B. Opioid and Fentanyl UseCOMBATING THE RISE IN
FENTANYL OVERDOSES
Dr. Michael
Sequeira
Public Health Officer
WHAT IS ?
Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and
100 times stronger than morphine. It is a major contributor to fatal and
nonfatal overdoses in California and the United States.
There are two types of fentanyl:pharmaceutical fentanyl and illicitly
manufactured fentanyl (illicit fentanyl). Both are synthetic opioids.
Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, such as
while in the hospital for and after surgery or for advanced-stage cancer.
Illicit fentanyl is distributed through illegal drug markets for its heroin -like
effect.
FORMS OF FENTANYL
•Brightly-colored fentanyl, known as rainbow fentanyl, has
been identified as a new trend in the US by the DEA.
•Rainbow fentanyl doesn’t have to be smoked or injected.
•It is found in many forms, including pills, powder,
liquid and blocks that can resemble candy.
•Rainbow fentanyl, like all forms of fentanyl, is extremely
potent and dangerous.
FENTANYL
TRENDS
•Fentanyl can be added to other drugs to make them cheaper, more powerful, and
more addictive.
•Illicit fentanyl has been found in many drugs, including heroin,
methamphetamine, counterfeit pills, and cocaine.
•Fentanyl-laced drugs are extremely dangerous and increase the likelihood of fatal
overdose
•It is nearly impossible to tell if drugs have been laced with fentanyl without the
use of fentanyl test strips because fentanyl cannot be seen, smelled, or tasted.
In 2018, there were 30 fentanyl
overdose deaths in the county. The
number rose to 74 residents in 2019,
and then to 227 in 2020.
Last year, there were 309 fentanyl
overdose deaths in the county.
San Bernardino
California
The San Bernardino County Child Death Review
Team (CDRT) provide data on child-related deaths
that are identified through the following case
reviews.
CHILD DEATH REVIEW
TEAM ANALYSIS (2021)
CDRT ANALYSIS: CONTINUED (2021)
CAUSES OF DEATH (AGES 15-
17)•Fentanyl toxicity is the
number one independently
identified cause of death for
those ages 15-17 in San
Bernardino County
JUST PUBLISHED:
NATIONAL DATA: CDC
Adolescents:
Deaths involving illicitly manufactured fentanyl increased by 182% in
this age group. Opioids accounted for 90% of the overdose deaths,
and illicitly manufactured fentanyl accounted for 84%. Nearly a
quarter of the deaths involved counterfeit pills.
***Bystanders were present for two-thirds of the overdoses among
this age group, but in most cases, they did not attempt life-saving
care!!!***
•Child mortality is rising at a rate not seen in at least half a
century, an era that had seen steady progress in preventing
deaths from automobile accidents, firearms and disease. The
increase is due to “manmade pathogens,” especially guns and
drugs.
•More teens are dyng of drug overdoses at a time when,
paradoxically, teen drug and alcohol use is in decline.
•Between 2002 and 2022, the share of 12th-grade students
who used illicit drugs dropped from 21 percent to 8 percent,
according to the national Monitoring the Future study. The
figure excludes marijuana, a prevalent drug among teens. But
marijuana use is declining, too.
•The share of 12th-grade students drinking alcohol dwindled
from 72 percent in 2002 to 52 percent in 2022. The cigarette-
smoking population plummeted from 57 percent in 2002 to
17 percent in 2022.
Improvement in Chronic SUD in Teens
Public Health Approach
1. Actionable Data
A. Focused (CDRT)
B. OD Map
EMS/ICEMA/FIRST WATCH
C. Coroner’s Data
2. Active Harm Reduction: Biggest Harm: Stopping the Deaths!
Naloxone; Fentanyl Testing; Needle Exchange; Stigma Education….
3. ID and targeting HOTSPOTS
4. Response
PROTECTING OUR
COMMUNITY
•The Department of Public Health is working to implement
various strategies to protect the community, including:
•Increasing the availability and accessibility of Naloxone. Naloxone is
a life-saving medication that can reverse an overdose from opioids-
including heroin, fentanyl, and prescription opioid medications-
when given in time
•Integrating harm reduction intervention services in the community.
Harm reduction emphasizes engaging directly with people who use
drugs to prevent overdose and connect them to support services
•Providing opioid awareness and overdose prevention education
•A health advisory was released to bring awareness to the
threat of fentanyl and what we are doing to reduce
community risk.
PROTECTING OUR COMMUNITY
TOGETHER
Several County agencies-Public Health, Sheriff, District Attorney,
Behavioral Health, County Superintendent of Schools, and Arrowhead
Regional Medical Center-are collaborating with community-based
organizations, healthcare providers, and schools to develop strategies to
raise awareness and identify solutions to reduce fentanyl use.
DPH is also working together with
the Inland Empire Opioid Crisis
Coalition (IEOCC) to reduce opioid
use and opioid related deaths in
San Bernardino and Riverside
County.
www.ieocc.org
CAMPAIGN AGAINST FENTANYL
•CDPH is working closely with local health departments, opioid
safety coalitions, and other local level partners to support local
prevention and intervention efforts.
•CDPH funds harm reduction programs throughout the state that
offer syringe services, fentanyl test strips, naloxone, and other
supplies/services to support the health of people who use drugs.
•CDPH created a media campaign to spread information and
awareness regarding fentanyl drug crisis.
HARM REDUCTION: WHAT IS IT?
•Accepting that there WILL be (at least
Experimental) Use
•The essence: minimizing the Harm from that use
•Key: Stigma: even the implication drives people
away
•Includes Nomenclature (Not ‘addict’, drug
‘abuse’)
•The Disease Model Of Substance Use (SUD)
•The benefits of Naloxone training…..
NEW(?) THREAT: XYLAZINE
•Added to Fentanyl in illegal labs
•Also called ‘Tranq’
•Depresses consciousness, causes respiratory depression,
serious skin wounds (with injection).
•Added to Fentanyl to prolong the high and mitigate
withdrawal symptoms.
•In the past, Urine Drug Screens would not test for Xylazine
•Philadelphia study: Found in 90% of illicit opioid samples!
•Just announced: Canadian company BTNX releasing Xylazine
test strips
•AB1598 (Bradford): test strips not considered illegal
paraphenilia.
XYLAZINE: PURCHASE ONLINE
ANYONE WHO ENCOUNTERS FENTANYL IN ANY FORM
SHOULD NOT HANDLE IT AND SHOULD CALL 911
IMMEDIATELY.
Recognizing the signs of opioid overdose can save a life.
Here are some things to look for:
•Small, constricted “pinpoint pupils”
•Falling asleep or losing consciousness
•Slow, weak, or no breathing
•Choking or gurgling sounds
•Limp body
•Cold and/or clammy skin
•Discolored skin (especially in lips and nails)
RECOGNIZING THE SIGNS OF
OPIOID OVERDOSE
NALOXONE
•Naloxone is a life-saving
medication used to reverse a
drug overdose.
•Works immediately and is not
addictive.
•Naloxone is safe and easy to
use, even by friends or family,
when a loved one experiences
an overdose event.
SAN BERNARDINO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
DBH provides mental health and substance use disorder services
to county residents who are experiencing major mental
illnesses and/or substance abuse issues and are uninsured or on
Medi-Cal, and individuals experiencing a behavioral health
crisis.
DBH serves all age groups, with a primary emphasis placed on
treating children/youth who may be seriously emotionally
disturbed, adults with a serious and persistent mental illness,
and individuals with substance use disorders. DBH services are
culturally and linguistically appropriate.
RESOURCES
•CDPH Fentanyl Information
•CDPH Naloxone Information
•CDC U.S. Overdose Deaths in 2021
•DHCS Naloxone Distribution Program
•CDC Life-Saving Naloxone Can Reverse
Overdose
•CDPH California Overdose Dashboard
•CDPH Substance Use Prevention
Resources for Adult Role Models
•National Health Institute (NIH) Drug
Abuse Opioids Facts Parents Need to
Know
•CDC: The Facts about Fentanyl
•National Harm Reduction Coalition:
Fentanyl
•DEA: One Pill Can Kill
•California Overdose Surveillance
Dashboard
•Syringe Services Programs in California
•www.cdph.ca.gov/StopOverdose
•CDPH’s Naloxone Standing Order
•DHCS’s Naloxone Distribution Project
•CDPH Page On Fentanyl (ca.gov)
•Recent News: Rainbow Fentanyl Alert (ca.gov)
•General information About Naloxone
•To submit questions CDPH’s Overdose Prevention
Initiative: (OPI@cdph.ca.gov)
•Fentanyl Awareness and Prevention Information
(including videos developed by Fresno County) are
in the latest version of SHARE, which can be found
here-https://schools.covid19.ca.gov/pages/share
•A Fentanyl & Overdose Prevention Communications
Toolkit was developed to share information about
the risks of fentanyl and how to prevent teen use
and overdose. Health and education partners are
encouraged to use images and messaging from the
toolkit to raise awareness.
wp.sbcounty.gov/dph
(800) 782-4264