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Drug overdoses have surged during the pandemic, and 82 homeless San Diegans died of overdoses involving fentanyl last year, a five-fold increase from the total the county Medical Examiner’s Office tallied in 2019.
The uptick in fentanyl-related deaths contributed to a nearly 72 percent increase in accidental illicit drug deaths among homeless San Diegans investigated by the county last year.
The Medical Examiner’s Office reports a more than 200 percent year-over-year spike in accidental deaths from fentanyl, an opioid painkiller that is 100 times more powerful than morphine, across San Diego County. The region’s homeless community has been particularly vulnerable.
Residents, business owners, service providers and public safety workers say they have noticed more open drug use and erratic behavior in homeless camps and on streets the past couple years, especially in downtown San Diego.
San Diego Fire-Rescue Department data shows city paramedics provided opioid overdose reversal drug naloxone – commonly sold as Narcan – to homeless patients 498 times last year, up 44 percent from 2019. Homeless-serving nonprofit Father Joe’s Villages also reports that security guards who patrol around its facilities intervened in 41 overdose incidents last year, reviving all they aided with naloxone.
Regional leaders and treatment providers are grappling with how to respond as the county begins to emerge from a pandemic that has exacerbated addiction and mental health challenges and forced service agencies to dial back in-person offerings to comply with coronavirus protocols. The county’s cancelation of a contract with treatment provider Volunteers of America after officials flagged significant billing issues has also meant the county has even fewer beds available to serve those in need.
City and county officials are pledging to step up efforts to tackle soaring substance abuse issues but many of the details of their plans have yet to be aired publicly, including a county commitment to a new strategy that lessens barriers to care and city plans to invest in new services.
For some homeless San Diegans, solutions can’t come soon enough.
Brittany, who spends most nights sleeping on Pacific Beach streets and struggles with addiction herself, is haunted by the drug crisis. The 25-year-old said eight of her friends died of drug overdoses in the last year. She suspects fentanyl, which is now often covertly added to other drugs, played a role in many of those deaths.
“All those people were good people,” said Brittany, who asked that Voice of San Diego not publish her full name. “They didn’t deserve it.”
Brittany tears up as she remembers them. Most recently, she lost Robert. She suspects his crystal meth was laced with fentanyl and now can’t shake the image of the yellow tarp thrown over his body outside a park restroom.
Experts say experienced and new drug users alike are often caught off guard by the potency of fentanyl, a reality that Brittany said has led her to worry other friends could be next.
There have been close calls too. On a recent Sunday night, she hurried to give two men naloxone she received from a state-funded program after both overdosed at a Midway District homeless camp. Another time, a friend turned blue while the two sat outside a Pacific Beach Wendy’s. Desperate, Brittany said she begged a customer who pulled into the drive-thru to call 911. All three men were using fentanyl.
Brittany also had her own close call recently. She said she collapsed in an In-N-Out Burger bathroom, smoking what she thought was heroin. She’s now convinced it was fentanyl. She doesn’t remember much, other than that an ambulance rushed to her aid.
“I didn’t even know I hit the floor,” Brittany said.
Dr. Jeffrey Norris, Father Joe’s chief medical officer, said patients coming to the nonprofit’s East Village clinic are confessing that they fear what will happen if they can’t stop using. Increasing uncertainty about what is in the drugs they are buying has amplified those fears.
“They’re just legitimately scared of dying,” Norris said.
Tara Buesig, executive director of the Harm Reduction Coalition of San Diego County, has heard similar comments from homeless San Diegans she serves via a state-funded program that provides users with naloxone, clean syringes and other supplies, including fentanyl test strips.
She said many have struggled even more during the pandemic, which has made it even more difficult to enter treatment programs that were strapped long before COVID-19 and added to the despair of living on the street. The dynamics of the pandemic also forced many users to turn to lower-cost drugs, which has led more homeless San Diegans to fentanyl.
Buesig said many homeless drug users are also pairing fentanyl and methamphetamine, a combination that can allow them to crash during the day and remain awake at night when the streets are more dangerous.
In other cases, fentanyl is quietly added to meth.
Medical Examiner’s Office data shows that combination, sometimes also paired with other drugs, led to 67 accidental deaths last year – up from just 12 in 2019.
Dr. Roneet Lev, who served as chief medical officer of the White House Office of National Drug Control Policy before returning to Scripps Mercy Hospital’s emergency department last year, said San Diego has long had a significant meth problem but that the introduction of fentanyl has proven far more deadly.
“What’s new is the amount of fentanyl in the meth that people are using, and that’s why they’re dropping dead,” Lev said.
Indeed, the federal Drug Enforcement Administration revealed in 2019 that one in four counterfeit, fentanyl-containing pills it had tested in its labs earlier that year had a potentially lethal dose of the drug.
For that reason, 37-year-old Billy Mroczka, who spends most nights in Midway, said he regularly tests drugs he is buying on the street to assess what he’s using. On a recent Monday, Buesig helped him use test strips to assess whether fentanyl was laced into his meth. It was. Mroczka chose to proceed carefully, knowing the risk. He isn’t ready to stop using yet. For now, he thinks he can handle it.
“Once you taste that high, nothing else is like it,” Mroczka said.
Still, Mroczka said, he’s watched the drug tear apart others’ lives.
“Fentanyl changes people,” he said. “It takes over almost like the plague and nothing else matters.”
City and county officials acknowledge the need for rapid solutions.
Luke Bergmann, the county’s behavioral health services director, said the county is moving forward with an order from Public Health Officer Wilma Wooten that will allow it to broadly distribute lifesaving naloxone throughout the region.
“We don’t want people to have to go out of their way to get access to naloxone,” Bergmann said.
Wooten is set to sign the order Friday, allowing community organizations to distribute naloxone without prescriptions.
Bergmann and County Supervisor Nathan Fletcher said the county expects to roll out other initiatives and plans in coming weeks and months.
One of Fletcher’s next moves will be to get approval from fellow supervisors on a strategy he has advocated to better serve those battling addiction with so-called harm reduction approaches once eschewed by former county leaders. Those plans are set to go to the Board of Supervisors next month.
Harm reduction models focus on reducing the negative consequences of drug use through tacks such as clean needle exchanges or housing and treatment programs that don’t force out those struggling with addiction when they relapse.
Last year, then-Surgeon General Jerome Adams promoted research showing that participants in safe syringe programs like the those Fletcher has pushed for are five times more likely to seek drug treatment and almost three times more likely than those not enrolled in those programs to stop using drugs.
Bergmann recently told an advisory board that the county’s new strategy will also include efforts to convene stakeholders to gather input on the substance use system, bolstered housing opportunities for people struggling with addiction, plans to boost the local substance abuse treatment workforce using the harm reduction model and efforts to better integrate treatment with the mainstream health care system.
The first step, he said, will be deploying naloxone broadly to people who know opioid drug users or are drug users themselves.
Fletcher said the county also expects to ramp up mobile crisis response teams that can respond to behavioral health calls in place of police and connect those in need with services countywide by the end of the summer, and is working to open new facilities where people in crisis can be evaluated and linked with proper care.
Mayor Todd Gloria last month released a budget proposal calling for the city to invest $1.35 million in expanding substance use disorder treatment options, including 65 short-term detoxification beds. Gloria and his team have said the plans for that money are yet to be finalized, and the City Council will have to sign off on them.
For weeks, city and county officials along with other stakeholders have deliberated behind the scenes over what to do and how to best align federal American Rescue Plan money and new state dollars they hope to direct toward the problem, as well how to maximize a $25 million behavioral health impact fund they jointly created to back new treatment projects using former redevelopment funds.
Keely Halsey, the city’s chief of homelessness strategies, wrote in an email to VOSD that the city’s goal in those talks has been to ensure there are additional safe indoor spaces for homeless San Diegans to seek addiction treatment.
“We are confident that our collaborative work with the county will help vulnerable San Diegans on their pathway to permanent housing and the services they need to thrive,” Halsey wrote.
Fletcher said the county is moving as quickly as it can on both interim and longer-term solutions.
“One of the hardest things with this problem is there’s not just one magic thing you can do tomorrow, and the problem goes away. It is very difficult,” Fletcher said. “It requires us to do a lot of things a lot faster, in a much more aggressive way, to try to make an impact.”
While the city and county hash out plans, the suffering on the street continues. Buesig of the Harm Reduction Coalition of San Diego County has a front row seat to the desperation during regular supply deliveries aimed at keeping vulnerable drug users alive – and whenever possible, connecting them to more help.
“It’s devastating,” Buesig said. “People are losing hope.”
Megan Wood contributed to this report.