On the frontline of the opioid epidemic in Sonoma Valley

Editor’s note: The is the second in a series that explores the opioid pandemic in Sonoma Valley.

As the scope of the opioid epidemic has grown deadlier and larger, particularly in the western United States, first responders and health-care workers are fighting what can sometimes feel like a losing battle.

Law enforcement agencies are introducing new methods to respond to drug overdoses and save victims, meanwhile health-care workers are battling two simultaneous public health crises.

Opioid-related deaths in Sonoma Valley more than doubled last year, according to data from the county Coroner’s Office. These deaths occurred most often in the City of Sonoma among older white individuals — a group less commonly associated with hard drug use.

The increase is part of some long-standing issues and some emerging trends that have made Sonoma County an “opioid county,” said Sonoma County Sgt. David Boettger. Mass prescriptions of Oxycontin and other highly addictive opioids, the influx of the illicit and highly potent drug fentanyl into the drug supply, and the pandemic obscuring the focus away from the opioid epidemic all worsened the situation.

“There was also quite a bit of economic hardship during the pandemic,” said Dr. Paul Cristo, a professor of anesthesiology at John Hopkins University, who speaks nationally about the epidemic. “Job loss. Underemployment... Either one of those or combined led to a lot of coping strategies and an increase in stress, and I think that's that led a lot of people to use illegal opioids.”

The Sonoma County Sheriff’s Department trains officers on how to use Narcan, which has the opioid-reversal agent Naloxone that can stop an overdose if administered quickly. Fentanyl started appearing more often in Sonoma County in 2018, Boettger said. That was when the training began.

“The sole purpose we got into obtaining all the Narcan for law enforcement was because of the dangers of fentanyl,” Boettger said.

But fentanyl is mixed into a variety of drugs now, Boettger said, from methamphetamine to heroin to counterfeit pills. Sonoma County even has a name for its local brand of fentanyl and heroin: Red Rock.

“We already had Narcan implemented, then we realized through testing procedures that this drug is not only heroin, it's fentanyl mixed with heroin,” Boettger said.

Boettger said police departments don’t track Narcan deployments because Narcan can be administered by paramedics, too. But a program called ODMAP, which started as a pilot program in three East Coast counties in 2017, is coming to the Santa Rosa Police Department.

ODMAP aids law enforcement’s response to overdose calls by providing real-time information about the incident, as well as information about where overdoses are occurring and any spike in cases in the area, allowing them to more effectively address the needs of victims.

“But at the crux, we were tracking overdoses, but only fatalities so it would be months before we were able to confirm, right?” said Jeff Beeson, deputy director of the Washington/Baltimore High Intensity Drug Trafficking Area program, who added that health care officials and law enforcement began to form partnerships to combat the opioid crisis in 2016. “If you had this emerging threat, which in 2016 fentanyl was becoming particularly bad on the East Coast, you didn’t have enough information to respond in time to save lives.”

So Beeson and Tom Carr, the executive director of the Office of National Drug Control Policy’s Washington/Baltimore HIDTA program, created an application to perform real-time tracking of overdoses with the premise to “create a system where first responders... could upload info to an overdose as they were responding to it.”

The program is still being fitted for the Santa Rosa Police Department, but once implemented it would be able to provide “spike alerts” to law enforcement if overdoses surge, Beeson said, in case a new shipment of drugs entered the area or a bad batch of illicit drugs was being sold.

To slow the number of addictions, new regulations have been put in place by the state to limit doctors’ ability to prescribe potentially addictive drugs, said Dr. Jasper Schmidt, the medical director of emergency medicine at Sonoma Valley Hospital. Community health centers, meanwhile, partner with addiction services to provide the long-term, in-depth care many addicts need to get healthy.

Sonoma Valley Community Health Center has been partnered with Pura Vida, a rehabilitation program in Santa Rosa, for two years. While some rehabilitation facilities can cost $30,000 dollars for a month of treatment, Pura Vida’s Chief Administration Officer Ben Pahlavan said, Pura Vida offers “affordable” treatment that seeks to ensure that addicts do not leave treatment before they are ready.

“We have two different programs if journey to recovery services,” Pahlavan said. “We have Pura Vida recovery services and Pura Vida sober living. They’re both completely separate and autonomous programs, but a lot of times they work together and in conjunction with each other.”

Recovery services help addicts detox, manage their withdrawal and other inpatient and outpatient services. Getting off drugs is the first challenge. Staying off drugs is the challenge that doesn’t end.

Getting sober was made all the more difficult by the pandemic, health professionals said. The pandemic exacerbated issues in accessing prescribed opioids because new regulations demanded patients meet in-person with a physician to gain a prescription, Schmidt said. That wasn’t easy in lockdown.

COVID-19 also “shut down community self-help resources for our local community, meaning there was no more indoor a meeting that people can go to for a safe haven,” Pahlavan said.

“The need for (addiction) services has increased since 2017 seemingly, and the severity of how acute these patients are is seemingly increasing as well,” Pahlavan said.

The state government has battled the opioid epidemic by providing grants to medical entities to treat addiction, said Schmidt.

“With the CA Bridge grant, (Sonoma Valley Hospital) got training for our providers and we got a substance abuse navigator to really help shepherd people through into treatment programs,” Schmidt said. The grant was for $100,000.

Anti-narcotic dependency drugs, like Suboxone that is used at Sonoma Valley Hospital, are prescribed so addicts don’t have to go “cold turkey” with their addiction.

“Converting them to something like Suboxone, which we can start in emergency department, and then transition them to some kind of online or even local treatment program where they can continue therapy — that is a real win,” Schmidt said.

The opioid epidemic is not ending anytime soon. Fentanyl is becoming more prevalent and even attempts to improve the epidemic can inadvertently cause more issues, like prescription regulations leading addicts to turn to street drugs to get their fix.

One of the keys to resolving the crisis, substance abuse clinicians and health care professionals said, is making resources easily accessible and available — and to intervene whenever there’s an opportunity to do so.

“It may be someone who has been prescribed Oxycodone for a long time,” Schmidt said. “And they come in in withdrawal and then you have a brief opportunity to say to them: This is opiate dependency.”

Contact Chase Hunter at chase.hunter@sonomanews.com and follow @Chase_HunterB on Twitter.