The pain under the pandemic: Opioid deaths double in Sonoma Valley

Editor’s Note: This is the first in a series that will explore the opioid crisis in Sonoma Valley.

While the pandemic dominated headlines last year, the opioid epidemic burned just beneath the surface, killing twice as many people in Sonoma Valley in 2020 compared to recent years.

Records obtained from the Sonoma County Coroners Unit show that 10 people suffered opioid-related deaths in Sonoma Valley in 2020, up from an average of 4.6 over the prior three years. That gives the area an opioid death rate of 26 per 100,000 residents. For comparison, if Sonoma Valley’s per capita rate was measured against all of California’s counties, it would have the third-highest rate of opioid deaths in the state, according to the California Department of Public Health (CDPH). Sonoma County, meanwhile, has the sixth-highest rate out of the state’s 58 counties.

The coroner’s data reveals a number of truths about the local opioid epidemic. Of the 26 deaths listed between January 2017 and February 2021, only one person was Latinx — the other 96% were white. While the Sonoma city limits contain about one-third of the Valley’s population, the city saw 88% (23/26) of the region’s opioid-related overdoses.

Spurred by a pandemic that harmed the financial well-being and mental health of many Sonoma residents, aided by the pharmaceutical industry which pressured physicians to prescribe addictive medicines, and worsened by the addition of fentanyl in hard drugs, the opioid crisis quietly grew in Sonoma.

“A lot of people suffered emotional hardship during the pandemic,” said Dr. Paul Cristo, an anesthesiologist with Johns Hopkins University who is focused on telehealth services for those seeking treatment with addiction, which has been on the rise since the pandemic set in. “They saw friends and family members get sick with the virus, hospitalized and sometimes die.”

In addition to the economic turmoil that some families faced, the pandemic spiked many people’s level of stress, he said, which led some to seek unhealthy coping mechanisms.

“Opioids typically provide a sense of relaxation and euphoria,” Cristo said, an attractive outlet in times of tension.

At Sonoma Valley Hospital, Dr. Jasper Schmidt said that the Sonoma community also consumed more alcohol per person in the pandemic, and in higher amounts. But others sought a stronger high.

“I can think of a few patients that I've seen over the last year who it's pretty clear was a potential overdose,” said Schmidt. “You can tell because fentanyl... doesn't last as long as pure morphine or even heroin.”

Schmidt saw this epidemic in its early days, when pharmaceutical representatives entered his medical classroom telling a new generation of doctors about pain medication that was “nonaddictive.”

“Starting way back in the ’90s, there was a big push from the industry to really change the way hospitals and physicians manage pain,“ Schmidt said.

Like heart rate and blood pressure, pain was pushed as a vital sign to monitor in patients, he said. And if a patient left the hospital before their pain had subsided, “You failed as a physician.”

“Pharma people who were sponsored by Big Pharma were coming into medical schools and telling students that things like OxyContin weren't addictive,“ Schmidt said. ”Or if they were used appropriately as prescribed, people weren't going to develop dependency issues.“

Instead, patients looking for pain relief often became addicts.

The maker of Oxycontin, Purdue Pharma, was sued by state and local governments, tribes, families and individuals who suffered due to the highly addictive painkiller. Ultimately, the company was dissolved and forced to pay $4.5 billion to the victims of the addiction epidemic it helped fuel.

Nearly 600,000 people have died as a result of the opioid epidemic since 1999, according to the Centers for Disease Control and Prevention (CDC). Deaths from opioids have increased six-fold since 1999. California saw an estimated 5,363 such deaths in 2020.

There’s a second layer to this crisis in the form of synthetic opioids like fentanyl.

“From 2018 to 2019, the largest increase in death rates involving synthetic opioids occurred in the West (67.9%),” the CDC’s website says.

Between 2017 and 2018, none of the 10 local opioid-related deaths recorded by the coroner involved fentanyl. Since then, half of the overdose deaths recorded involved some amount of fentanyl.

Sgt. David Boettger said the Sonoma County Sheriff’s Department began noticing the change during its drug seizures around three years ago.

“We started seeing a specific type of heroin that had a different appearance to it,” Boettger said. “It had a different feel to it. It didn't have the typical heroin smell to it. And we're like, ‘What is this stuff?’”

It was dubbed Red Rock, a mixture of black tar heroin and fentanyl.

“It's quickly progressed. Now we don't see any heroin in this county,” Boettger said. “It's out there, but it's creeping across nationally where heroin here very soon will be obsolete, and it's going to be fentanyl only.”

Boettger said that fentanyl can be found in any neighborhood, rural or urban; any income, rich or poor; and any age, from 18 years old to 72 years old in Sonoma Valley, according Sonoma County Coroner’s data.

The increase in opioid deaths has happened, in part, because drug cartels created their own fentanyl to put in the drug supply, hoping to induce addictions with an opioid that’s 50-100 times stronger than morphine, Boettger said.

The high hits quicker and dissipates faster. Just a few granules of fentanyl are the difference between living and dying, Boettger said. But drug dealers don’t always know how much fentanyl is added into their drugs.

“We have had a handful of cases within the last year or so... where people thought that they were using methamphetamine, but it was actually fentanyl,” Boettger said.

Those who mistakenly take fentanyl can die instantaneously, Boettger said. Especially if someone is attempting to nasally consume (snort) a line of what they think is cocaine or meth, but is actually the powerful opioid.

Recently, more people with opioid dependence have turned to the streets. In an effort to quell the tide of addiction, regulations for prescribing opioids have become more stringent in recent years.

“The regulations are still really against prescribing opioids for patients who you haven't seen in person,” Schmidt said. “Patients who weren't seen in person weren't getting their usual oxycodone or hydrocodone or morphine prescriptions the way they had before.”

Sonoma County seems to be bucking that trend, with 270,435 opioid prescriptions filled in 2020, according to CDPH, for a rate of 417.8 prescriptions for every 1,000 residents. That’s more than double San Francisco, at 206 for every 1,000.

The policies that attempted to limit prescription drugs became a catalyst for people to head to the streets for their fix, Schmidt said.

COVID-19 showed how interconnected the world was, stopping ships in ports, shutting down entire industries like hospitality and interrupting international supply chains. But the ability to respond to one crisis can inhibit the response to another.

“Health care shifted and completely focused on COVID 19... It probably needed to,“ Cristo said. “At the same time, though, everything else, including the opioid crisis and addiction medicine services were sort of left by the wayside.”

Emily Charrier contributed to this report.

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