Fentanyl epidemic: Riverside county using partnerships, prevention to attack overdoses

According to 2019 data provided by the San Diego County Medical Examiner's office and a report from the county, "unintentional fentanyl overdose deaths in the San Diego region increased by 68% when comparing this year's midyear data with the same period for 2018. ... from January through June this year, there were 69 fentanyl deaths compared to 41 in the first six months of last year."

"In the last decade when someone overdosed on fentanyl, it was often when someone was prescribed it, and perhaps put on too many fentanyl patches or altered the patches," Dr. Steven Campman, chief deputy medical examiner for the county, said. "I can't even remember the last time I saw a death from misused prescribed fentanyl.

"Now, in the deaths we see, the fentanyl is illegally obtained as counterfeit oxycodone or alprazolam. Illegal drug makers and dealers make pills to look like oxycodone or alprazolam, but the pills have fentanyl in them, and they are deadly," he said.

There were 92 deaths related to fentanyl in 2018 up from 84 in 2017, according to the San Diego County Medical Examiner's Office. In 2016, 33 deaths were reported and 12 fewer in 2015.

Starting in 2014, the San Diego County Sheriff's Department began putting Narcan (Naloxone) into patrol vehicles. The SDSO administered the antidote 78 times since then – 23 times in 2018, 26 times in 2017, 16 in 2016 and 13 in 2015.

In September 2019, the county announced it was to be a beneficiary of a $1.8 billion national push by the federal Department of Health and Human Services to combat opioid addiction and deaths.

The county was one of 16 counties in the nation awarded grants and San Diego was to receive $6.5 million over three years.

The San Diego District Attorney's office in February announced they were planning to launch a digital outreach campaign dealing with what they said in a news conference was an opioid epidemic in San Diego County.

The San Diego Opioid Project was to hopefully reach vulnerable demographics through social media platforms such as Instagram, Facebook and YouTube. A website has also been established at http://www.sandiegoopioidproject.org.

Currently, there are no updated statistics for San Diego County regarding fentanyl-related deaths, and the outbreak of the COVID-19 virus means county health officials have their hands full at the moment.

If what Riverside County is facing is similar, then the rise in the number of deaths occurring in the county is rising at a similar rate.

In 2016, there were 10 overdoses related to fentanyl in Riverside County, a synthetic opioid that is 80-100 times stronger than morphine.

In 2017, that number grew to 28 overdose deaths. In 2018, there were 53.

In 2019, according to numbers still being calculated by the Riverside Overdose Data to Action team assembled by Riverside University Health System – Public Health, 122 could be attributed to the inclusion of fentanyl in overdose deaths.

"In terms of specifically for fentanyl, it's really scary," Wendy Hetherington, chief of epidemiology and program evaluation/vital records for Riverside Overdose Data to Action at RCPH, said. "If you look at our fentanyl overdoses, we had five, maybe, a year since 2013 and then starting in 2015 the number of fentanyl overdoses doubled. Then, 2019, our most recent year, it pretty much skyrocketed."

Hetherington leads the team of Brian Gray, Dianne Leibrandt and Erin Curlee at Riverside Overdose Data to Action which provided a report regarding overdose deaths for this story.

Hetherington said that in 2019, RCPH received a $2.3 million Centers for Disease Control and Prevention grant, Overdose Data to Action, to improve fatal and non-fatal overdose surveillance and use the data to guide prevention efforts.

"We started this program and then we started actually looking at overdose stats specifically," Hetherington said. "And one of the activities in this grant is we're partnering with the Riverside County Sheriff's coroner's office, and we actually have a Riverside County sheriff's employee that's co-located in my office here in public health and he helps us get data from the coroner's office.

"Previously our only source of data for overdose deaths in public health was from death certificates and what the information is on death certificates. But unfortunately, on death certificates, not all toxicology is listed. And you may, we may miss out on some of what people are actually dying of the cause of death is oftentimes listed as, as multi-drug toxicity without any sort of specifics about what drugs led into that," she said.

According to the report, fentanyl-involved overdose deaths increased from four in 2013 to 122 in 2019. Of the 122 deaths, 23% involved fentanyl only. The remainder included at least one other substance. Fentanyl-involved overdoses were more likely to be younger with a median age of 34 versus 51 years old and non-white compared to non-fentanyl overdoses. The team reported that fentanyl-involved overdoses were less likely to inject drug use and less likely to be homeless.

Basically, most of the deaths associated with fentanyl are people under the age of 45, she said.

"I would say about half of the fentanyl overdoses are in the 25 to 44 age group," Hetherington said in a phone interview. "Then about a quarter are in the 15 years old to 24 age group. And then a quarter is in the 45 to 64. It's very rare to see someone older than 64, 65 for an overdose with fentanyl involved. Which is different from our other overdoses because non-fentanyl overdoses or just, in general, all overdoses in Riverside County, the No. 1 drug involved is methamphetamine. For Riverside County, over 50% of our overdoses are methamphetamine.

"So far for 2019, meth-related overdoses, we've had 228," she said. "For fentanyl, we had 122. Some of those are not exclusive categories. About 30 of those meth overdoses included fentanyl. In terms of prescription opioids not including fentanyl, just prescription opioids with no fentanyl, we had 77 in 2019."

Those numbers are expected to increase on all fronts.

"It's really scary," Hetherington said. "My biggest concern is that it's going to get really into our meth because, as I said, most of our addiction issues and overdoses are meth-related and once it's super ingrained in meth, that may cause a big problem."

April Marier, services administrator for the substance abuse prevention and treatment programs for Riverside University Health System – Behavior Health department, is one of many who are on the front lines of dealing with addiction countywide.

"When we think of drug addicts, many people commonly picture someone being on the street, having a bad appearance, living a life with a lot of disruption and difficulties," Thomas Peterson, senior public information specialist at RUHS – BH, said. "And one thing that is different about the opioid epidemic, it is more suburban. It seems to be landing more in suburban, upper-middle-class and white communities, which is the opposite of what many might think about drug addiction. I hope this series of articles can encourage more discussion and promote understanding about opioid addiction and the more general topic of substance abuse and recovery."

Marier said she recently presented on the subject at a library in Beaumont. 

"I asked the community members, what did they think of when they think of the opioid addict?'" she said. "Everybody thinks of the homeless person on the street. We had a 50-year-old soccer mom who was in recovery from opioids come and speak to them. It wasn't who they expected to see. 

"One of the things that our recent data has shown is the rise of opioid addiction in the older adult population. The aging process can often be accompanied by injuries and chronic aches and pains which may be treated using prescription opioid medications. Without careful monitoring and supervision, dependency and addiction can occur. It becomes a challenge of trying to avoid addiction and still manage the pain," Marier said.

Fentanyl is now being mixed into Xanax, Oxycontin and other opioids in the illicit street drug market.  It makes addiction to those types of drugs even more dangerous. 

"When somebody uses opioids and benzodiazepines, it creates a greater risk because it can affect their respiratory system," Marier said. "Mixing medication and opioids across the board has become one of our biggest challenges."

Marier said Riverside County has made significant changes to be able to respond to the epidemic. As of Feb. 1, 2017, Riverside County implemented the Drug Medi-Cal Organized delivery system or DMC.

"DMC changed our treatment opportunities," Marier said. "We're able to provide intensive outpatient treatment and broadened recovery services, which also includes aftercare. DMC can also cover residential treatment and detox, which had not been previously covered. And the number of residential and detox providers has increased over the past three years. We are serving many more people than we used to."

The county has also created a "SU CARES" line for Riverside County residents only at (800) 499-3008.

"When we first implemented the SU CARES line, we got about 240 phone calls a month," Marier said. "We're up to 6,000 calls a month now."

The San Diego Opioid Project suggested people looking for resources in the county should call San Diego Access and Crisis Line at (888) 724-7240 for free assistance any time or day of the week.

Editor's note: This is the fifth in a series of stories pertaining to fentanyl and the fatal risks associated with the drug and its effects on the community. Village News is speaking to people on the front lines of this epidemic.

Jeff Pack can be reached by email at [email protected].