Forum: Facing Down Fentanyl
Ventura County is viewed statewide and nationally as an innovative leader in prevention work. So while the serious issue of the Fentanyl crisis has touched us here in our community, we are probably better positioned than many in dealing with it.
On September 27, 2023, our County CEO, Dr. Sevet Johnson, Ventura County Behavioral Health Interim Director, Dr. Loretta Denering, and County Supervisors Matt LeVere and Jeff Gorell, welcomed attendees to learn more about the fentanyl crisis in our county and what we are doing about it.
See the video of the forum:
Audience Questions and Answers:
Q: Doctors – All – So many people moved from heroin to fentanyl in recent years. Do you worry that there is something worse coming after Fentanyl? What’s next?
Fentanyl mixed with Xylazine is an emerging threat in the United States. Xylazine is an animal tranquilizer that is increasingly being found in the US illicit drug supply and linked to overdose deaths. We have seen only a handful of these cases in Ventura County to date.
Q: For D.A. – What can parents do and what can you do to change how easy it is for kids to use social media? Why can’t Snapchat be prosecuted or stopped?
It’s very important for parents to talk to their children on a regular basis about the dangers of drugs and the immediate threat in buying illegal drugs like fentanyl online. The United States Justice Department (DOJ) and the Federal Bureau of Investigations (FBI) announced earlier this year that they were investigating Snapchat over the possible use of their platform for drug sales, specifically targeting fentanyl-related instances. Snapchat has said it’s made operational improvements to detect and remove drug dealers from the platform and works closely with law enforcement and other groups in raising awareness of drug issues, fentanyl and counterfeit drugs. They say they have blocked search results for drug-related terms, redirecting Snapchatters to resources from experts about the dangers of fentanyl. People are still able to purchase these drugs online because drug dealers are creative in how they ‘outreach’ to users, including the use of emojis.
Q: What does Fentanyl look like? What are different types of use?
Powdered fentanyl looks just like many other drugs. They are available in different forms, including pills, powder and liquid. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs are laced with fentanyl.
[source, CDC Fact Sheet]
Q: I need to know how to find recovery houses that state insurance covers? Also need to hear how to find sober living houses so they can work and live there.
Recovery Housing is not an insurance benefit. However, VCBH currently contracts with Khepera House, who provides recovery housing for participants who are participating in outpatient SUD treatment. We have 14 beds for males and are hoping to expand this service in the next year to add beds for women as well.
Q: What population demographic is the most impacted by the use of Fentanyl and what is the % or whole number of deaths in said impacted population we know it impacts everyone, but what is the most impacted, and what steps are being taken to provide favorable outcomes?
Of the Opioid related deaths from 2022 and the first 6 months of 2023, the top 3 demographics in Ventura County by percentage are:
- Non-Hispanic White – 59.6
- Hispanic – 36.9
- Non-Hispanic African American – 3.5
Steps being taken for favorable outcomes include:
- Town hall outreach events
- SUS/Prevention Outreach with Schools
- Public Health/VCBH Collaboration for high-risk populations via Syringe Exchange Program and naloxone distribution/education
- Increased availability of naloxone across the county through VCBH Overdose Prevention Program and VCBH Access Line
- COAST Leads meetings which enhance interagency collaboration regarding this crisis
- Rx and Illicit Drug Workgroup meetings which folds multiple organizations working on the front lines of the opioid crisis into the broad initiative of preventing overdose across the county
Q: How much are people paying for Fentanyl? What is driving people to purchase/use Fentanyl? How can the faith community entity support in fighting Fentanyl? Where is Fentanyl being purchased/locations. You mentioned it’s growing in China or is it also being grown here?
Prices for fentanyl are broken down depending on weight and the area it is bought. Typical prices we see in Ventura County are approximately: $100 for a gram, $1000 for an ounce and $22,000- $24,000 for a Kilogram brick. Fentanyl pills vary on the amount bought, but generally it is about $1-$4 per pill when bought in bulk.
Q: We are at VCOE with all of you in the panel. I believe that prevention is one tool that could help many young people to stay away of drugs. We need the collaboration of VCOE and any agent to promote prevention. What is a strategy plan that our county is building for prevention?
The County of Ventura Behavioral Health has a Strategic Plan in place, and a division dedicated solely to Prevention. Our Prevention efforts are numerous, including outreach teams that are present in the community at health fairs and events throughout the year, distributing information about resources and naloxone kits. The strategic plan can be found at www.vcbh.org/VCBH_Strategic_Plan_At-A-Glance-English.pdf. They’re also out in the community giving presentations at schools on a regular basis.
We host community events, such as the ‘Facing Down Fentanyl,’ event at VCOE. As the liaison to Ventura County Schools, VCOE also has adopted a fentanyl prevention curriculum developed by “Natural High” that includes engaging lesson plans for students of all ages to learn about the current scientific findings on youth behavior, brain development, social norming, and substance abuse prevention. The latest research on prevention speaks to the power of “positive example” of engaging influential people (Tony Hawk, Kelly Slater and other professional athletes, musicians, artists) to share their story and how their true passion (healthy activities that uplift, motivate, and inspire) creates a “Natural High”. The curriculum includes opportunities for student storytelling, positive alternatives to drugs, tools for effective engagement, and the skills to a happy and successful life.
VCOE has been providing Natural High’s Fentanyl Toolkit to schools to learn about the lethal effects of fentanyl and illicitly manufactured pills.
Q: Why can’t someone go to mandatory rehab, if they can die?
Currently there is no law that allows for involuntary placement in an SUD residential program.
Q: Here in Ventura County, where is our greatest need? Where is our weakness and what can a person do to help alleviate that weakness?
Our greatest immediate need is to support high-risk populations across the county. This includes the unsheltered all over the county as well as zip-codes with disparities in social determinants of health. The long-term need is to increase awareness in parents and youth regarding the dangers of fentanyl and other illicit drugs.
Q: For Erik Nasarenko – Prosecution seems too lenient on drug dealers. What can be done to the smaller dealers, they seem to pay bail and be released.
While a defendant on sales cases can receive sentences of up to five years, the majority of “low level” dealers are not given the maximum sentence because aggravating factors do not exist when the quantity of drugs is “low.”
Typically, first time dealers will receive a sentence from a court of 180 days in jail and be placed on felony probation. Defendants can receive up to 50% credit on cases such as these because the crime is not a strike for “third strike” purposes.
Certainly recidivists and those who commit an additional crime while on probation will receive longer sentences and a court will take into consideration the circumstances of each case when imposing additional custody time.
Q: What barriers does the Sheriff’s department face in fighting our counties current crisis and what can the community do to help?
The biggest barrier to law enforcement in fighting this issue is our own state legal system. While law enforcement recognizes drug addiction and the behavioral and medical issues that go along with treating it, the current system allows for drug dealers to face very little if any consequences when they are arrested for selling these substances. Even when these individuals are arrested and prosecuted when they are selling narcotics or possess it for sale, the penalties are very minor, and they are usually back to their old ways of selling very soon.
The best thing the community can do is be aware and educated on the issues that law enforcement faces. If you see something, reach out and report it. Often we serve search warrants at residences and are approached afterwards by people who thought things were “suspicious” but never brought it up to law enforcement. The other thing is to make sure you are talking with your children about the dangers of drugs. Make sure you are aware of the people they hang out with and monitor who they are contacting on social media.
Q: San Francisco and other cities have utilized ‘street teams’ to go to where behavioral health and substance use disorders are highly prevalent. Are there any ‘teams’ in Ventura County? For example, if you know someone who is suffering, any team available to go to the individual as it is often difficult for the individual to ‘go get help.’?
Through our addiction medicine team, we have a program called Backpack Medicine. This involves medical and behavioral health doctors that fan out into the community – largely homeless encampments – to treat people abusing drugs and direct them to services.
Q: Is Fentanyl the same as crystal or is it different? What are the symptoms so I can see for kids?
Illegally made fentanyl is available on the drug market in different forms, including liquid and powder.
Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs are laced with fentanyl. NOTE: typically, ‘crystal’ refers to methamphetamine, to which fentanyl can be added, but the terms ‘crystal’ and ‘fentanyl’ refer to different drugs.
Q: Does Ventura County have inpatient rehabilitation places for people to go to if they are using opioids or Fentanyl?
Currently, VCBH has a contract with a residential and withdrawal management (detox) treatment provider located in Ventura County. Prototypes is a perinatal residential and withdrawal management treatment provider offering services to women and children. Currently, males that are assessed to need residential or withdrawal management levels of care, receive services at Tarzana Treatment Center in Los Angeles county. VCBH is actively seeking opportunities to contract with additional residential providers in county.
Q: Why as parents are we not allowed to obtain information or help find treatment for our children, 13 and older? Please help us parents not lose our children and the rights as parents to be able to help them get into treatment for substance use. Why do some schools ignore parents when we want to report drug use or drug incidents?
There should be no barrier to parents obtaining information or treatment for children 13 and older. The county website www.venturacountyresponds.org has information for parents and everyone interested in learning about treatment options, medication safety and more.
Q: Why is it so easy to get dangerous drugs and so hard to get the M.A.T. you just talked about? Can I just get it from my regular doctor?
There are many ways for individuals to receive MAT. All VCBH clinics and contracted residential programs provide Medications for Addiction Treatment (MAT). If an individual is already in treatment, they may ask to see a doctor to be assessed for which medication is right for them. If someone is not already in treatment and would like information or speak to a provider about MAT they can call the Access Line at 1-844-385-9200.
VCBH also contracts with Narcotic Treatment Providers (NTP), that dispense Methadone and Suboxone. They are Aegis Treatment Centers and Western Pacific. To get connected with a NTP, they may call the NTP provider, or they can call the access line at 1-844-385-9200 and a care coordinator can assist with connecting you to the provider.
There is an Addiction Medicine Clinic through Ventura County Medical Center that offers MAT to patients that generally have a co-occurring secondary mental health or physical health complication. In addition, because the x-waiver requirement to prescribe buprenorphine (the primary ingredient in Suboxone) has been lifted, ANY active medical doctor or psychiatrist can prescribe MAT in an outpatient setting.
Q: For Sheriff – What happens in the schools when children bring drugs to school? Or to the parents? Is anyone charged or in trouble for it?
If children are caught in school with drugs, they can be arrested, and the investigation will probably reach back to the household with Child and Family Services involved. Juvenile justice is a sensitive topic, with the focus on rehabilitation. That said, the criminal consequences are never severe. If the investigation shows that adult members of the household are the ones supplying the juvenile with drugs, they will be arrested. This is one case where California law does provide enhancements for prosecution.
Q: Are drug addiction places treating fentanyl?
Yes. As a powerful synthetic opioid, a fentanyl use disorder is typically treated with MOUD—Medication for Opioid Use Disorder. Several local providers offer services which include a treatment protocol using buprenorphine, along with counseling and other services which depend upon the level of care needed. Visit www.VCBH.org for our clinic service locations.
Q: How easy or how hard is it to get into treatment for any type of substance?
To access VCBH substance Use Treatment Services, call our Access Line at 1-844-385-9200. Individuals interested in receiving services will be given a brief screening related to current and history of use with alcohol and/or substance use. The screening will provide a pre-determined level of care and an appointment will be scheduled at a VCBH outpatient clinic or with an assessor if the screening indicated that withdrawal management (formally known as detox) or residential services may be warranted. VCBH Substance Use services offer a continuum of care, and through the screening and assessment process, medical necessity and Diagnosis is established to determine level of care and treatment needs for each individual.
Recovery Services is also a Drug Medi-Cal benefit for individuals who have completed treatment or immediately after incarceration and designed to support substance use recovery and prevent relapse with the objective of restoring the beneficiary to their best possible functional level. Individuals interested in receiving services can call the Access Line at 1-844-385-9200, or visit www.VCBH.org.
Q: How can parents join the VC Focus? Do you have a program at the high school level?
VC Focus was formed In January 2023, when all Ventura County law enforcement agencies and the District Attorney’s Office joined together and created the Ventura County Fentanyl Overdose and Crimes Units (VC FOCUS). This task force has enabled the Ventura County Sheriff’s Office and the county’s municipal police departments to mutually support each other with personnel and resources to investigate the sources of fentanyl supply to Ventura County, as well as the dealers responsible for selling this deadly product within our community. This partnership allows VC FOCUS to conduct investigations on recent fatal and non-fatal overdoses and is a law enforcement only task force.
VC FOCUS does go out and speak with many community groups, schools and other citizen organizations who are interested in learning about current drug trends and dangers. We do not contact known drug users since there are professionals in behavioral health and the medical field far more qualified to talk to them about addiction, treatment, and health concerns due to their drug use. We are also narcotics detectives, so our expertise is in drug investigations and enforcing the law.
Q: I work with high schoolers with substance use problems. They tell me all types of drugs are available, used on campus. They talk about being loaded at school with little being done by authorities. We must begin educating our youth, and it’s sad when our schools cannot keep our youth safe. Is this serious problem being addressed?
This past May 9, on National Fentanyl Awareness Day, the Behavioral Health Department, in partnership with the Ventura County Office of Education, featured a 30-minute presentation in all area high schools called ‘Real Talk: Fake Pills, 100% Danger’ to educate youth on the dangers of fentanyl. This will be an ongoing effort annually.
The Ventura County Office of Education (VCOE) has adopted a fentanyl prevention curriculum developed by “Natural High” that includes engaging lesson plans for students of all ages to learn about the current scientific findings on youth behavior, brain development, social norming, and substance abuse prevention.
Q: Is there any way that we can have dogs to find drugs out of our high schools? Can we start doing more or given more information to elementary schools?
The Sheriff’s Office will use K9’s at schools if there isa specific incident where drugs are suspected, and an investigation has been initiated. The K9’s do not do routine or administrative checks for narcotics at our county schools. Depending on where you live, there may be K-9 units used for drug detection. Start by asking your school administration about local needs and policies.
Q: Are doctors and pharmaceutical companies also being prosecuted for mis-prescribing opioids?
Yes, pharmacies and physicians have faced consequences with regard to the opioid crisis. The largest three US pharmacy chains, CVS, Walgreens and Walmart have faced more than 3,000 lawsuits claiming they contributed to the opioid epidemic by dispensing opioid drugs despite obvious red flags. Individual medical providers who prescribed opioids without a legitimate medical purpose, or over-prescribed opioids to individuals, have also faced legal consequences. The Opioid Settlement Funds recently distributed to all counties and state jurisdictions that applied and will continue to be distributed over the next two decades in an effort at restitution.
Q: Have we seen Xylazine in our county? Is this going to be the new crisis? What are the educational programs looking like for our school systems in Ventura County?
Fentanyl mixed with Xylazine is an emerging threat in the United States. Xylazine is an animal tranquilizer that is increasingly being found in the US illicit drug supply and linked to overdose deaths. We have seen only a handful of these cases in Ventura County to date.
Q: Are there inpatient detox options in Ventura? We often hear that police take a person’s Narcan kit. Is there a reason for this?
Yes, there is a withdrawal management (or detox) provider for women called Prototypes in Ventura. Very soon there will be an impatient detox at VCMC which is projected to open in November 2023. In addition, a men’s detox facility is planning on opening in Ventura early 2024.
As for police seizing naloxone kits upon arrest, the general reason this is performed is that the arrestee is also carrying their illicit drugs and paraphernalia in the same bag/container.
Q: As a concerned citizen, how can I have naloxone or where can I get one?
Residents of Ventura County can obtain naloxone anonymously by calling (805) 667-6663 and receive training on how to use it. Visit www.FentanylVenturaCounty.org and click on ‘get naloxone’ for locations near you.
Q: If opioids are so dangerous then why are doctors still allowed to prescribe them so freely?
Opioids are a legitimate drug for serious pain issues, such as for cancer patients and people who have undergone surgery, when prescribed by a doctor. What’s dangerous is illicit opioids – those not prescribed by a doctor but illicitly manufactured in a lab – and sold by drug dealers, often on the internet. The only safe drugs to take are prescribed by a physician, and even then, there is education to the patient about appropriate use.
Q: Is it not true that the pharmaceutical companies were pushing opioids and doctors were being encouraged to prescribe opioids? Which, in turn created this problem?
Prescription opioids have always been used to alleviate serious pain, such as after surgery. The opioid crisis, that is the rise in opioid overdose deaths, can be outlined in three distinct waves. The first wave began with increased prescribing of opioids in the 1990’s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999. The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills and cocaine.
Q: What do you believe is the root cause of the issue? Thoughts on patients and long monopolies of drugs? People self-medicate when existing medicine doesn’t work. How do you determine the success of current programs? Do you use metrics? Can those be reported publicly to our community? Measuring, reporting, transparency and accountability: How does VC compare globally? This is a global issue, not local so are we, and who is that work to benchmark? Do we have all stakeholders at the table? No. Should we have a user speak too? Or patient?
Addiction is a complex and much-studied societal issue. Research demonstrates a strong link between exposure to traumatic events and problematic substance use. Many people who have experienced child abuse, assault, war, natural disasters, or other traumatic events turn to alcohol or drugs to help cope with emotional pain, sleep disturbances, intrusive memories, anxiety, or terror. People with substance use problems are more likely to experience traumatic events than those without these problems. The county has an Opioid & Illicit Drug Workgroup, which meets six times a year and has numerous county agencies and community partners, such as non-profits like Give-an-Hour and Nate’s Place, to name a couple, to discuss everything from law enforcement strategies to deal with drug dealers, to education in schools to vulnerable teens. The original COAST funding supported dashboard visualizations showing various local data to provide trend information and insights on opioid abatement opportunities. This involved creating a dashboard receiving data securely from various agencies, including naloxone administration by all pre-hospital care providers as well as the VCBH rescue kits issued to county residents. These data are used to monitor trends and assist in enhancing outreach and targeting prevention services. For an example, please see www.coastventuracounty.org/news-updates. Additional data is available at www.coastventuracounty.org.
The County Behavioral Health Department does plan on hosting a number of these Town Halls in the coming year and will be inviting speakers including those with lived experience.
Q: How is Fentanyl created? What chemicals are in it that make it so dangerous? How is it processed?
Illicit fentanyl, primarily manufactured in foreign clandestine labs and smuggled into the United States through Mexico, is being distributed across the country and sold on the illegal drug market. Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays and increasingly pressed into pills made to look like legitimate prescription opioids. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.
Q: If you take Fentanilo, does it take just a little bit to die? If I take this drug with other ones will I die of an overdose?
Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl, or 10-15 grains of table salt, can be lethal depending on a person’s body size, tolerance and past usage. The Drug Enforcement Agency (DEA) has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet. In reviewing medical examiner data for opioid-related fatal overdose, fentanyl is a contributing factor in multiple “poly-drug” overdoses.