Santa Cruz County fentanyl deaths are down, but public health officials express caution about the trend

Fentanyl deaths appear to be on a noticeable downward trend across the county, according to new figures released by the Santa Cruz County Sheriff’s Office. Public health officials point to better collaboration and improved access to overdose-reversal and substance-use treatment medication but caution that it’s too early to declare success in combating the opioid crisis.

After repeated requests to local agencies for updated data, the Santa Cruz County Sheriff’s Office sent Lookout the county’s fentanyl death statistics as of July. So far this year, the county has recorded 38 deaths related to fentanyl. Of those, 24 were in the city of Santa Cruz, 11 were in unincorporated areas and three were in Watsonville. If those trends hold, that would mark a notable decrease from 2023, when the county saw a total of 133 deaths. 

However, those working directly to combat the opioid crisis have reservations about celebrating the numbers.

County Health Officer Dr. Lisa Hernandez stressed that the data is preliminary, and added that there are likely cases still under investigation that have not yet been declared fentanyl deaths, even if they ultimately are: “I really don’t feel comfortable making a comment specifically on those numbers at all, because there’s so many factors that might change them.”

Deputy health officer Dr. David Ghilarducci said data on deaths is typically a “lagging indicator” — numbers that measure the current moment and past results, but do not predict what should be expected in the future — and that it often takes as much as eight weeks for toxicology reports to be completed that allow public health officials to determine whether a person’s death can be attributed to fentanyl.

“Unfortunately, I don’t think we know enough yet to know if it truly is a decrease,” he said.

Rita Hewitt, regional director for Central Coast Overdose Prevention (CCODP) — a coalition of providers, nonprofits and community members across Santa Cruz, Monterey and San Benito counties — said drug-related fatalities often go in cycles. “We have a bad year and then the numbers go down, ” she said.

However, she pointed to broader efforts across the county to tackle the fentanyl crisis as something that might be making a difference: “I don’t know that there’s a direct correlation with what we’re doing, but there has been a lot of work done in the community.”

The opioid crisis has been a scourge on the county for the past several years. Much of it has been driven by the synthetic opioid fentanyl. Between 2020 and 2022, the county recorded rises in overdoses just about every month. Last May, the county recorded 101 total overdoses — more than any single month in 2022. (Not all overdoses are fatal.) The crisis has been so intense that the county will receive about $28 million over the next decade from a national opioid settlement.

Hernandez said that while she would “rejoice” if there does turn out to be a substantial decrease in fentanyl-related deaths this year, it does not minimize the devastation that the epidemic leaves in its wake: “Any life lost, especially to a drug overdose, is significant to our community and to the friends and family members of that person.”

Hernandez likened the opioid crisis response to that of the response to COVID-19, in the sense that it requires a “holistic, coordinated response from all stakeholders throughout the county.” 

That has included several major undertakings. Local substance-use safety coalition SafeRx has begun distributing the opioid overdose-reversal medication Narcan both in the community and in schools. The county’s syringe services program provides drug users who cannot or will not stop using with clean syringes and places to safely dispose of used ones. And the Homeless Persons Health Project (HPHP) is a clinic that provides medication, therapy and counseling — a strategy called medication-assisted treatment (MAT) — to people experiencing homelessness.

Ghilarducci, who has been a county leader in organizing emergency services collaboration among the same three counties participating in CCOPD since July 2022, said that the hospitals and first responders in Santa Cruz County now are better able to track the people they are treating and follow up to see how treatment is going or what is happening with them if they’ve stopped treatment. 

Ghilarducci added that the collaboration also allows the jurisdictions to be more proactive and use suboxone and buprenorphine — drugs used to treat opioid-use disorder and begin recovery, rather than simply reverse an overdose — immediately upon responding to an overdose. That way, patients can get started on treatment medications before even getting to the hospital.

“We’re realizing that national data shows that there is a 10% chance that a person who overdoses will be dead within a year from a subsequent overdose,” he said, adding that he had to get state approval to use buprenorphine on the scene of an overdose, rather than solely in a clinical setting. “With that high of a mortality rate, we have to do more than just give naloxone [Narcan] and hope for better outcomes later.”

Ghilarducci said that in the three counties, first responders have administered buprenorphine 25 times over the past year. He calls that “a slow start,” but that’s to be expected because of extra steps paramedics have to take before administering the drug — the patient must be awake, and must consent to it.

Still, he said that “dropping jurisdictional boundaries” and increased communication among medical facilities in each county is a big step forward.

“All of our hospitals are talking to each other rather than operating independently, and we have three counties working together, which is relatively unique,” Ghilarducci said. But he said assessing changes in patient outcomes will require more time and observation.

Hewitt said that CCODP also just began a project called Naloxone Box, which involves refurbishing old school newspaper boxes into containers for Narcan. The boxes will sit outside clinics and offices within the three counties, allowing people to access Narcan for free and without having to talk to anyone. 

County public health has also begun working more closely with the sheriff’s office, said Hernandez, as well as probation and juvenile hall, the behavioral health division and the human services department. Together, these agencies have identified three major priorities — improving data tracking and sharing systems, increasing education opportunities particularly for youth and families, and improving access to care upon release from custody for those incarcerated. 

There are still gaps in local response, and officials said perhaps the biggest ones are two of the most ubiquitous issues of the current times: housing and mental health.

“We need to have supportive housing with wraparound services for individuals who are both homeless and using substances, and may have a mental health diagnosis, too,” Hernandez said. “It’s not a monthlong process, it’s a month- to yearslong process.”

“We can get these folks sober and doing great, but then how do we find them jobs and support their transition after treatment? I think those are our next steps,” said Hewitt. “We’re doing great getting people into treatment, but that’s a huge part that’s missing.”

And Ghilarducci said that stigma remains one of the biggest barriers to care.

“I see a lack of eagerness to respond forcefully on the part of medical care providers,” he said, explaining that some providers still hold the belief that addiction is a self-induced problem that the patient should be responsible for, and are reluctant to fully treat it. “But it’s truly a medical issue and, I think, really a cancer on our society. I’m hoping that attitudes will continue to evolve within our medical care community to recognize this as a real problem to be taken seriously.”

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