
problems with South Korea with
trade, on top of it they give them
the b est movie of the year?”
Nevertheless, Americans’ em-
brace of “Parasite” probably isn’t
an accident: By any number of
measures, inequality here is
much, much worse than in Bong’s
South Korea.
According to the World Inequal-
ity Database, an authoritative re-
source on income and wealth
around the world, the top 1 percent
of South Koreans own about
25 percent of the nation’s wealth,
while the bottom half of the popu-
lation owns just under 2 percent.
Think of it this way: If South
Korea were a country of 100 peo-
ple and its wealth a pie with 100
slices, the richest person would
get 25 slices of that pie all to
himself, while the poorest 50
would have two slices to split
among them. That disparity is at
the h eart of “ Parasite.”
But i n the United S tates, r eturn-
ing to the pie analogy, the richest
American gets a w hopping 39 slic-
es while the bottom 50 don’t have
any. I n fact, they a re a ctually in pie
debt, collectively owing a tenth of
a slice to their creditors (most of
whom, incidentally, are probably
in that top 1 p ercent).
Looking at income, rather than
wealth, paints a similar picture:
The top 1 percent of South Kore-
ans earns about 12 percent of the
national income, while in the
United States that figure is more
than 20 p ercent.
It’s worth noting that other
sources of inequality data, such as
the federal reserve, give slightly
different figures for these break-
downs, owing to the different
ways you can calculate the distri-
bution of a nation’s wealth. The
reason I’m using the World In-
equality Database’s data is that it
allows for r elatively e asy compari-
sons between countries.
Though the situation in South
Korea is indeed dire, at least the
bottom half owns something of
value. In the United States, thebottom 50 percent have literally
none of the n ation’s w ealth and, i n
fact, have a negative net worth.
That’s a relatively new phenome-
non: As recently as the late 1980s,
the bottom half of Americans
could claim several percent of the
country’s wealth as their own.
As many economists have not-
ed, g rowing inequality i n the Unit-
ed States is no accident but rather
the direct result of policy deci-
sions made by lawmakers and
their w ealthy a llies in the business
community. As t he U nited Nations
recently put i t in a report on global
inequality, “People in positions of
power tend to capture political
processes.” The wealthy use their
power to write rules that allow
them to accrue more wealth.
There are many similarities be-
tween the e conomies o f the UnitedStates and South Korea. Both na-
tions are members of the organi-
zation for Economic Cooperation
and Development, which is a sort
of international club of the w orld’s
most prosperous countries. Like
the United States, South Korea
enjoys a low unemployment rate,
with annual gross domestic prod-
uct growth in the range of 2 to 3
percent. Also like the United
States, South Korea provides a
stingy social safety net relative to
other wealthy nations.
But there are big differences.
South Korea provides universal
health care — something many
economists and public health ex-
perts have identified as a key tool
in the fight against poverty. It also
provides more support for work-
ing families: New parents can
claim up to 40 weeks of paid leave(American parents, by contrast,
are guaranteed nothing). It also
provides universal early-child-
hood education, something lack-
ing in the U nited States, and subsi-
dizes child care for children
younger than 3.
on the revenue side, South Ko-
rea collects higher taxes on corpo-
rate profits than the United States
does. South Korea also collects
four times as much revenue (as a
share o f GDP) from e state, gift and
inheritance taxes as the United
States does. Those taxes have the
potential to be a powerful correc-
tive to r unaway i nequality.
overall, it’s not difficult to
imagine that if the United States
had similar social programs and
collected a similar level of corpo-
rate and estate taxes, the distribu-
tion of wealth here would be simi-
lar t o that in S outh Korea.
None of this is to minimize the
extent o f inequality experienced b y
South Koreans. A number of fac-
tors make the country’s economyunique, and potentially uniquely
miserable f or those living at i ts low-
er end. The economy developed
rapidly after the Korean War, one
consequence of which h as been dis-
parate outcomes between larger
and smaller businesses. Youth un-
employment is high, with a grow-
ing sense among the young that “no
matter how hard people try, they
remain stuck at the bottom of the
social ladder,” a ccording to Choong
Yong Ahn of South Korea’s Chung-
Ang University.
That frustration with a rigid hi-
erarchy is at the heart of Bong’s
film, and its reception in the Unit-
ed States nevertheless suggests
that many Americans find they can
relate. As the director said last
year, “The film talks about two
opposing families, about the rich
versus the poor, and that is a uni-
versal theme, b ecause w e all live in
the same country now: that of capi-
talism.”
christopher.ingraham
@washpost.com‘Parasite’ paints grim image of Korean inequality. U.S. inequality is worse.
kim hong-Ji/agence france-Presse/getty images
“Parasite” director Bong Joon-ho, left, whose film won four Oscars, attends a luncheon with south
Korean President Moon Jae-in at the presidential residence in seoul on thursday.Source: World Inequality Database THE WASHINGTON POSTTwo wealth gaps
Share of national wealth among top 1 percent and bottom 50 percent of
adults in the United States and South KoreaTOP 1% U.S.0%10%20%30%40%2000 2014TOP 1% S.K.BOTTOM 50 % S.K.BOTTOM 50 % U.S.38.6%25.0%1.8%-0.1%