San Mateo County seeks ways to fight illicit drug use

Compared to neighboring jurisdictions, namely San Francisco County, San Mateo County’s struggle with opioids, and specifically fentanyl — a synthetic painkiller up to 100 times more potent than morphine — is not as extreme.

While about 435 people died from opioids in San Francisco and 777 visited the emergency room due to opioid-related overdoses in 2021, about 83 San Mateo County residents died and 146 went to the ER for the same reasons in the same year, according to the California Overdose Surveillance Dashboard managed by the California Department of Public Health.

On average, about 90 San Mateo County residents die from opioid overdoses annually, County Health Officer Dr. Scott Morrow said during Tuesday’s special meeting. In 2017, overdoses from fentanyl accounted for about 10% of those 90 deaths. By 2021, that ratio grew to about 50%.

Nationally, the crisis is also growing more urgent. Opioid deaths had been on a steady incline since the Federal Drug Administration granted approval of slow-release versions of the lethal medications in the late ‘90s, beginning a first wave or “perfect storm.” By 2010, a second wave hit with an increase in heroin overdoses.

But the introduction of fentanyl to the streets has caused deaths to skyrocket nationally since around 2014, marking a third wave. Experts are now sounding the alarms on a fourth wave being sparked by a combination of fentanyl and stimulants, usually methamphetamines.

“It took off. It’s easy to manufacture, it’s easy to import, it’s fast acting and it fed these overdose deaths and this epidemic,” said Clare Boyden, deputy director of Behavioral Health and Recovery Services’ Alcohol and Other Drugs Services unit.

Concerns are growing over a combination known as tranq, a mixture of fentanyl and animal tranquilizers that helps prolong the short-lived euphoric effects of the opioid, Fullerton said. The animal tranquilizer is not an opioid, which means the one trusted treatment for opioid overdose, naloxone, doesn’t work on the medication.

Still, officials routinely underscored the value of having naloxone widely available. The life-saving medication is easy to use, coming in the form of either a nasal spray or injectable, and is effective on a variety of opioids including heroin, fentanyl and prescription opioid medications.

“Seeing through the glass darkly”

Accurate figures on the extent of drug use in the county can be hard to come by. Many who use substances do not interact with agencies that keep data like the medical or criminal justice systems, Morrow noted. Ultimately, as noted by multiple presenters during Tuesday’s meeting, even one death is one too many.

Having presented on the opioid crisis 25 years ago, Morrow said many things remain true. Opioids remain one of the most lethal threats to society, adding climate change, political polarization, economic instability and other dilemmas to that list. While the state has made strides to address the opioid crisis, communities still lack an adequate system to address the issues holistically as other diseases have been, he said.

“What do we know about drug use in the county, which is not a lot I would say, is this is the perfect example of the phrase seeing through the glass darkly,” Morrow said. “Seeing through the glass darkly means we don’t have a clear sense of what’s going on. We know in part, we believe in part, we surmise in part, we hope in part but our understanding is especially limited and imperfect and we should be very, very, very, very wary of any conclusions that we draw from such limited and imperfect knowledge.”

What Morrow could say for certain is that as long as fentanyl remains as prevalent as it is, “it is assured that youth use and youth death will increase.” The opioid is already behind 1 in 5 overdose deaths of California youths ages 15 to 24, according to Song for Charlie, a nonprofit started in honor of Charlie Ternan who died in 2020 after taking a fentanyl-laced Percocet to treat an aching back.

And while overdoses are most common in people who actively and knowingly are consuming the drugs, national data indicates that drug deaths among young people — between the ages of 10 and 24 — are growing faster than any other age group, BHRS Clinical Services Manager Mary Taylor Fullerton said.

The trend underscores the importance of collaborating with education leaders including the County Office of Education and individual school districts to help educate students, officials noted.

Kris Shouse, associate superintendent of the Educational Services Division, said the county is already ahead of many jurisdictions on this issue given that its 23 school districts, serving about 87,000 students, have already tapped into a Naloxone for Schools Toolkit.

Supervisor Ray Mueller said he’d support even stronger partnerships with school boards and Supervisor Noelia Corzo, a mother of a 12-year-old boy and a former school board trustee, said she plans on reaching out to school boards in her district to make sure boards are actively discussing the issue.

“It weighs heavily on me the many ways our youth are more vulnerable,” Corzo said. “They have more access to things than any generation before. It can be good and it can be bad, and in this way, it could be lethal.”

Barriers and future measures

A number of barriers exist that keep people with opioid use disorder out of treatment: including stigma, a belief that they don’t deserve care, and a lack of support, resources and confidence to continue treatment, Fullerton said.

National data by the Substance Abuse and Mental Health Services Administration also shows that about 96.8% of drug users do not believe they need treatment, Fullerton added. And only about 10% of people with a substance abuse disorder access care.

The county already has a number of programs and services in place meant to help people access the treatment they need including sober living sites, behavioral counseling and support groups, emergency services response teams and case management, detox sites and shelters or temporary housing.

But more services are still needed including educational campaigns and anti-stigma marketing, community outreach and education, expanded access to naloxone and fentanyl testing strips, school-based treatment programs, housing, employment opportunities and equitable access to programs.

Supervisors shared broad support for pursuing recommendations from staff meant to address those gaps. The recommendations focused on five key areas — prevention, harm reduction tools, increased availability and access to treatment services, investing in expanded data and surveillance and policy advocacy.

“I’m not niave enough to believe we can stop drugs from coming in. They’ve always been around and I’m sure will always be around. But, make no mistake about it, fentanyl is the deal breaker here,” said Bonnie McNamara, a mother who lost her son to an accidental fentanyl overdose. “Early progress is key, knowledge is key, education is essential. … Together I believe we can make the must-needed changes.”