Cal Epstein was a freshman at the University of Hawaii. On a college break in December 2020, Cal came back home to Portland, Oregon. A few days later, Jennifer and Jon Epstein found their son unconscious in his bedroom. They started CPR and called an ambulance.

Cal was transported to the ICU. He was barely breathing. “The sheriff’s deputy said to us: ‘if you’re the praying type, you should start praying’,” Cal’s father Jon Epstein said.

The Epstein family, from left-right Miles, Jon, Jennifer and Cal (The Oregonian)

Cal did not make it. He was only 18.

Next to Cal’s body was a bag of small blue pills marked “M30”. Cal allegedly took what he thought was OxyContin –that he bought from a drug dealer on Snapchat. A few days later, he was pronounced dead at Providence St. Vincent Medical Center.

Yet, Cal knew the risks of over medication. “We later found in his Google search history that the day before he purchased the pill online, he had researched what OxyContin was and the thick dose for his weight.” Cal only took one pill. And yet he still died.

What Cal ingested was not an oxycodone pill. He swallowed a lethal dose of the painkiller that had been laced with fentanyl.

“Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine,” according to the Center for Disease Control and Prevention.

Only two milligrams of fentanyl, which equals 10 to 15 grains of table salt, is enough to be lethal. Cal did not stand a chance.

“You can’t beat it. You can’t outrun it,” Cal’s father said.

“He made a mistake. It used to be ‘kids made mistakes and learned from them’. With fentanyl, if you make a mistake, you die,” Jennifer Epstein said in a drug prevention video for the Beaverton School District.

Jon Epstein, Cal's father

It’s been three years. And the wound is still wide open. “Our family will never be the same and nothing we do will bring Cal back,” Jon Epstein said.

Cal’s story is one of many. The Drug Enforcement Administration is paying tribute to the fallen with an exhibit where bereaved families can display pictures of their loved ones lost to fentanyl.

“Fentanyl is the single deadliest drug threat our nation has ever encountered,” DEA Administrator Anne Milgram said in a press release. “Fentanyl is everywhere. From large metropolitan areas to rural America, no community is safe from this poison.”

Illicitly manufactured fentanyl pills are the most dangerous. They are cheaper and easier to produce in large quantities. Most of the street drugs and counterfeit pills seized by the Drug Enforcement Administration contain a deadly amount of fentanyl. “An estimated 6 out of every 10 counterfeit pills with fentanyl contain a lethal dose,” according to the DEA.

Cutting a drug with fentanyl is a technique used by drug traffickers to reduce their costs and make their final product more addictive. From heroin to cocaine to meth, not a single drug user is spared –which leads to accidental poisoning.

“We had talked about substance abuse with both of our kids regularly and we had talked about medicine safety. But we never talked about fentanyl," Jon Epstein said.

Flooded with fentanyl

For the past few years, accidental fentanyl failures have been skyrocketing in L.A., a report from the County of Los Angeles Public Health Department read.

Accidental overdose deaths soared 12-fold between 2016 and 2021, going from 109 to 1,504. Fentanyl-related visits to the emergency department increased 621% in the same time period, according to the report.

Courtesy of Cleveland CLinic

Ever since the wake of Cal’s death, the couple has been raising awareness about the dangers of fentanyl in counterfeit pills. “Everybody has a Cal in their life,” Jennifer Epstein said. “For me, getting the message out is something that I need to do in order to move forward, to know that I’ve done everything I can to honor Cal.”

The number of counterfeit pills containing fentanyl seized by law enforcement over the last few years went through the roof. It increased 33-fold between 2018 and 2021.

The couple has been rewarded by the FBI for their combat counterfeit pills distribution and drug prevention. In collaboration with the Washington County Sheriff’s Office they launched the “Fake & Fatal” campaign, about deadly fake pills.

A response from universities

But the lives lost to fentanyl could have been spared. In the war on fentanyl, universities have implemented harm reduction programs to try to avoid tragedies. USC has been spreading Naloxone reversal kits that are aimed to prevent death in case of an opioid overdose.

Naloxone is a FDA-approved opioid antagonist that blocks the effects of the opioid and reverses an overdose, when given in time. It can be injected into the veins or given as a nasal spray to restore normal breathing in a person who is overdosing.

In California, the Campus Opioid Safety Act went into effect on January 1, 2023. The bill requires community colleges, California state universities and regents of the University of California system to distribute an opioid overdose reversal medication like naloxone and provide training.

“There is an increase in requests for training on how to administer naloxone,” said Shannon De Leon, of the American Association of Psychiatric Pharmacists – USC chapter. “The people in charge of student housing want us to go to the student dorms and train the RAs in the event of an overdose.”

De Leon said that 300 blocks of kits were distributed to students alone in 2022. “From June 2019 to May 2020, there was a 38% increase in overdose deaths involving synthetic opioids, which include fentanyl,” she said.

Ed and Mary Ternan founded Song for Charlie in honor of their son Charlie lost to fentanyl

“No one should ever bring cocaine to a party without also bringing test strips. Anybody who lays out some cocaine in college and tries to test it in front of everybody is not ‘cool’. It doesn’t matter what the dealer told you: you don’t know where it came from, you don’t know whether it was contaminated. Ed Ternan, President of Song for Charlie, said.

Ed Ternan lost his son Charlie to fentanyl poisoning in 2020. Charlie was a senior at Santa Clara University in the Bay Area in California.

“There is an antidote for opioid overdoses. That’s a gift, that’s a miracle. And every single person on every college campus in the country, every fraternity, every sorority should have naloxone at the ready and should know how to use it.”

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Charlie Ternan

In May 2020, Charlie was found unresponsive in his room by his friends. He was a senior at Santa Clara University.

As it turned out, Charlie had purchased a Percocet online because his back was hurting. The pill was laced with fentanyl. Charlie died within 30 minutes. He never had a chance. Charlie was three weeks away from his college graduation.

He was 22.

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Madeline Globe

In 2017, Madeline was a senior at CU Boulder. She purchased what she thought was Xanax. The anti-depressant medication was laced with fentanyl.

The $5 pill ended her life in a couple of hours.

She was 21.

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Peter Jeske

Peter Jeske died of fentanyl overdose in 2021. The senior in finance at Indiana University had no history of susbance issues.

Exams were coming up. Peter decided to stay in and study instead of going out with his roommates. His family believes that he ingested a study drug like Adderall.

He was 22.

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Tiffany Iler

In May 2023, Tiffany Iler died of fentanyl poisoning. She was a pre-med neuroscience major finishing up her junior year at Ohio State University.

Tiffany had ADHD. Authorities believe that she purchased Adderall, a drug that has long been popular among students to stay up and cram for exams.

She was 21.

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Eitan Weiner

Eitan Weiner was a sophomore majoring in history at Stanford University.

In 2020, he was found dead at the Theta Delta Chi fraternity house after ingesting counterfeit Percocet pill.

Eitan’s family sued Stanford and TDX over alleged mishandling, negligence and inaction against the TDX fraternity.

He was 19.

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Ivan Aguirre

In 2019, Ivan Aguirre was found dead in his room at one of Arizona State University’s fraternity housings. He was starting his junior year.

Ivan died of mixed drug intoxication that included etizolam and fentanyl. Ivan’s death was the university’s first documented incident involving fentanyl.

He was 20.

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In an attempt to stem the surge of fentanyl-related overdose deaths, Santa Clara University has installed a free vending machine on campus that dispenses packs of Narcan naloxone nasal spray. A QR code on the machine provides a link to a training from the state Public Health Department on how to administer the spray.

“A very common misconception is that reversal kits encourage drug users to take more drugs,” De Leon said. “Our naloxone kit is designed for harm reduction, to lessen the negative social and physical consequences associated with these human behaviors.”

Harm reduction programs work in two ways. “The upstream work is to warn young people and give them enough information and tools to stay away from this,” Ternan said. And the downstream work is the Narcan.”

Are harm reduction programs enough to combat the opioid crisis?

According to Ternan, it seems that three stakeholders are involved in the drug conversation: the harm reduction, and the supply and demand groups. “It’s primarily a supply and demand problem,” Ternan said. It’s a business issue. People who are causing this harm are in it for the money. So I think it’s time to update the war on drug framing because they’re not trying to kill us, they’re trying to profit from us.”