County seeks faster response to tidal wave of fentanyl overdoses

Paramedic Susan Monroe explains how to administer Naloxone.
Paramedic Susan Monroe explains how to administer Naloxone (in her hand), an overdose drug delivered with an inhaler through the nose, during a demonstration at the County Administration Center on Friday, May 21, 2021 in San Diego, CA.
(Eduardo Contreras / The San Diego Union-Tribune)

Set of initiatives aims to spot patterns in overdoses and deliver Naloxone more quickly

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The county is doubling down on fentanyl-fighting resources as overdose deaths continue to climb.

On Tuesday, Dec. 13, the Board of Supervisors unanimously approved a four-point public health strategy focused on more quickly spotting overdose outbreaks while also taking a more proactive stance on both the public availability of the opioid-neutralizing drug naloxone — also called Narcan — and on community education efforts.

Updated numbers presented during a public forum in June indicate that fentanyl deaths hit 817 in 2021, significantly more than the 381 partial count listed by the San Diego County Medical Examiner. There were, according to updated numbers, 462 in 2020 and 151 in 2018.

While the region’s public health department was already tracking opioid-related deaths and overdoses, and previous approvals have already set the stage for naloxone vending machines in several locations, Tuesday’s decision calls for nearly $5 million in spending over the next three fiscal years to hire additional workers to provide both surveillance of trends and additional outreach.

Dr. Cameron Kaiser, deputy public health officer for the county, said in a recent briefing that more person power is needed to sort through near-real-time data coming in from paramedics and other first responders throughout the region to determine where batches of fentanyl-laced drugs are threatening lives.

As was the case when the department staffed up to handle the deluge of positive COVID-19 tests during the pandemic, Kaiser said that the fentanyl crisis has simply grown to a scale that demands a bigger commitment of resources.

“It’s not that this wasn’t a problem before, but it really wasn’t to the same magnitude that we’re experiencing today,” Kaiser said. “You can use an umbrella in a rainstorm, but you can’t in a tidal wave.”

The key, he added, is receiving and analyzing information on possible overdoses as quickly as possible. Doing so, he said, provides an opportunity to act.

“If we get numbers going high in a particular geographic region, or clustered around one hospital provider, ... the rationale here is to have enough of that analysis power to be able to hand it off and do those interventions in the field as quickly as we can,” Kaiser said.

What might those interventions look like?

Dr. Nicole Esposito, the county’s chief population health officer, said that investments have already been made in providing naloxone to those who are at risk of overdose, especially working with organizations that serve the homeless.

Cases where overdose and death data shows that there has been an increase present an opportunity to “flood the area” with outreach workers able to give the drug to anyone who might find themselves with someone who needs it, she said.

“Right now, we have a lot of outreach workers all across the region, so we would just be increasing the number of contacts,” Esposito said. “Some of those teams are out for specific hours; we could extend those hours, we could extend the days they’re operating.”

The effort also plans to incorporate a naloxone “leave behind” program that has emergency services leaving a supply of the drug when they are finished with calls that they suspect or outright know involve fentanyl or other drugs. Such programs have become very popular in some states, with Maryland especially favoring their ability to prevent overdose deaths.

In approving the initiative, Supervisor Tara Lawson-Remer applauded the idea that more resources will be spent on prevention.

“We absolutely need all hands on deck to save lives with Narcan when someone has an accidental overdose,” she said. “But to truly address the problem, we have to go upstream and stop people from falling in.”

Updates

4:13 p.m. Dec. 14, 2022: Total cases fentanyl case count updated with information presented during a June community forum by the the San Diego County Medical Examiner.


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