S1: Welcome in San Diego , it's Jade Hindman. On today's show , what's working and what still needs to be done as overdose deaths decline. And research now points to a connection between social media and depression in kids. This is KPBS Midday Edition. Connecting our communities through conversation. For decades , overdose deaths led by opioid abuse have been rising across the country. In fact , over the last few years , those deaths spiked to more than 100,000. But that trend is changing. Something is finally working because for the first time , the U.S. is seeing its steepest drop in overdose deaths , down 27% in 2024 compared to the previous year. San Diego County says it's seeing the same trend. So my panel of guests joined us to talk about the advancements in substance abuse treatment that are saving lives. Doctor Shayan Parvin is San Diego County's public health officer. Shayan , welcome to midday edition.
S2: Thank you. Jay.
S1: I'm also joined by Doctor Eric Berg. He is assistant medical director from the county. Eric , thanks so much for being here.
S3: Thank you for having me.
S1: And finally , Doctor Jim Dunford is here. He is the medical director with the McAllister Institute , which runs many substance treatment programs here in San Diego. Jim , welcome back to Midday Edition.
S4: Thanks for having me.
S1: So , Sayan , you just started in your role as the county's public health officer.
S2: Jade. Yes. And even though I just started , I've been working in this space with my colleagues here for years. Um , right. We recognize this pattern. Back when I was the deputy public health officer , and I came to San Diego in 2015 that overdoses were increasing. And then there was this new substance , fentanyl , which was really getting into and permeating into our drug supply locally. So and we saw those increasing numbers of deaths and we did things like we started the first naloxone distribution program , really getting the word out around this life saving medication that we know has done so much to really reverse the epidemic and the fatalities and non-fatal overdoses from happening. So so we've been monitoring , tracking , and I'd say probably the best thing we've been doing is building a coalition of individuals and groups , you know , from interested affected parents to public health and public safety entities , and really just working across collaboratively on on solutions , getting awareness and getting the word out about things like naloxone , but not only about naloxone and just as importantly , really reducing stigma for those people who are impacted so that people are more comfortable and open in terms of talking about their substance use and then hopefully seeking treatment at places like McAlester. Wow.
S1: Wow. I know naloxone for sure has been really important to this as well as collaboration , and I'm going to get to all of that. But Eric , tell us more about these numbers here in San Diego County specifically. Right.
S3: Right. Um , so really , 2024 marked a big turning point in , in the drug overdose epidemic across the country , in California and in San Diego , um , in 2024 , we saw a 28% decrease in overdose deaths in San Diego County. So that was better than the state , better than the country as a whole. Um , so it tells us what we're doing here in San Diego is working. Um , still way too many deaths. So we're still talking about 80,000 deaths across the country due to drugs in 2024 , 812 deaths in San Diego County in 2024 for drugs. So really , you know , we're talking about multiple people every single day , so the numbers are still way too high. We should be celebrating the progress we've made , but we still have a lot of work to do.
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S3:
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S5: I mean , it's 50 times more potent than , you know , traditional narcotics. Therefore , its ability , number one , to stop breathing in people in very small doses. I mean , if you can imagine two milligrams is considered a lethal dose. That's just a few little grains of pure drug. So that can be hidden. And so the lethality basically has to do with , um , a number of things. The way the , um , the drug was actually being brought onto the streets , um , in counterfeit form. We went through an episode of rainbow fentanyl , which look like candy that kids were , you know , mistaken. It's hidden in all sorts of things. It comes as a powder form. It looks it would not. If somebody thought they were using cocaine , it could very well have had fentanyl in it. They wouldn't have known it. So the the counterfeit fentanyl industry basically was able to disguise the drug and infuse it into these vulnerable markets. And we could see it coming. I mean , we knew back in Philadelphia and Ohio and West Virginia , uh , San Diego and the West Coast was waiting for this to happen. And it started coming with a vengeance , probably around 2017 , 2018. Hmm.
S1: Hmm. You mentioned something that just seems that is so awful and cruel and that is that , um , rainbow fentanyl made to look like candy for children. Um , what's the reason behind that given in your space ? You've worked a lot with , um , with folks. I mean , what's the reason behind that ? And does that cause a lot of deaths in kids who might accidentally pick it up.
S5: Well , the good news is children are way down to in terms of the fatalities. Um , I think it gets back to money. I mean , I don't think there's any other logic other than profitability margin. It doesn't even make sense to me that that would happen. But , you know , why would you be essentially exposing people to things that would be lethal to your customer ? Right. Um , there's not that much fentanyl in fentanyl. A lot of the time. There's so much stuff cut into it. Everything from Tylenol and there's sugar called mannitol and all other kinds of junk in it these days. So , um , it's not a precise science. The people that are doing this , you know , do not have , uh , PhDs from Oxford and Cambridge.
S1: Okay , I'll accept that. All right. Well , so , Ian , you started touching on this earlier. So I guess the most important question here is why are these numbers going down ? Um , what do you think is the biggest reason for the drop ? Yeah.
S2: And , Jade , I definitely want to emphasize what Eric also said. Is that right ? We we're seeing the numbers drop and we're ecstatic to see that progress. But there's still so much work to do. Right. If you can think about it as a hill and we've gone up and we're coming down the hill , but we are nowhere close to the bottom of the hill , so that we we know that many things have played a role in this. And we we think and the CDC thinks that naloxone is a major contributor. It's hard to say the individual contributions of any one intervention. And probably there's a synergistic effect of all of them. But we also think , as I mentioned , you know , reducing stigma around getting access to treatment , helping these populations. You know , we have partners across the spectrum , I think supporting. Right. We have our own sheriff's department distributing naloxone , for example. And then we have us and our contractors and many others and the accessibility of that. But in addition to naloxone , we we have many other kind of harm reduction efforts. We have fentanyl testing where ? Where people who may not know or want to know , you know , what am I actually taking and what I am , what I purchasing actually what I think it is. They're now able to test for that. We know that there's a lot more community awareness of the potency , like Jim said , of fentanyl and these other kind of contaminants of these drugs. So I think all of that collectively has been helping. And then there's been a lot stronger of a prevention response and a response for treatment. Right. A lot more expansion and , you know , acknowledgement of this and an acknowledgement of harm reduction. Right. And that , of course , we want everyone to not never use drugs in the first place. And we would love ideally for everyone to stop using drugs. But we know that with addiction , that's not the reality we live in. Just like , you know , when you're talking about people who are diabetic and , and , you know , avoiding certain foods or things like that , we , we know that with substances that your brain is rewired completely. So we need to do everything we can to meet them where they are. Yeah.
S1: Yeah.
S5: One of the things that I've noticed is that the progressive adoption of the concept of addiction as a chronic disease very , very important as opposed to a weakness of character. And that's the stigmatization component. And that extends , you know , among people using as well as even treatment providers have actually had a reformation in how they view things. There are some really effective medicines. We call them medications to assist in the treatment of addiction. And so one medication that's extremely important is called buprenorphine , also commonly called Suboxone. One of the most important things I think in a way California took the lead on something called a bridge program. And they basically leveraged the importance of emergency departments as a point of contact , essentially a hotspot where you could reach people who have just overdosed and are , you know , coming into the emergency department. We're coming in for craving because they've run out of whatever they're taking. And instead of kind of vilifying these people , basically making emergency departments a safe zone where they could actually be treated. And it's remarkable. There are some recent data on that show. You know , even in California , it used to be maybe a half a percent of the prescriptions for buprenorphine were written by E.R. doctors. It's up to over 16%. So emergency medicine , quite uniquely , has adopted this from strategies that came out of Highland up in LA , but have gone across hundreds of emergency rooms in California , all of them in San Diego County , participating in these kinds of navigation programs , warm handoffs , trying to get to people in their most vulnerable moments so we can actually get them started and then move them downstream. You know , after the crisis is over.
S1: Well , Eric , in addition to your work with the county , you also Uh , work in the emergency room. Can you talk about the role emergency rooms play in helping people access treatment ? Uh , that Jim was just touching on.
S3: Yeah , absolutely. And Jim is an emergency physician as well. Uh , but , uh , really , emergency medicine emergency departments are are one of the front lines , uh , for for patients who experience overdoses , who are struggling with substance abuse. Um , it's , uh , the emergency departments are , uh , as many of us know , are chaotic environments. And , um , so really , our goal in the emergency department is to get is to stabilize patients and get them to the treatment that they need specific to , to their situation. And so the programs that that Jim was talking about are , are , are really necessary , are the , the specific programs that that patients who are experience overdoses need. And so having access from the emergency department to get patients to those to those treatments. Um , is is really critical um , one to , to help those patients who are , who are experiencing overdoses , but also to free up room for all the other patients that need emergency medicine. Mm.
S1: Mm. Um , you know , as Eric mentioned , Jim , you also have experience working in emergency rooms.
S5: I spent over 30 years in the ER at UCSD , so I saw my fair share of overdoses and complications of of injection drug use and just in general , um , addiction. So it , it clearly shaped what I knew was the kind of final common pathway , which was , you know , we weren't solving the problem in the emergency room at the point when there was no buprenorphine. Today , it's so exciting to know that , you know , that the culture is completely different than when I was there. Um , the drugs are so different to , you know , we had heroin on the streets , for , you know , 30 years. Most of the time it was too weak to actually hurt somebody. They would sign out against medical advice and and leave. And there was a time when these overdoses were , you know , thought of as , um , the lethality just wasn't there. Now , the lethality is profound. Uh , and again , particularly when we see the accidental overdose affecting kids , I think that had a profound impact. Um , you know , on everybody. Right. And , um , and so , yes , the low barrier concept of getting people started is really it. We have we're still working on this. We're trying to move people as fast as we can into treatment. Uh , the county the state has really funded a lot of important initiatives. Um , we are we in our clinics offer these medications on site for , you know , everybody who wants them. And we screen everybody to make sure that they are , um , if they're eligible , that they are offered this kind of treatment. This didn't exist a few years ago.
S1: You know , when fentanyl entered the picture ? Um , you know , in this opioid epidemic , uh , it seems like overdose deaths really spiked.
S3: Uh , and , uh , that seems to have peaked in 2023. Um , uh , you know , I think thanks a lot in part to the efforts that , uh , that we're talking about here. But , uh , again , still , uh , the numbers last year are still a lot higher than , than the pre 2017 numbers. So still a lot of work to do.
S2: And I just wanted to add there's a couple other interventions that I think are worth mentioning. You know some of our EMS partners or agencies they're piloting you know giving buprenorphine in the field because many people overdose , they wake up , they're thankfully it's not fatal. And then they don't refuse kind of being transported to a hospital or emergency department. So so that's an opportunity right there that we're taking advantage of our public health services department. We have a harm reduction services that's at the Rosecrans area right now. And then we're looking to expand where we provide a lot of supportive services , harm reduction kits and things like that. And so as much as possible , we're trying to lean in on these evidence based practices , especially these medications. These medications are as effective as blood pressure medications , but we're not always using them. And there's a stigma sometimes for people to say , hey , well , I don't want to replace one drug with another drug , but you would not say that around hypertension or diabetes or anything else like that , right ? We're trying to apply the medical model , you know , and , and support these individuals through addiction with evidence based tools as much as possible.
S1: Go ahead. Eric.
S4: Eric.
S3: I do think one of the effective strategies that's been in place in San Diego is what we call primary prevention. So really , um , uh , through education , getting people to avoid the initiation of drug use. And this is not the just say no to drugs of our of our parents age. These are evidence based curricula that we know delays the initiation of drug use or prevents the initiation of drug use among young people. And really , we're seeing the steepest drop in encounters for drug use in the in our emergency departments. The steepest drop was in the 15 to 24 year old age group. So I think preventing young people from starting drugs is a huge win. And I do want to note that a lot of that work that's done in San Diego is done through law enforcement agencies. And so it really highlights why addressing the drug epidemic requires partnership. Public health can't do it alone. Emergency departments can't do it alone. We need we need partners. Jim.
S4: Jim.
S5: There may have been an unintended consequence of Covid because Covid spurred the adoption of telemedicine for addiction in a way that you can't account for fully , but it absolutely made a big difference in the way that people came to realize this is safe and this is actually very effective. Another thing that came was patients that use methadone normally would have to go to the , you know , every day to the clinic. Well , new laws actually were tested and then shown to be safe that they can take they're called take homes. So many clients now are actually more likely to have their medicines on hand , which again makes made a big difference. And then thirdly , of course I can't say there may be an epi phenomenon. I mean , there was so much crisis during Covid , right. And that that fueled a lot of anxiety and psychiatric comorbidities. And for almost certain , that's why , like in West Virginia and some of these places that were already hard hit to begin with. You know , why were they the epicenter of these lethal early on epidemics ? It was probably because of the , you know , nothing but the dead and dying in my little town. You know that song , right ? And I. And I think that those communities around the country , from a nation point of view , we've finally reached them. Public health has reached these places. Even Alaska's , you know , turning the corner in their in their death rate because probably because we're finally able to reach these people and maybe in part through telemedicine or at least acceptance of treatment , which used to not be very common.
S1: Still to come. Our conversation continues with how changing the culture around addiction has also changed how it's treated. Hear more when KPBS Midday Edition returns. You're listening to KPBS Midday Edition. I'm your host , Jade Hindman. Today , we're talking about overdose prevention and the major decline in deaths across the country , including here in San Diego. My guests today are Doctor Jim Dunford from the McAllister Institute , along with San Diego County's public health officer , Doctor Sayan Parvin , and the county's assistant medical director , Doctor Eric Berg. So , you know , before we jump into into this , something that you all have mentioned is what seems to be a real cultural change around treatment and drug addiction. Can you all talk a bit more about that ? Jim , you talked about it in emergency rooms. Um , you know , Sayan , you've kind of touched on it in terms of policy a little bit. So talk a bit about that.
S2: Whenever anything rises to the level of a , of an epidemic and really like a public health emergency as , as we are seeing with these fatalities and these overdoses that that does bring people to the table in a different manner than you would if they were just kind of happening at a low level. So. So I think that kind of forces the conversation to think differently about about this. And so and that it's also an opportunity for us to work with our partners and educate each other right on what is going on. Why is this happening ? What is how does addiction work ? And this is not something , you know , that even myself in medical school really fully understood until I was working in addiction , um , type of work in New York City and here. And so I think that allowed us to really reframe and , and bring that into the conversation with not just our public health partners , but our public safety partners and everyone in between. And then knowing that then then it's easier to make the case that , hey , if someone is having a heart attack in front of you , you would not look the other way. We would try to as easily , as quick as possible get them , you know , in a place where we can address the heart attack. And so we would want to do the exact same thing. If someone's having an overdose , we'd want to use a reversing agent like naloxone to stop and delay that overdose and get them somewhere safe , like the emergency department , where they can be further treated. Jim.
S1: Jim.
S5: That's a matter of minutes. And the same thing with cardiac arrests , bleeding problems. Heimlich maneuver , these sorts of things. Educating the public , the importance of them being able to handle things in the first few minutes is really an essential strategy that we should all learn. And the same thing goes now with this. This is another time critical condition. It's a matter of minutes before somebody has too little oxygen to the brain , and they end up really never waking up. They may be alive , but never waking up. So this time critical component. And then when you add stories of success with naloxone all of a sudden and then unfortunately , sprinkle in the inevitable , um , thing that's going to happen is that you're going to know somebody who died of an overdose , somebody family member. And , and I think that's what really brought this home , as opposed to all the horrible , abstract things that are happening in the world , that we have a hard time being able to understand when when somebody you know or or someone that someone loves dies of this and it happens to all across the spectrum of society , then everybody feels they have to pay attention to what's going on.
S3: Um , to add to that , I totally agree. I think , you know , the culture change was driven by how really how bad this epidemic has been. And , um , again , you know , last year we're celebrating last year , 80,000 still 80,000 deaths across the country. That's more deaths than the Vietnam War , the Iraq war , the Afghanistan war combined , uh , in one year. Uh , and so you probably do know somebody that has died from from an overdose and and that's , that's what's changed the culture of us realizing we need to we need to change something to to address this.
S1: Do you all feel like changing the idea that addiction is a character flaw to addiction ? Being a condition has really opened the door up for different , um , pathways to treatment , um , and policy around this ? Absolutely.
S2: When , when you think of and reframe your brain in terms of thinking of addiction as , um , something that that rewires your brain and , and is not a character flaw , um , then then you're much more likely to avoid stigmatizing this population to be more supportive of these individuals. So , uh , which we should. And like I said before , with other examples in medicine , that's how we treat other individuals with other , um , um , you know , disorders or are what you call whatever. So. So we want to apply the same approach. And you rely on the data and see what helps and is most supportive , both from prevention as well as really helping people and support them through their addiction.
S1: And this question is for all of you. I mean , you've we've noted that though less people overdosed in 2024. You know , as you said , the numbers are still very high.
S3: They can be they could be marketed as pills. They could be marketed as cocaine. There is almost certainly fentanyl mixed into that. And so people that may not be seeking out opioids may not be seeking out fentanyl , maybe are just experimenting , trying something they can be. It's. We're truly in an era of one pill can kill. Um , and and so that's what concerns me the most is just the prevalence of fentanyl across the , the drug market. Mhm.
S4: Mhm. Yeah.
S5: Yeah. And I think , um , you know , other emerging threats in this field are the things that are getting mixed in with fentanyl. I mean we already I mean methamphetamine is , is got so much fentanyl in it these days. And meth is a separate problem. We routinely have people come to our detox program testing positive for fentanyl in withdrawal , and never knew that they were taking , uh , fentanyl. They thought they were just using methamphetamine. Um , other things , you know , we've heard about psilocybin. This is this crank anesthetic that is an animal tranquilizer that sort of decimated Philadelphia and some of the big cities. It's a sedative drug. So really , there's no , uh , there's no ethic behind what people are willing to put in these drugs. There's lots these days. Just in the last couple of months , there have been a whole bunch of different anesthetic agents that are now being detected. The kinds of stuff that you go to the dentist and you get Novocaine. Well , those things are now getting cut into this , and they're toxic. If there's enough in there that they have their own severe potential side effects. So , you know , as we just see these unregulated manufacturing processes kind of really only , I think , be concerned about a profit margin more than anything. That's basically , to me , the most dangerous thing. Um , even funny , I mean , the dose of , of fentanyl , the amount in it has seemed to have gone down. They're cutting it with more junk to probably increase the profit margin. And the prices are going up , by the way , for fentanyl because it's such a preferred drug , believe it or not , on the streets people seek out the strongest stuff. Somebody else overdosed. I want to try that. That must be good. So there's a kind of a still a perverse thinking that underlies the the addict until they actually get a chance to get into recovery and basically get their , you know , get their thinking back together. Yeah.
S4: Yeah.
S1: And then talk to me about some of the funding threats. Absolutely.
S2: Absolutely. And just before going to funding threats , I just wanted to say that I wholeheartedly agree with what Eric and Jim said. And one other concern I have is that there are two other concerns is that , you know , some people may slow down some of the involvement and the proactive kind of nature of our response so far as a community , and we can't let our foot off the gas. Right. Just because it's a positive trend. We still have a lot more to go. That's one thing. And then also the second thing is that the gains are not necessarily equitable. By that I mean when we look at things through different equity lenses , whether it's urban or rural or race ethnicity or age categories , you know , we have to look and not all groups are coming down in terms of overdose. That's the same as other groups. So so we have to look at which pockets are kind of still disproportionately impacted. And I know. Who's.
S4: Who's.
S1: Disproportionately impacted.
S2: From race ethnicity. I know that in recent years we've seen black African-American , San Diegans , you know , have a higher rate of overdose deaths. And so so I worry around certain populations , and I'm just not as familiar with the recent data and how that's broken down. But but , you know , that is something that we absolutely have to keep a pulse on. And we may have to do specific or targeted efforts that are work in certain populations more effectively. The other thing , in terms of funding cuts to your original question , Jade , is that yes , we absolutely have to keep keep also a pulse on the funding cuts and really the federal government and then the state budget and everything that may impact our ability to provide , you know , these resources , these treatment , whether it's the Ed Bridge program , which is largely funded by the state or or Medicaid , which is the state and federal funding component. So so we we're we're tracking those. We of course , any Medicaid cuts would affect the ability for people to access programs and services. But it's a question of kind of what the degree of those cuts could be. And and then what the degree of those the consequences could be. I will also say , though , to be fair and look at this comprehensively , we also have to look at things like the tariff conversations , right , with countries like China , which may be exporting some of the materials that are used and cut into these drugs. So. So , you know , I don't know. And we are I'm at least not a subject matter expert in that area and would have to talk to others , but that should probably be part of a larger kind of conversation of of how the federal administration may be impacting substance use treatment. Wow.
S1: Wow. Well , so while these declining numbers seem to be a small victory in a much larger war , that's nowhere close to being over , it seems. I've been speaking with San Diego County Public Health Officer Doctor Cynthia Parvin , along with San Diego County Assistant Medical Director Doctor Eric Berg and Doctor Jim Dunford , the medical director with the McAllister Institute. Thank you all so very much for being here today.
S2: Thank you so much.
S5: I appreciate you being here.
S3: Thank you. Thank you. Jane.
