San Diego County looks for solutions as fentanyl deaths continue to rise
Speaker 1: (00:00)
Fentanyl is a deadly trifecta. It's cheap. It can be easily disguised as a different drug, and it's 50 times more potent than heroin. And the numbers show the challenge. Health officials face fentanyl overdoses have more than quadrupled in San Diego county since 2018 K PBS's Katie Stegel has the story.
Speaker 2: (00:22)
There really is no safety net out here on the streets. Emmy McLarty survived, homelessness and addiction, and she wanted her best friend, Josh Palmer, to be able to say the same, but each push from her was met with an empty promise. He wasn't ready to get clean. Her last words to him were that she'd see him later. There was always
Speaker 3: (00:41)
Is gonna be a see you later always was supposed to be a see you later. And, um, I'm not gonna see
Speaker 2: (00:49)
Him later. Palmer died of a fentanyl overdose in March on the steps of the fraternal order of Eagles. Just off the bustling university avenue in Hillcrest data from the San Diego county medical examiner's office, I was at least 446. People died in 2020 with fentanyl in their system. That's four times higher than in 20 18, 9 months into the year. And already more people have died with fentanyl in their systems than last year. By the end of August, 2021, at least 534 people have died with fentanyl in their system. Even more people are expected to die by years end says Dr. Luke Bergman, he's the director of San Diego county's behavioral health services.
Speaker 4: (01:32)
It's really hard to say when you know, the epidemic curve is gonna turn. Um, we are continuing to see increases. It's very difficult to, to control supply, right? Particularly with fentanyl because it's so strong. It's odorless, it's colorless. It's very easy, um, to transport as an illicit narcotic, it's very easy to hide in other substances because of that. So it, it represents a, a
Speaker 2: (01:57)
Challenge with the disheartening truth is these deaths are mostly avoidable because the anti Naloxone is easy to access. But misinformation about the drug and stigmas about addiction, prevent people from helping someone who's overdosing. So says Dr. Ryan Marino, a Cleveland based addiction, medical specialist,
Speaker 5: (02:17)
People don't deserve to suffer, die, anything like that, just because, because they use drugs. Um, and, and so to me, this is just more stigma that, that kind of hurts people with, with substance use disorders and addiction, and even people who just casually use drugs, um, and prevents them from getting appropriate treatment.
Speaker 2: (02:36)
Misinformation can also impact the loved ones of those who die of fentanyl overdoses. Diane hodgkis lost her husband to a $15 hit of fentanyl in 2019, but she says the man she knew was already gone when he died. I realize though he was too far gone. His personality was gone when her husband overdosed, hoki vividly remembers calling 9 1, 1, hoping paramedics could help. They were the ones
Speaker 6: (03:02)
That let me know, like, Hey, you have a one year old here. Like if he touches it, he will die. Instantly.
Speaker 2: (03:08)
She and Dominic left their home. The day Derek died and never returned. Marino said the team did not have the correct information. Any, any drugs,
Speaker 5: (03:17)
I mean, near an infant can be problematic. Um, but it, it's not something that is gonna get into your body unless you are injecting or snorting it, uh, it, it doesn't just cross through the skin. It isn't just getting into the air.
Speaker 2: (03:31)
Since the democratic majority took over the board of supervisors, Bergman with the county says they've shifted their treatment methods toward a model to reduce the likelihood of harm for drug users that can include Naloxone clean tools to inject with primary care shelter and showers.
Speaker 4: (03:50)
The spirit of it is getting people what they need and what they want. Uh, even if they're not, uh, in a particular moment able to commit to, uh, uh, a trajectory towards abstinence.
Speaker 2: (04:09)
Those changes came too late for people like Josh Palmer and the hoki family, whether they make a dent in the number of overdoses in future years remains to be seen.
Speaker 1: (04:20)
Joining me is KPBS investigative research, assistant, Katie Stegel and Katie, welcome to the program. Thank you for having
Speaker 2: (04:27)
Speaker 1: (04:28)
You outlined the increase in fentanyl related deaths in San Diego in 2020 and the first part of this year, but you used the phrase that the people died with fentanyl in their systems. So our are, these deaths actually caused by fentanyl overdoses.
Speaker 2: (04:44)
So with the way that the data is structured, that the county medical examiners gave us, there's a thing called the cause of death string, which essentially shows us in order what the most prevalent drug was in the person who died, the actual pure or fentanyl death with nothing else in their system only happened about 54 times in the three years. But there's a lot of times where this drug is either mixed with, or, uh, you'll hear the word cut with something else. Um, so fentanyl was prevalent in, um, like say like the top one, two or three chemicals in the person system. But I wanted to use that wording specifically because there's, there's a lot of times where you'll have people using say like meth with it, or there's alcohol in their system, or cocaine or heroin in their system as well.
Speaker 1: (05:38)
So it's possible people are using fentanyl, but they don't know it because it's disguised in other drugs. Is that
Speaker 2: (05:43)
Right? Exactly. Yes.
Speaker 1: (05:45)
What are some of the theories as to why fentanyl related deaths increased so dramatically during the pandemic?
Speaker 2: (05:52)
I heard a lot of different theories while I was reporting on this. Actually there's some that have to do with say the border being shut down and the drug supply being impacted. But the one I want to really hone in on is the fact that the pandemic encouraged isolation and isolation is one of the worst things that you can have with drug use. Because say example, you're using in an apartment alone by yourself and you overdose. There's no one there to help stop that overdose.
Speaker 1: (06:25)
And I wanna speak more about the antidote. You mentioned in your report, the substance popularly known as Narcan. How is that administered? There's two
Speaker 2: (06:36)
Ways that there's a, the brand name for it is Narcan, but the technical name for it is Naloxone. And that can be distributed. One of two ways. You can either use the, the nasal spray, which is where you see Narcan the most. There's also, um, an injection like with a needle, a syringe, and you'd shoot it into their muscle.
Speaker 1: (06:55)
So how effective is it in bringing P people out of overdose?
Speaker 2: (06:59)
So while it's not a hundred percent effective, there are studies that show that it's at least 93% effective.
Speaker 1: (07:06)
I think the most mind boggling aspect of this story is the myth that's grown around. Fentanyl that it's dangerous to touch or breathe the air around the substance. Why do people think that?
Speaker 2: (07:18)
So I actually asked one of the experts, um, a similar question when I was talking to him and he essentially was telling me that we see this pattern within drug history, essentially where people, if they don't understand the drug, they're extremely afraid of it. That's kind of, that's a normal human reaction, right? If we don't understand something. So there was an expert that I was talking to that used an analogy, and he compared it to the HIV and aids epidemic with this aids reference that he used. It showed clearly how we as a society, tend to stigmatize what we don't understand. And since drug use is already. So stigma ties as is. It makes sense to me that the fentanyl would currently be the modern day boogieman of drug use.
Speaker 1: (08:08)
There was a controversial video released by the San Diego Sheriff's department about the contact effects of fentanyl. Can you remind us about that? Yes.
Speaker 2: (08:19)
So this video essentially was released as a PSA and it was showing one of their rookie sheriff deputies overdosing. What, what we believed to be an overdose on fentanyl, he's shaking and the man's clearly not responsive. And it looks like he's, um, like he's struggling to breathe. And the Sheriff's put this video out as basically a way to warn about the dangers of fentanyl. However, they didn't actually consult any medical professionals on this. And the story went viral incredibly quickly. Uh, medical experts across the country were saying that this was inaccurate and it was misinformation. Sheriff's department eventually admitted that they did not consult any medical professionals on this story, but they never actually took the video down, even though they said they did. The video currently has over 5 million views on YouTube.
Speaker 1: (09:12)
You know, since this drug, fentanyl is so pro to causing overdose, do San Diego health officials expect its use to decline as the pandemic eases up in the coming months?
Speaker 2: (09:23)
Unfortunately it looks right now, like fentanyl is not going anywhere. So even though we're kind of in the decline of the pandemic, the county, doesn't see how they're going to, to combat this uphill battle. Right now.
Speaker 1: (09:38)
I've been speaking with KPBS, investigative research assistant, Katie St. Katie. Thank you. Thank you.
Emmy McLarty was desperate to get her best friend Josh Palmer sober and off the streets. She had gotten sober herself and found housing and she wanted the same for him.
McLarty asked Palmer whenever she saw him if he was ready to start the journey towards a new life. He always declined, but promised she would be the first to know when it was time.
The last time they had this conversation in March 2021 was also the last time she saw him.
Palmer died of an accidental fentanyl overdose a week later.
He is one of the hundreds who have died from the highly addictive drug in San Diego County since the beginning of the pandemic.
Data from San Diego County Medical Examiner’s office shows fentanyl overdoses in 2020 are more than four times higher than 2018, with at least 446 people dying in 2020 with the drug in their system.
“We anticipate seeing as many as 1,200, maybe more, deaths across the county as a result of unintentional drug overdose in 2021. We are up against a challenge, the ceiling of which we don't understand.”
What's more, in the first nine months of 2021, more people have died with fentanyl in their systems than last year: at least 534 people as of the end of August 2021. Even more people are expected to die by year’s end, said Dr. Luke Bergmann, the director of San Diego County Behavioral Health Services.
“We anticipate seeing as many as 1,200, maybe more, deaths across the county as a result of unintentional drug overdose in 2021,” he said. “We are up against a challenge, the ceiling of which we don't understand.”
The increase in overdose deaths is a trend researchers are seeing nationally as well. According to The New York Times, more than 100,000 people died of drug overdoses within the first 12 months of the pandemic. That’s 30% more than the previous year.
Fentanyl is a deadly trifecta — it’s cheap, it can be easily disguised as a different drug and it’s 50 times more potent than heroin, according to experts. And the disheartening truth is fentanyl-related deaths are mostly avoidable, said Dr. Ryan Marino, a Cleveland-based addiction medical specialist.
That’s because fentanyl’s antidote is easy to access. Naloxone, an opioid overdose medicine commonly known as Narcan, can be bought over the counter for as low as $20. But people are afraid to give people Narcan because they don’t want to touch someone suffering an overdose, which compounds on other stigmas that drug users face, Marino said.
“People don't deserve to suffer or die or anything like that just because they use drugs,” he said. “And so to me, this is just more stigma that kind of hurts people with substance use disorders and addiction. And even people who just casually use drugs, it prevents them from getting appropriate treatment.”
In San Diego County, white people were overrepresented in fentanyl overdose deaths in 2020. About 61% of the people who died were white, whereas 49.5% of the county is white, according to U.S. Census data. Meanwhile, 18% of the people who died were Hispanic, 11% were Black and 3% were Asian or Pacific Islander.
McLarty doesn’t know if anyone saw her friend Palmer and tried to help him during his overdose. He died on a staircase outside of the nonprofit Fraternal Order of Eagles, mere feet away from the bustling University Avenue in Hillcrest. McLarty said she didn’t know what the last minutes of his life were like, but hopes he wasn’t alone because people were too afraid to help him.
“Because I think that is most people's absolute worst nightmare come true,” she said.
Marino said misinformation about the danger of touching fentanyl can sometimes stop people from helping others.
In July, the San Diego Sheriff’s Department released a video about a rookie deputy falling to the ground and struggling to breathe after handling fentanyl while wearing a mask and gloves. The department later said the overdose claims were not verified by a medical professional.
Marino said bystanders are not at risk of absorbing fentanyl through the skin.
“But for whatever reason, over the past few years, fentanyl has kind of taken on this boogeyman personality,” he said.
This misinformation can also impact the loved ones of those who die of fentanyl overdoses. Diann Hotchkiss lost her husband Derrick to a $15 hit of fentanyl in 2019. Derrick was sober when they met. He had admitted to struggling with addiction years prior, but Hotchkiss said the man she fell in love with had a large and consuming presence who always made sure to care for those he loved. This changed when he started using fentanyl shortly after their son was born.
When her husband overdosed, Hotchkiss vividly remembers calling 911, hoping paramedics could save her husband.
Instead, emergency responders came in and told her she needed to immediately evacuate the family home. She was told their backyard, car and the home office had tracings of fentanyl that could have killed her and her son, Dominic. She and Dominic left their home the day Derrick died and never returned.
Marino said the team did not have the correct information.
“Any drugs near an infant can be problematic, but it's not something that is going to get into your body unless you are injecting or snorting it,” Marino said. “It doesn't just cross through the skin. It isn't just getting into the air. And unfortunately, we've seen a lot of these law enforcement agencies have used hazmat and have used a lot of the PPE that we didn't have for the pandemic on these situations where it is chemically and physically impossible to be such a concern.”
Changes at county
San Diego County’s Behavioral Health Services department has shifted its methods for treating the rising fentanyl epidemic after the new Democratic majority took over the Board of Supervisors, said Bergmann.
Now the county is focusing on harm reduction, an alternative drug use treatment plan that focuses on human behavior and societal impacts of drug use instead of the punishment or incarceration route, he said. A common example of this is providing clean needles to users to reduce the spread of disease.
“It's extremely important that we get them resources to reduce the likelihood of harm,” Bergmann said. That can include Naloxone, clean tools to inject with, primary care, shelter and showers.
“The spirit of it is getting people what they need and what they want, even if they're not in a particular moment, able to commit to a trajectory towards abstinence,” he said.
The county has also created Community Harm Reduction Teams to help with harm reduction, specifically for the homeless community. Bergmann said the teams are only in the city of San Diego for now, but they are working to make it a county-wide initiative.
“We're doing everything we can to make sure that people are getting access to the formal clinical care that we do know over the long haul reduces the likelihood of overdose, death and other harms associated with substance and misuse,” Bergmann said.
Diann Hotchkiss’ husband died before these changes had the chance to make an impact and before the pandemic hit. She worried his mental health would have pushed him towards the drug if he had lived through COVID-19.
“I also believe that if he had gotten clean, he wouldn't have survived the pandemic,” she said. “I think he would have relapsed.”