Fentanyl Epidemic: County using partnerships, prevention to attack overdoses

These statistics, provided by the Riverside Overdose Data to Action team at the Riverside University Health System – Public Health, shows the manner in which overdoses involving fentanyl have skyrocketed over the past three years in Riverside County. Valley News Graphic by Jeff Pack/Shane Gibson photo

Jeff Pack
Staff Writer

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 (RCPH), 122 could be attributed to the inclusion of fentanyl in overdose deaths. 

“In terms of specifically for fentanyl, it’s really scary,” said Wendy Hetherington, MPH, Chief, Epidemiology and Program Evaluation/Vital Records for Riverside Overdose Data to Action at RCPH. “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 to Valley News for this story. 

Hetherington reported that In 2019, RCPH received a $2.3 million CDC 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 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.”

According to the report, Fentanyl-involved overdose deaths increased from 4 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 than our other overdoses because non-fentanyl overdoses or just, in general, all overdoses in Riverside County, the number one 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, Behavioral Health 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 drug abuse 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,” said Thomas Peterson, Senior Public Information Specialist at RUHS – BH.  “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.”

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.”

According to Marier, the county now has 12 outpatient clinics throughout the county, along with 18 residential service providers that have 53 different locations for residential outpatient treatment. 

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.

“With the (Medi-Cal waiver) we’re able to do field-based services, we’re in 20 different schools throughout Riverside County providing treatment and prevention services,” she said. “We’re in five different group homes serving our adolescent youth, we are in the Moreno Valley Hospital now doing screening for individuals that are identified to have a substance use disorder, trying to link them to outpatient services or residential treatment. We work with our homeless teams and we’ll go down to the river bottom sometimes to try to reach people and link them to services.”

Marier said county leadership is being proactive in attacking the problem. 

“At our behavioral health and community health clinics, we now provide screening for substance use disorders and we can link people to outpatient care and provide services within the community health clinic or we can link people to residential treatment,” Marier said. “We’re working with regional opioid coalitions to try to reach all the different populations that we haven’t partnered with before. We see the increase in opioid use and recognize the need to work with our community partners, our county partners, and law enforcement. We understand the importance of working together as a team and relieving the burden on just one person or one organization.”

In our region, the county has three locations to help combat substance abuse. 

The Temecula location is at 40925 County Center Drive, Suites 100 and 200 and the phone number is (951) 600-6360.

In Lake Elsinore, the clinic is located at 31764 Casino Drive, Suite 200. Call (951) 471-4649.

San Jacinto’s office is at 1370 S. State Street, Suite A. The phone number is (951) 791-3350.

“Anyone can call and make an appointment or just walk into the clinic and ask for screening and we’ll provide a screening that day,” Marier said. “We will serve anyone although most of our clientele are Medi-Cal consumers. We can treat those with private insurance only if the patient gets a letter of denial from their insurer first. Some private insurers have their own referral system.”

Our services are confidential as well, meaning minors can contact SU CARES or walk into a clinic without parental permission. However, Marier encourages minors seeking treatment to include their parents in the process. 

“When we do their screening and feedback, there is a section where we try to get information from the parent or guardian because the youth may not be as forthcoming with us,” she said. Sometimes the parent can provide valuable information that will enable us to do a better assessment.”

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. Valley News is speaking to people on the front lines of this epidemic. 

Jeff Pack can be reached by email at jpack@reedermedia.com