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Rise in fentanyl use likely caused by different factors

Over the last several years deaths related to opioid overdoses have risen sharply across the nation, and with the coronavirus pandemic leaving many underemployed and isolated, COVID-19 may be amplifying that trend both nationally and in Nevada County.

According to the Centers for Disease Control and Prevention, since 2013 deaths due to synthetic opioids such as fentanyl increased tenfold. Last year more than 37,000 Americans died from fentanyl use, bringing the national average to 10 deaths per year per 100,000 population.

A study published this month by the National Institute of Health explains until recently the opioid epidemic had been largely concentrated in the East Coast and Midwest, with fentanyl use particularly prevalent in New England. But the use of fentanyl and other synthetic opioids have increased across western states in just a few years, with mortality rates shooting up nearly four times between 2017 and 2019.



In 2017 fentanyl-related deaths in Arizona went from fewer than five deaths per 100,000 population to just under 25 by the end of 2019. San Francisco County had the highest rate of fentanyl-related deaths (189) in California last year, going from fewer than three deaths per 100,000 population in 2017 to 24.5.

Nevada County has been no exception.



“Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation’s already severe opioid epidemic in the long-term,” the study concludes. “Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.”

The dramatic spike in such a short period led many public health and law enforcement agencies — including the U.S. Drug Enforcement Agency — to issue warnings about overdose deaths from the highly potent drug.

As of October, 23 Nevada County residents died due to drug overdoses, more than 2.5 times the average from the previous four years. In 14 of those overdoses, fentanyl was found in the victim’s system.

In 2018, the year for which the latest hospital data is available, the county’s opioid-related overdoses that resulted in hospitalization were higher than the state average at 23 per 100,000 residents.

“We are witnessing the introduction of fentanyl into the local drug supply and tragic deaths as a result, and we need to reach all Nevada County residents to inform them of the lethal threat presented by fentanyl,” Deputy Health Officer Dr. Glennah Trochet said. “As a community, we can help prevent additional deaths by knowing what resources are available.”

CAUSES

According to county officials, the cause for the recent spike locally may be a mix of factors, including unwitting use and an increase of tainted opioid supply coming from China. Some of the most recent fentanyl-related overdose cases were associated with laced or counterfeit Percocet pills, the Nevada County Sheriff’s Office reported.

“While opiates, including fentanyl, have been around for many years, our office is aware that fentanyl use has become more prevalent in the illicit narcotics market,” said sheriff’s Lt. Sean Scales.

The theory was bolstered this month by an NPR investigation that found Chinese suppliers have found a way to work around an export ban by working with Mexican cartels to finish manufacturing. Officials believe the pandemic, along with other regulatory measures, disrupted the drug’s typical trade route, leading to newer and apparently deadlier production methods.

Compounding this, while the available data is scarce, in the few months since the onset of the pandemic opioid and fentanyl use has again increased dramatically.

According to the CDC, from April 2019 to April 2020 — one month after California issued a stay-at-home order and the latest month for which data is available ­­— the state had a 22% increase in drug overdoses.

The available 2020 data shows a 63% increase in fentanyl deaths from 2019, according to the National institute of Health.

“As evidenced by mortality data from as recently as the first half of 2020, fentanyl is not only meaningfully present west of the Mississippi River, but is spreading rapidly in nearly all jurisdictions with timely data,” the institute study states. “If public health officials do not react strongly and quickly, a significant exacerbation of the U.S. opioid epidemic could follow.”

Similarly, in Nevada County, 13 of 14 overdoses have come since May.

One potential reason for the increased drug use is the pandemic’s adverse economic and mental health impacts.

A National Bureau of Economic Research study found as unemployment rises 1%, the opioid death rate per 100,000 population rises by 3.6%. The same change increases opioid-related overdoses that lead to emergency rooms visits by 7%.

While Nevada County has fared better economically than some, ranked 14 in the state for unemployment, the rate is double what it was this time last year.

In October, unemployment was at 6.4%, compared to 3.4% in February just before the shutdown, and 2.9% in October 2019.

RESPONSE

In light of the growing numbers of users, both intentional and accidental, Nevada County officials have responded by upping the availability of naloxone, a medication that can reverse opioid overdoes, as well as fentanyl testing kits.

People can pick up naloxone – sometimes called Narcan — by appointment from the Nevada County Public Health department by calling or texting 530-388-6364.

According to the CDC, increasing distribution of and access to naloxone, particularly for bystanders and in rural counties, could be critical to preventing accidental deaths. While naloxone administration requires some training, a benefit is that it can be given to people only suspected of taking opioids with no adverse effect.

The public health department also offers free fentanyl testing strips, which can curb unintentional or over use from people who believe they are consuming a different drug or smaller dose.

In western Nevada County people can call or text 530-687-2295 for testing strips. People in eastern Nevada County can call or text 530-913-4467.

To contact Staff Writer John Orona, email jorona@theunion.com or call 530-477-4229.


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