Fentanyl deaths in Santa Clara County rise during pandemic
A small dose of fentanyl, such as the two milligrams pictured here, is enough to kill a person. Image courtesy of the Drug Enforcement Administration.

The number of fatal fentanyl overdoses in Santa Clara County nearly tripled during the pandemic, and experts say the two are intricately linked.

“(The pandemic) seems to have exacerbated a lot of latent trauma that our clients have,” said Gary Montrezza, CEO of Pathway Society, a substance abuse counseling center based in San Jose. “Those who are already under a lot of trauma and stress just see this as one more brick on their back, of one whose back is already breaking.”

Last year, 86 people died from fentanyl overdoses in Santa Clara County, with most deaths occurring in young adults in their 20s and 30s. Twenty nine people died from fentanyl in the county in 2019, a marked increase from the 17 who died in 2018.

These numbers make fentanyl the deadliest drug in Santa Clara County, according to officials in the county's Behavioral Health Department.

“Fentanyl is the most dangerous and can kill in a matter of minutes,” the department wrote in an email to Lucescamaray Blog. “Exposure to even small amounts can cause overdose and death.”

Though Santa Clara County's number of fentanyl deaths rose during the pandemic, the county still falls short of San Francisco which saw 500 residents die from fentanyl overdoses in 2020, according to a report from the county's chief medical examiner.

Nationally, deaths from synthetic opioids like fentanyl have increased by 38.4% between 2019 and 2020, according to the Centers for Disease Control and Prevention. Fentanyl also contributes to overdose deaths from stimulants like cocaine and methamphetamine, according to the CDC.

Fentanyl is a synthetic opioid similar to morphine used to treat severe pain after surgery. The drug is 80-100 times more potent than morphine, and just a quarter of a milligram can be fatal.

Fentanyl patch packages from several German generic drug manufacturers. Image courtesy of Alcibiades / Wikimedia Commons.

Fentanyl is often mixed with other drugs, including heroin, according to Dr. Christian O’Neil, medical director at Pathway Society.

“The rate of dealers cutting their heroin with fentanyl, because it’s so much cheaper, is extremely high,” O’Neil said. “For people using heroin on the street, there's an extremely high likelihood that they could also get fentanyl.”

However, fentanyl is also used along with non-opioids. In fatal fentanyl overdoses, the drug has been detected alongside methamphetamine, cocaine, alcohol and benzodiazepines, according to Dr. Michelle Jordan, Santa Clara County's chief medical examiner-coroner.

O’Neil said he’s treated patients who have only taken methamphetamine, but whose symptoms resemble opioid withdrawal. While fentanyl is the drug of choice of some addicts, other drugs sold on the street are contaminated with the synthetic opioid.

“A long time ago, it was almost an urban myth about drugs contaminated with this or that,” O’Neil said. “I just never bought into that before... But it's a reality now, and it's driven by profit because it's so much cheaper than pure heroin.”

Dr. Aimee Moulin, an emergency physician at UC Davis who specializes in behavioral health, said California is traditionally warmer to stimulants such as methamphetamine. However, many addicts have shifted to using a combination of meth and opioids.

Moulin said fentanyl became popular on the East Coast, but started growing more popular in California prior to the pandemic. O’Neil confirmed that fentanyl use was already apparent in Santa Clara County as early as 2012.

The pandemic's effect on economic security and disruption of social routines pushed many people over the edge, Moulin said.

“Those combined forces... and isolation are recipes that certainly don’t help drug use,” Moulin said. “From the emergency department standpoint, what we saw was that people who were in stable in-treatment… the pandemic was very disruptive.”

The abuse of substances like fentanyl goes deeper than individual addiction, Montrezza said.

“When we speak about drug use, what we're talking about is a symptom of something else,” he said. “We need to really examine the fraying of our societal bonds and the way we relate to each other.”

Though opioid addiction may be permanent, Moulin said it's possible for people to recover from its worst effects.

“People can absolutely go into recovery and have a normal life,” Moulin said. “It’s a chronic illness, but it can 100% be managed, and there’s a way out.”

Contact Sonya Herrera at [email protected] or follow @SMHsoftware on Twitter.

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