Think your kid is spending time on Snapchat just sharing funny photos or chatting with friends? Maybe not: It’s also where kids can connect with dealers to buy drugs that contain fentanyl, which Fresno County officials say is the No. 1 cause of opiate deaths here.
Teens and young adults are buying and sharing counterfeit Xanax and Percocet pills that may be laced with fentanyl, and it only takes a tiny amount — the equivalent of two to three grains of salt — to cause a fatal overdose.
Fentanyl overdoses are contributing to the rapid rise in overdose deaths in Fresno County in recent years.
There were 123 in 2018, 164 in 2019, and 254 in 2020, said Dawan Utecht, the county’s Behavioral Health director.
Getting a handle on how widespread the misuse of fentanyl is will not be easy because of a lack of rapid testing capability as well as limited reporting capacity, said Dr. Rais Vohra, Fresno County’s interim health officer.
Although 60 fentanyl overdoses have been reported by “prehospital partners” in Fresno, Madera, Kings, and Tulare counties just since April, Vohra said many more likely have occurred but were undocumented. Of the 60 overdoses, 36 were revived with naloxone, he said.
Officials say the doubling of overdose deaths in Fresno County is due in part to the increase in availability of fentanyl combined with problems brought on by the pandemic — social isolation, economic impacts, the trauma of losing loved ones.
Getting the Word out
Because drug dealers are specifically targeting teens and young adults through social media apps, community agencies, educators, and law enforcement officials are combining forces in Fresno County to get the message to kids and their parents about the dangers of fentanyl and what services are available, both for overdoses as well as drug treatment.
“The difference between what went on in the ’60s and the ’70s and the ’80s and the ’90s is that the drugs that people did then didn’t kill them instantaneously, and they didn’t have the ability to kill them the first time” — Fresno County District Attorney Lisa Smittcamp
Fentanyl is an opiate that can be legally prescribed for pain treatment. When used as an illicit drug, it produces a high more intense than heroin or other opiates. Because it’s odorless and tasteless, users can’t tell how much they may be ingesting.
And because it’s created in unregulated laboratories, there is no guarantee of consistency. Young people who split a fentanyl-laced pill at parties might be getting a portion with either all or none of the fentanyl, and they won’t know the difference until they start overdosing.
Education efforts are being at directed specifically toward parents, some of whom may have more relaxed attitudes about drugs because of their own youthful experiences.
District Attorney Lisa Smittcamp says parents may recall their own youthful experiences with beer or marijuana and wonder why such a fuss is being made over fentanyl.
But they need to know that “the difference between what went on in the ’60s and the ’70s and the ’80s and the ’90s is that the drugs that people did then didn’t kill them instantaneously, and they didn’t have the ability to kill them the first time,” Smittcamp said.
Decriminalized Drug Laws
Because drug-related criminal offenses have been downgraded in California in recent years, state prosecutions that end in convictions still wind up with little jail or prison time for the defendant. If there is enough evidence to warrant a federal prosecutions, county prosecutors hand over those cases because of the potential for stiffer sentencing, she said.
One such case being prosecuted by the U.S. Attorney’s Office involves a pharmacy tech accused of selling fentanyl-laced counterfeit pills that resulted in five New Year’s Eve overdoses, Smittcamp said.
There have been efforts to beef up state laws that would enable prosecutors to file murder charges against drug dealers when overdoses result in death, similar to what some defendants with prior drunk-driving convictions face if they kill someone while driving drunk, she said.
But Smittcamp says she recognizes more education is needed to open eyes and minds in the community about the dangers of fentanyl.
“These drugs are so prevalent today and they’re being produced in such mass that we cannot investigate or prosecute our way out of this problem,” she said. “We have to educate the community, and that is parents and users, teenagers, young adults, grandparents, teachers, educators, the health care industry.”
Taking New Approaches
Many agree that the “Say No To Drugs” and Red Ribbon Week activities of the past aren’t doing the job. County health and education officials say they are taking a more focused approach to reach their target audiences.
“If I can get that to happen, where a parent is having a conversation with their child about it, I think we’re moving in the right direction.”– Fresno County Superintendent of Schools Jim Yovino
The county is preparing to roll out a billboard campaign, Utecht said.
Meanwhile, the Fresno County Superintendent of Schools office has produced short public service announcements aimed at kids or parents that are running in movie theaters and on social media platforms such as Snapchat and TikTok, Superintendent Jim Yovino said.
Senior students volunteered to watch videos and evaluate them for impact, and the office is using geofencing to target specific videos to specific audiences, Yovino said.
It can be hard to connect with parents, who are often inundated with materials coming from schools and tend to tune out messaging that they think doesn’t or won’t apply to their children.
“On our own social media posts when we post them, I’ll get responses back, saying ‘I showed it to my 12- year-old, Jim. And I just want to let you know that the question they asked was, what is fentanyl?’
“And, you know, if I can get that to happen, where a parent is having a conversation with their child about it, I think we’re moving in the right direction.”
What to Watch for
Some of the things parents should watch for include behavior changes in their kids — such as changes in dress, friends, and music, said Flindt Andersen, who heads a Fresno-area drug counseling nonprofit.
“When somebody is in an overdose, you have seconds, not minutes, to get to somebody” — Flindt Andersen, president and CEO of PAIN — Parents & Addicts in Need
If kids are awake overnight and sleeping during the day, that’s not normal, he said.
Andersen recounted how one Clovis Unified parent checked on her 19-year-old son at 9 a.m. and he was awake and alert. She knocked on his door at 1 a.m., got no answer and figured he was sleeping. When she heard sounds from his room around 4 a.m. she knocked again but didn’t enter that time either because she thought he was asleep and didn’t want to disturb him. When she checked on him at 11 a.m. later that morning, she found him dead. The coroner later said he had probably died around 3 a.m.
If parents suspect drug use, they need to open their kids’ bedroom doors — and break them down, if need be — to make sure their kids aren’t overdosing, and be prepared to give them treatment if they are, said Andersen, founder and president of Parents & Addicts in Need.
He says Narcan, a form of naloxone administered through a nasal spray, should be as common in homes as a fire extinguisher because friends and family parents must act quickly to deliver the life-saving dose in the event of an overdose. In some cases, even a few minutes before first responders can arrive with naloxone is too long.
“When somebody is in an overdose, you have seconds, not minutes, to get to somebody,” he said. “The majority of the time, if you get there soon enough you will be able to bring that person out.”
Just in the past few months, at least three families in Fresno and Clovis have lost children to fentanyl overdoses “that we know of,” Andersen said.
If naloxone is not covered by a family’s health insurance it can cost $140 to $180 per dose, Andersen said. So his organization, which on Thursday was recognized by Fresno Assemblyman Jim Patterson’s office as 2021 Nonprofit of the Year, has been authorized to provide training and free Narcan doses that can be stored indefinitely at home.
“But we don’t typically talk about mental illness or substance use disorders because in our society, that’s a shameful thing to talk about, because people have ascribed it to poor moral character, bad choices.” – Fresno County Behavioral Health Director Dawan Utecht
Utecht said she has naloxone in her medicine cabinet, and she agrees with Andersen about having it on hand at home just in case.
Some parents may be reluctant to store it at home, concerned about what their own children or others might think.
That needs to change, Utecht said.
“Another thing that really helps us is normalizing the conversation about it,” she said. “You know, if you have a loved one that has cancer, you don’t mind talking about it. Oftentimes you’ll see on social media different reports about all kinds of health care conditions.
“But we don’t typically talk about mental illness or substance use disorders because in our society, that’s a shameful thing to talk about, because people have ascribed it to poor moral character, bad choices. But the reality is it’s a brain disease that needs to be treated as such.”
The Path Forward
The community task force that was formed to address fentanyl misuse will need improved data so officials have a better understanding of how significant the problem is and where to target resources to screen and treat patients and improve education efforts, Vohra said.
“If every person who needs access to recovery resources and medication were able to get it, the opioid epidemic would be substantially less deadly than it is now.” — Dr. Rais Vohra, Fresno County interim health officer
He sees prevention as a two-pronged effort, starting with focusing on educating younger children and adolescents as well as at-risk adults, teaching them how to develop positive ways to deal with anxiety and depression instead of self-medicating with opioids. Through secondary prevention, people struggling with substance abuse need access to recovery resources.
“If every person who needs access to recovery resources and medication were able to get it, the opioid epidemic would be substantially less deadly than it is now,” he said in an email to GV Wire.
Educational efforts aimed at younger children are being augmented with the addition of behavioral health clinicians on school campuses across Fresno County, hired by funding provided through Yovino’s office. Students who might be suffering from trauma, anxiety, or mental illness have someone to turn to for help at school.
Those same clinicians can help students develop the coping skills and mechanisms that will keep them from turning to illicit drugs to ease their anxiety or depression as they grow older.
“We started with the mental health focus, but always with the intention that we would layer on our substance use disorder, prevention and services as we got this partnership up and going,” Utecht said.
Yovino said he wants to take that partnership a step further and add a clinician at Valley Children’s Hospital. Parents of children who come to Valley Children’s because of an overdose would get assistance from someone who would serve as a liaison between the family, medical providers, and the school, he said.
Here are websites with information about fentanyl and Fresno County’s 24-hour hotline.
Resource page for information on fentanyl, opioids, and naloxone and other resources: www.opioidsafefresno.com
Information that parents and caregivers can use: www.havethetalkfresno.com
Regional resource: https://centralvalleyopioidsafety.org
The best source for current public data associated with fentanyl use is the California Opioid Overdose Surveillance Dashboard: https://skylab.cdph.ca.gov/ODdash/
Synthetic opioid related data can also be found on the Healthy Fresno County Dashboard: http://www.healthyfresnocountydata.org/
People can call the 24/7 access line at 1-800-654-3937 for information about treatment for substance use disorder or mental health. They will speak to a live person who will connect them to the right services. If they are looking for medication assisted treatment geared for opioid users they can also reach out to the Bridge MAT Program at (559) 250-4822.