Quick Take:
For years, it has seemed like law enforcement and social services providers have been playing a game of catch-up. Now, with added resources and a new effort at coordination, will their efforts match the growing crisis?
Santa Cruz’s record fentanyl-related death toll last year doubled the total for 2022. But are overdose deaths still worsening in 2024?
We don’t know. The county’s coroner declined an interview with Lookout, and her office has not shared its latest statistics.
Still, whether the current trend is up or down, the fentanyl overdose grows in response, Sheriff Jim Hart has doubled the size of his fentanyl crisis response team to five detectives, a sergeant, a lieutenant, and a drug detection dog this spring. He also says his office works with the U.S. Attorney’s Office in San Jose and the Drug Enforcement Administration.
His office is treating every fentanyl death as a homicide investigation, the sheriff said, a recent pivot he hopes will deter dealers and traffickers in the county. If his detectives and forensic units can prove a dealer sold fentanyl to someone, which led to that person’s death, his office will send the case to prosecutors. Those cases are still under review, with no timeline for prosecution known.
Hart emphasizes law enforcement can’t arrest its way out of the fentanyl crisis. “It’s going to take a concerted effort from our health services agency. It’s going to take the treatment community. It is going to take a lot of education for school-aged people,” he said.
Fentanyl is a generational problem, the sheriff said, and is not going anywhere — illicit drug chemists keep coming up with ever-stronger drugs. The only way he sees a way to get ahead of the problem is to prevent first use and reduce demand. How to reduce demand is an open question.
Part 1: With fentanyl deaths doubling, Coral Street is a “hot spot”
Part 2: Fentanyl response: Redoubling efforts as the crisis doubles
“I haven’t seen a real effective education program in my 36 years [in law enforcement],” said Hart. “D.A.R.E. was a program that everybody’s familiar with. I’m not sure how effective it was. But any type of education is helpful. I don’t think that’s necessarily law enforcement’s job.”
The county jail, however, is under the Sheriff’s Office’s purview.
At the jail, the sheriff said that Narcan, used to revive overdose victims, is available in all housing units at the press of a button. A MAT program is also available to help the jailed and addicted ease off fentanyl and other illicit drugs. As an alternative to jail, he said the sheriff’s office partnered with Janus, a local addiction treatment center, to open a “sobering center” at 265 Water St. in Santa Cruz earlier this year.
Sheriff Hart’s “can’t arrest our way out” approach extends to county public health officials, who are increasingly sharing data, they say.
Ramy Husseini, the county’s health services manager, told Lookout that the data team at the Sheriff’s Office and public health are working together, something he has not seen in his 15 years as a public health professional.
Like most public health programs, when they are underfunded, they underperform, said Husseini. But, thanks to the opioid settlement cash the county received, his office hired an epidemiologist to focus solely on opioid overdoses and work with a counterpart at the Sheriff’s Office.
“All the right partners are in the mix right now,” he said. The partnership will allow the county health services and the Sheriff’s Office to understand the relationships between county-wide criminal and health data and gain new insights.
Beyond the scope of law enforcement, the educational piece of the substance abuse puzzle falls largely on coalitions like the Health Improvement Partnership of Santa Cruz County’s SafeRx. The coalition comprises “social services, government, behavioral health, and healthcare organizations.”
SafeRx was created in 2015 to decrease opioid-related addiction and dependency through better medication-assisted substance disorder treatment and increase the availability of overdose reversal medications. SafeRx is funded by Santa Cruz County Behavioral Health, Santa Cruz Public Health, the California Youth Opioid Response Project, the California Opioid Prevention Network, and the Public Health Institute.
SafeRx hosts numerous public education events, promotes prevention strategies, and shares evidence-based knowledge with medical providers, therapists, and counselors. Its website features information on MAP access, naloxone distribution locations, prevention best practices, partner programs, and a Xylazine Library. (Part three of our series focuses on the rising concern about xylazine.)
“One hundred, thirty-three people dying is devastating,” said Jen Hastings, a co-lead physician affiliated with SafeRx. People who choose to use illicit drugs, she said, may be unaware the substances they inject, smoke, or ingest contain fentanyl.
Sometimes, said Hastings, even when people use test strips on their street drugs, false negatives can occur. She describes the problem using a chocolate chip cookie analogy: The chips represent fentanyl, and the dough represents the substance, alprazolam (Xanax), for example, a user expects. When someone tests the cookie, they may test the dough and miss the chips.
“There’s something about our [American] culture that is stressful and toxic,” Hastings said. “Many people have trauma. Many people have been in abusive families and abusive relationships. People turn to drugs to feel better.”
Even with higher levels of government and nonprofits working toward solving an intractable problem like fentanyl, it is those who need help the most who need convincing.
As Max Silverstein, SafeRx’s Overdose Prevention AmeriCorps VISTA Member, pointed out, not all resources available to reduce harm or help people are harmless.
READ MORE OPIOID CRISIS RELATED NEWS
“Things like psych wards can be harmful, especially when someone can be held a lot longer than they expect,” they said. “A lot of times, mental health care providers can end up dehumanizing the experience. It can be traumatic.”
But even the sheltered are still at risk of a fentanyl overdose if they, or someone they live with, is using the drug, either intentionally or unknowingly.
In December, Lt. Nick Baldrige of the Santa Cruz County Sheriff’s Office reported that 50 percent of the pills the Sheriff’s Office confiscated and tested contained fentanyl.
Santa Cruz County’s Emergency Medical Service personnel use naloxone, brand name Narcan, to revive overdose victims and then offer buprenorphine to their patients to prevent such a relapse. While medical intervention – such as Narcan – may help someone experiencing an overdose, the MAT medications help ease users off fentanyl.
“Buprenorphine is a pretty cool drug,” Dr. David Ghilarducci, the county’s EMS medical director, told Lookout. He considers Narcan a great drug — it saves lives. “It’s the only drug that can reverse an overdose. But it’s not the solution. It’s a Band-Aid. What can we do going forward to prevent the next overdose? Buprenorphine acts like a vaccine against an overdose.”
“As more people get their own experience [with substance users], compassion deepens,” said SafeRx’s Dr. Hastings. “But when it’s someone who looks different than you, who looks scary or different or bad, the stigma increases.”
James Dobbins is a journalist based in the Bay Area. His work has been published in The New York Times, Texas Observer, Texas Monthly and alt-weeklies.
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