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Challenges, Strategies and Systems of Care to Reverse the Bay Area Fentanyl Crisis

California’s Bay Area counties are struggling to addressing a growing fentanyl crisis, especially among youth. Experts from PHI’s CA Bridge program weigh in about challenges, strategies and systems of care to help reverse this trend.

  • The San Francisco Standard
prescription drugs on a table

“Nearly 60% of all drug overdose deaths in San Francisco and four of its neighboring counties involved fentanyl last year, new data shows. And while San Francisco has the highest per capita fatal OD rate, 57% of the region’s 1,510 overdose deaths occurred outside the city.

The 2022 data was obtained exclusively by The Standard from county coroners and medical examiners in San Francisco, San Mateo, Alameda, Santa Clara and Marin counties. Together, the statistics indicate that the multipronged efforts across Bay Area counties to fight the fentanyl crisis are failing.

San Francisco remains the epicenter of the Bay Area overdose crisis: 647 people died from accidental overdoses in 2022, the majority of which involved fentanyl. The city’s preliminary count of fatal overdoses from January through April this year shows ODs have killed 268 people versus 196 over the same period last year. If overdoses continue at this rate, San Francisco will see its deadliest overdose year ever.

Hundreds more died by fatal overdose in nearby counties in 2022: 373 in Santa Clara County, 355 in Alameda County and 54 in Marin County. In San Mateo County, 81 people died of overdoses between January and November 2022. (December data is not yet available.)
“The drug supply, and drug use, doesn’t recognize geographic, county lines,” said Mary Sylla, director of overdose prevention policy at the National Harm Reduction Coalition. While it’s San Francisco’s deadly overdose crisis that dominates headlines, the surrounding Bay Area counties are also hard-hit and may be less prepared to deal with the problem, she said.

Most counties have adopted a version of the harm-reduction approach, pushing outreach campaigns educating people on the dangers of fentanyl, providing addiction treatment programs and expanding Narcan supply to reverse overdoses.

However, some say the counties’ health care systems are not ready to counter fentanyl’s potency and ubiquity in the Bay Area drug supply.

The Crisis in Santa Clara County

Overall, Santa Clara County recorded 373 total accidental drug overdoses last year, which included deaths from non-opiate substances like alcohol and cocaine. Fatal opioid overdoses—which count deaths from drugs like fentanyl, codeine, morphine and hydrocodone—in Santa Clara County more than doubled between 2019 and 2022, reaching a high of 167 accidental opioid-related fatalities last year.

“Those numbers are lives—and those lives lost are what is driving our work on this,” said Otto Lee, a county supervisor who spearheaded numerous bills to combat fentanyl. The issue is personal to Lee, who lost a 29-year-old cousin to an overdose.

Santa Clara was the only Bay Area county out of the five analyzed where fentanyl was not linked to the majority of all overdose deaths in 2022. However, of the opioid-related overdoses last year, roughly 82% were linked to fentanyl. The deadly synthetic opioid spread rapidly throughout the South Bay drug supply in recent years, and between 2019 and 2022, fentanyl-linked overdoses increased fivefold in Santa Clara County.

Dr. Reb Close
We had to start talking about [the overdose crisis]. It was so in our faces, and we were that frontline. As much as many would try to pretend like [opioid use] was somewhere else—NIMBY kind of business—those of us that are in the rooms with the patient, trying to revive people from overdoses, we were seeing it. Reb Close, MD

Attending Emergency Physician at Community Hospital of the Monterey Peninsula; and Regional Director, CA Bridge, Public Health Institute

The county has also launched a series of overdose prevention campaigns in recent years: The “Expect Fentanyl” slogan was plastered across the city in 2021, in direct response to a spike in overdoses the Santa Clara County Medical Examiner-Coroner’s Office attributed to fentanyl-laced narcotics and pills.

But some experts say that the region’s health care system has been too slow to respond to the ballooning numbers of fentanyl-linked deaths.

headshot of Elizabeth Keating
In the South Bay and the Peninsula, there was a perception that the drug crisis was something that was happening in [San Francisco’s] Tenderloin, and that there weren't patients in these towns using fentanyl. We still heard a lot of hospitals saying, ‘Oh, well, those patients don't come here,’ or ‘We don't see those kinds of people in the hospital.’ Elizabeth Keating, MPA

Clinical Program Director, CA Bridge, Public Health Institute

The Crisis in San Mateo County

San Mateo County saw 134 fatal overdoses in 2021—a record—but deaths appear to have dropped significantly in 2022.

A comparison of overdoses between January and November 2021 and the same period in 2022 showed San Mateo’s fatal overdoses dropped 33%. The county did not provide data for December 2022.

Yet, the share of fentanyl-linked deaths appear to be rising in San Mateo. The county documented 81 fatal accidental overdoses between January and November last year, 62% involving fentanyl. Just over half—53%—of 2021’s fatal accidental overdoses involved the synthetic opioid, by comparison.

San Mateo County’s health department has sought to reduce overdose deaths by producing safe-use pamphlets and pushing for naloxone distribution in public spaces like libraries. Alarmed by the rash of teenagers overdosing in neighboring Santa Clara, the department has expanded outreach to youth in recent months.

Still, Bay Area counties should have been more proactive about the youth crisis earlier, said Luftig, the co-founder of CA Bridge, who is also a physician’s assistant based at Highland Hospital in Oakland.

Josh Luftig, Co-Founder, CA Bridge
If we’re looking back at the adolescent crisis we’re having, if it wasn’t substance use disorder, this would be headline news every day,” he said, in reference to what’s unfolding in South Bay counties. “It's so upsetting that there's a health care condition that is plaguing the youth in our community and driving fatalities up [...] and we're not up in arms every day about this. Josh Luftig, PA-C

Co-founder, CA Bridge, Public Health Institute

Efforts are also now reaching the state and federal level. San Francisco supervisors called for more federal support to target drug trafficking, while Gov. Gavin Newsom deployed the highway patrol and California National Guard to the city in May. State legislators have passed a slew of bills designed to prevent overdoses, and statewide coalitions, such as those run by the Public Health Initiative, have tried to create addiction treatment networks across the Bay Area.”

Dr. Mary Maddux-Gonzalez
No single entity can address this major issue that we are confronting. We really need the collaboration of all of these entities in communities to address it. Mary Maddux-Gonzalez, MD, MPH

Family Physician and Coach with the California Overdose Prevention Network, Public Health Institute

To read the full article, click on the link below.

Originally published by The San Francisco Standard

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