As the national fentanyl crisis continues to reverberate in Santa Cruz County at record rates, killing 42 people in 2021 and 39 officially so far in 2022, another record was set in September: 82 overdoses, spread out more around the county than usual. Public health officials noted the correlation and Lookout sought opinion from others about how the sweeping of a homeless encampment like the Benchlands in a county that lacks adequate addiction and mental health services can lead to “poor outcomes.”
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As Santa Cruz County’s deputy health officer and its director of emergency medicine, Dr. David Ghilarducci’s job is to protect lives in this community.
Even — and perhaps especially — its most vulnerable lives.
It’s why, as he compiled data in advance of last week’s annual countywide meeting on drug use trends, what he spotted had Ghilarducci diving down rabbit holes, looking for answers: A September spike of 82 overdoses was the highest one-month total he’d seen.
He used the county’s new mapping tool to track overdoses in real time to create a heat map for that September time span. It showed that overdoses had been less concentrated in downtown Santa Cruz than normal and were suddenly seeping out from the typical downtown nucleus and occurring all over the county.
What did it mean?
“This is just a theory,” Ghilarducci said. “But that’s about the time the Benchlands began to close, right?”
The City of Santa Cruz stands by its decision to clear the deteriorating downtown homeless encampment at San Lorenzo Park in September and October before the rainy season began, offering residents shelter at several other locations. A city spokesperson also told Lookout there is no proof of a correlation between the Benchlands breakup and September’s rash of overdoses.
More Benchlands coverage
But the overdose spike shortly after the Benchlands clearing began raises important public health questions about the methods of displacing those with serious substance-use disorders in a way that doesn’t put them in perhaps even greater danger.
It also highlights concern over whether the city and the county have adequate resources to deal with the chronic homeless population’s serious addiction problem — the ones most vulnerable to overdose and possible death.
That’s particularly true at a time when county data shows the number of fentanyl overdose deaths in 2022 is on pace to surpass the record-breaking numbers of 2021. That and other concerning revelations were in the spotlight during the county’s fifth annual drug-trends presentation by Ghilarducci, coroner’s examiner Dr. Stephany Fiore and SafeRx’s Rita Hewitt and Dr. Jen Hastings last week.
When the annual point-in-time count survey was released in August, it showed a large increase in the most vulnerable populations who suffer from disabilities: seniors, veterans and those experiencing mental health and substance use issues.
Many among the unhoused population — the vulnerable group of hundreds living outside during this cold, wet December — struggle with serious substance-use disorders and untreated mental health conditions. According to the city, of the 217 Benchlands residents given notice of the encampment’s closure, 68 accepted shelter — a rate of about 31%.
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The unhoused population is living an already vulnerable existence in one of the most dangerous moments to consume illicit street drugs America has witnessed. The ongoing fentanyl crisis — which Lookout has been following closely and which a Washington Post analysis estimates is killing 196 Americans daily — is now the leading cause of death for those between the ages of 18 and 49.
The state of California is beginning to treat it like a crisis, in October forming a fentanyl-abuse task force and last week announcing $12 million in grants available to nonprofits, schools and other groups tackling opioid use among young people.
The scientist in Ghilarducci knows there won’t be data to directly connect the Benchlands breakup to overdose numbers. But he is the county’s top proponent for introducing medically assisted treatment (MAT) to opioid addicts — buprenorphine has supplanted methadone as the primary tool to reduce painful cravings and withdrawal symptoms — on the street and in emergency rooms.
Therefore, Ghilarducci understands the practical challenges an opioid addict faces while trying to safely use. Overdose is easy given the strength and prevalence of fentanyl, either intentionally used or disguised as an additive in most street drugs. Narcan can be tough to come by and requires a buddy system to be effectively administered.
“It might be that by breaking up the community,” he theorized, “that they’re more isolated.”
Isolation with a drug as easy to overdose on as fentanyl can be deadly. It’s why “Never Use Alone” has become a prominent advocacy campaign. And, as Ghilarducci notes, it will be the fatality numbers — still many months from being finalized by Fiore — that might ultimately tell the harshest story.
“The reported overdose numbers may actually be low since I suspect there are many cases where two people are out there using together, Narcan is needed, but it never gets to a point where 911 is called,” he said. “If that theory holds, I would expect we’d see more fatalities due to the breakup of the Benchlands.”
‘There’s no Narcan station anymore’
No one is claiming that the Benchlands was a safe living space by any reasonable standards. But the encampment did provide a centralized location for Narcan, also called naloxone, the opioid disruptor nasal spray that acts as a lifesaving fire extinguisher during what experts are calling a fentanyl pandemic.
“As Dr. G says, causality is tough,” said Rita Hewitt, who helps lead the county’s primary drug safety coalition, SafeRx. “But we know people have been displaced and there’s no Narcan station anymore like there was at the Benchlands. You could walk right up and get it. Now finding it can be touchy, spotty.”
Hewitt says the fact that the presence of Narcan, and its use, have become so necessary is a testament to the toxicity of all street drugs right now. And it’s the same supply chain whether you’re unhoused with a substance use disorder or an experimenting teenager.
“There’s a risk in everything right now,” she said, referencing the story of an 18-year-old from Boulder Creek who had recently moved out of the county with his family before dying from a lethal dose of fentanyl. “You may trust your drug dealer, but he may be getting a bad batch.”
‘They don’t want to die‘
Denise Elerick of the Harm Reduction Coalition of Santa Cruz County cites research showing that sweeping out encampments — a statewide movement set in motion from Sacramento — is not good for keeping lives safe or the spread of disease.
“People feel better when they don’t have to see these problems,” she said. “But moving people out of the Benchlands hasn’t solved anything. It’s just moved the problems elsewhere.”
Elerick takes heat from public officials for her insistence that drug addiction be treated like a disease.
But many others in the worlds of public health and local medicine recognize the work she’s doing to remind people that everyone on the street didn’t end up there by choice and that they are someone’s son, brother or uncle.
Even if they chose not to relocate to one of the locations offered by the city, she said, “They don’t want to die. They don’t want to freeze. They want access to services.”
Elerick attended last week’s drug presentation and said she hopes Fiore’s data helps elevate the level of concern “not just for those who overdose in houses, but those it’s happening to in the unhoused population, too.”
Elerick and Hewitt also said those running the primary outlet presented to Benchlands residents — the armory at DeLaveaga Park — are having problems dealing with the substance-use disorders they’re seeing.
“The staff up there is really stressed — they’ve got 135 people, a lot of them are using drugs and they’re not sure how to handle it,” Elerick said. “It’s a big challenge because the organization that’s running it, the Salvation Army, is very Christian-based and is not very harm reduction-oriented. That makes it very challenging to deal with this population.”
Erika Smart, the city’s communications manager, confirmed that drug use is not allowed at the armory and “there is a process for surrendering substances in possession upon entering.”
‘We don’t have a safe space for people to go to’
Smart said the city rejects the notion of any connection between the closure of the Benchlands and recent overdoses: “There is no justification to make that claim. There is a opioid epidemic across the nation and Santa Cruz is not immune to that crisis.”
But that doesn’t mean Santa Cruz is equipped to properly help its most vulnerable citizens enduring mental health and addiction emergencies.
“That’s lacking in our community,” said Shebreh Kalantari-Johnson.
When she finally walked through the Benchlands to see it up close, the Santa Cruz city councilmember said it became immediately clear that the situation there wasn’t OK.
“It was pretty dramatic what was going on in there — tents where women were getting drugged and raped, prostitution happening, drug deals happening and ODs happening,” she said. “So I don’t think the breaking up of the Benchlands put people at an increased risk of partaking in unsafe behaviors.”
At the same time, Kalantari-Johnson acknowledges that there aren’t adequate services available to help those who have reached a point of crisis and desperately need it.
“We don’t have a safe space for people to go to,” she said. “We don’t have a facility where folks can stabilize, whether it’s mental health psychosis that they’re experiencing or it’s drug addiction.”
What isn’t lacking, she believes, is an understanding that addiction is a disease and that the people suffering on the streets deserve adequate medical care. Separating that knowledge from how one feels, though, can be tricky.
“I do think we are losing our compassion because we have reached our limits,” she said. “Intellectually people understand it, but then they wonder, ‘Why isn’t what we’ve been doing working?’”
‘Dispersed to the wind’ leads to ‘poor outcomes’
Informed of Ghilarducci’s overdose data, Don Lane was saddened but not surprised. The lessons learned from such situations are important, says the two-time Santa Cruz mayor and affordable housing and homelessness advocate.
He echoes Kalantari-Johnson’s belief that the lack of a centralized location for those with dire needs to get help and stabilize is the biggest one learned through the unwinding of the Benchlands.
“I think it speaks to the point that having people in select places with some resources is better than just having people dispersed to the wind, where there aren’t resources,” Lane said. “You have poor outcomes and poor health when people are completely on their own without resources.”
While the lawless nature of the Benchlands was becoming its own liability for the city, what it meant for many as a community and safety net underscores the need for better versions of what it provided, Lane said.
“Even though, yes, people were there looking for their next fix, it did provide somewhat of a safer environment for them because they were in a known place and there were resources available to them,” he said. “There were outreach workers there, trying to engage on substance-use disorder issues. The Benchlands was a little too loose for people’s taste, but it did work for some.”
What needs to happen? There need to be more facilities and resources that treat addiction and mental health afflictions like other diseases, Lane said: “And that’s a community attitude problem more than anything. I think the people in government are more amenable to this than many in the community.”
One small victory came from South County last week: The Sí Se Puede Behavioral Health Center was awarded a $9.36 million state grant to update and expand facilities at one of the state’s first bilingual recovery centers.
Local experts agree that it will take a lot more of those victories countywide to catch up to the ongoing need.
Kalantari-Johnson said the communication and synergy between the city and county — a longtime challenge — continues to improve. But it still comes down to an amount of funding that matches the problem, and there is much work to be done in securing what’s needed and allocating it effectively.
“Population-wise we are a small community, but we have big-city problems. That has really shifted the past decade and the funding hasn’t kept up,” she said. “We need more treatment beds and more resources in general. We are a caring community but there is a cognitive dissonance because what we’ve been doing hasn’t worked.”