Drug overdose deaths in California involving the potent synthetic opioid fentanyl increased 45% between 2020 and 2021, but it wasn’t just San Francisco contributing to that spike.
Fentanyl-involved overdose deaths also increased in the smaller and more rural counties of the state. In Butte County, for example, the number of fentanyl overdose deaths jumped sevenfold from just six in 2020 to 42 in 2021, according to preliminary data from the California Overdose Surveillance Dashboard.
As fentanyl’s influence grows beyond the state’s largest cities, where treatment and prevention resources tend to be most concentrated, communities coping with the swell in the death toll must adapt to a new reality — one in which the drug they’re dealing with is much more potent and lethal.
The risk and dangers of fentanyl are not yet as widely known as other drugs, said Monica Soderstrom, Butte County’s health division director, which is especially alarming given how fentanyl is known to be sold mixed with other drugs or as counterfeit pills. “That’s definitely something that poses a different risk with fentanyl,” she added.
Where fentanyl has become available, spikes in overdose deaths have often followed. Trafficking of the drug, and synthetic opioids in general, has been declared a national security emergency by the White House.
Until recently, the fentanyl crisis in California has been concentrated mostly in the state’s largest cities — particularly in San Francisco, where the mayor declared a state of emergency over skyrocketing overdose deaths. Fentanyl-involved overdose deaths have been climbing in the city since 2017 until last year, when dozens fewer people died than the year before.
It’s just in the past few years that some of the more remote parts of the state have begun to see fentanyl’s deadly impact.
“A number of us started seeing in the data back in 2019 fentanyl overdoses really rise and essentially all overdoses rise,” said Jill Phillips, a registered nurse with the Shasta Substance Use Coalition, which brings together dozens of organizations to work on overdose-related issues.
In 2019, there were just 18 opioid overdose deaths in Shasta County, six of which involved fentanyl. Two years later, the tally would balloon to 47, 41 of them involving fentanyl. The data was clear, she said. “So we knew this was a problem.”
Phillips said Shasta’s street outreach teams started to notice in recent years that it was becoming increasingly difficult for patients to get heroin. “Then it started to be that essentially fentanyl completely replaced heroin in the community,” she added.
It was also in 2019 when many people in the neighboring Butte County began to better understand the deadliness of fentanyl.
In January 2019, police and emergency personnel responded to a mass drug overdose at a house in Chico, the largest city in Butte County. Twelve people, most of whom were in their 20s, were found with life-threatening conditions and taken to the hospital. The young people had used fentanyl in combination with another substance, according to media reports at the time.
Of the 12 people, just one died, Soderstorm, the Butte County health division director, said. First responders were equipped with naloxone and knew what to do.
Even before fentanyl began killing people there, health officials and first responders had experience working on harm reduction and treatment efforts, but with more of a focus on issues related to prescription opioid use, she said. Fifteen out of the 17 opioid overdose deaths in Butte County in 2018, when there were no fentanyl overdose deaths, involved prescription opioids.
Fentanyl’s growing influence required them to shift gears, including by increasing naloxone and fentanyl test strip distribution, and adapting their outreach efforts to include better messaging warning people of fentanyl’s risk, the Butte County health officials said. The county health department has produced ads in nearly every possible format — billboards, newspapers, buses and even business card-sized information cards that can fit in a wallet.
Another important aspect of the response has been to improve access to medication-assisted treatment, or MAT, said Anna Zepeda, a public health education specialist with Butte County. Doing so includes making sure the staff at clinics are not treating patients with substance use disorders with stigma, but empathy. “I think stigma is one of those things that is still prevalent,” she said.
Butte and Shasta counties both have licensed treatment programs in their counties. But not all counties do. Twenty-one counties — all of them rural or semi-rural — have none, data from the California Department of Health Care Services shows.
Among the counties that do not have licensed narcotics treatment programs are Calaveras and El Dorado, where death rates have significantly increased. Calaveras County had six fentanyl-involved deaths in 2021, preliminary data shows, compared with just one the year before. El Dorado went from 10 deaths in 2020 to 19 in 2021.
But state and federal grants aimed at reducing overdose deaths may soon help some counties create new access points. For example, The U.S. Department of Health and Human Services announced a $10 million grant in June of this year specifically to aiding rural communities to expand substance use disorder treatment.
Educating the public about fentanyl remains one of the biggest challenges in preventing further deaths, Soderstrom of Butte County said. That includes not only helping people who use drugs understand what they’re dealing with, but also educating the community as a whole about the underlying causes of substance use disorders.
“I personally feel it’s all about trust and building relationships, and knowing that so many people who do use substances come from a background that includes trauma,” she said. “We’re here to be with them and to help provide that support when they’re ready for it. I think that’s what is going to make a difference in our community.”
Yoohyun Jung is a San Francisco Chronicle staff writer. Email: yoohyun.jung@sfchronicle.com Twitter: @yoohyun_jung
