Myriad problems persist in dealing with overdose deaths

The Bakersfield Californian - 7/31/2022

Jul. 31—The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in October 2017.

Despite billions of dollars spent on research, outreach and treatment in the nearly five years since, Kern and counties throughout the nation are still being ravaged by rising addiction rates and opioids that seem to have grown more lethal in that span.

This stark reality provided the backdrop for the discussion of a July 21Centers for Disease Control and Prevention report on the rise in overdose deaths between 2019 and 2020.

Residents are not getting the help they need, sometimes due to a lack of resources, other times due to societal and cultural stigmas that foster judgment and shame around addiction and seeking treatment.

For these factors and others, according to heath experts, the epidemic has been particularly impactful to Black and Indigenous communities.

While the nation saw a 30 percent year-over-year increase in drug overdose deaths in 2020, the rate was 39 percent higher among Indigenous peoples, 44 percent higher among Black Americans and 86 percent higher among Black Americans ages 15 to 24. And it didn't just affect youth disproportionately. Black men 65 and older suffered from fatal overdoses at a rate seven times their white counterparts.

Those who work with drug-addicted populations point to a number of reasons for the rising rates and lingering disparities.

"It's much more dangerous now for people that are using," said Isaiah Crompton, who has 32 years of sobriety under his belt and has worked to help addicts for the last 28 years. In addition to being a deacon, he runs Isaiah's Sober Living, a residential treatment program in east Bakersfield that offers help to those trying to get clean.

"A little, small, tiny pill can kill you, you know, it can take you out," he said. "I had a neighbor whose son just got out (of jail), and went to a party and got a hold of something, and ... now he's no longer here.

"The drugs are worse and the drug-addicted person doesn't really know what he's taking unless he's a pharmacist," he added. "It's crazy. So I think the problem is worse. The drugs are different."

And the numbers bear that out, particularly in Kern County.

For the 12-month period ending in December 2020, there were 361 overdose deaths — an average of nearly one every day — reported in Kern, according to provisional data from the CDC as of July 3. In 2021, that figure grew by roughly 35 percent to 489 deaths.

The number of opioid-related deaths in Kern for 2021 was 270, which represented a 128 percent increase over the 2019 figure, according to the state's Department of Public Health dashboard.

The rise comes as prescriptions for opioids in Kern are in decline but remain relatively high. In 2021, there were 424,514 prescriptions for opioids in Kern, or 455.43 per 1,000 residents, which was a 24 percent decrease from 2019. Statewide, there were 14,867,426 opioid prescriptions among 39,538,223 residents in 2020, the most recent figure available from the CDC. Californians accounted for about 27.7 percent of the nation's 142,816,781 prescriptions that year despite accounting for about 12 percent of its population.

A dangerous disease

In Kern, Ana Olvera is responsible for managing the county's treatment network and ensuring that residents know about it. She is the county's substance use disorder administrator for Kern Behavioral Health and Recovery Services.

"What we are seeing recently, maybe over the last year, or year and a half, is just the increase in fentanyl that is out and about in the community," Olvera said.

Part of the danger that Crompton and Olvera have recognized in fentanyl involves how the drug is made.

The synthetic opioid started as an analgesic, or painkiller, for surgery, according to the UMass Medical School's website. It has "a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency." One structure, for example, carfentanil, can be up to 100 times stronger than its "parent structure." Acetylfentanyl, which is three times more potent, is strong enough to result in a number of deaths, according to CDC data.

"A very, very small amount can cause an overdose in someone, for example, who regularly uses an opioid, either because it's a prescribed medication or just illegal drug use. As people use more, they build up a tolerance," Olvera said. "The problem is that fentanyl is so much more potent and people are not aware that there might be fentanyl in the drugs they're consuming."

Cultural differences

Another significant challenge in addressing the problem is an issue that Olvera and her team are well aware of: There's a historical distrust of government entities, including public health departments, in underrepresented minority communities.

It's a problem that extends well beyond Kern's borders, as it's reflected in the national numbers.

CDC data indicated "a substantial decrease in evidence of minorities ever receiving treatment for this abuse compared to white people," with the rate being about 1 in 12 for Black Americans and 1 in 10 for Indigenous and Hispanic communities among those who suffered fatal overdoses, according to Dr. Mbabazi Kariisa, health scientist with CDC's Division of Overdose Prevention, in her presentation of the CDC data. "This difference is not simply because of a lack of availability of services. In communities that have a higher capacity to provide care, overdose deaths were higher, particularly for Black and American Indian and Alaska Native people."

Olvera said her staff regularly trains to gain "cultural competency" so it can address how different attitudes might impact outcomes for addiction treatment.

"But the trouble that we see is that it's difficult for us to get people to come into our treatment system," Olvera added. "So part of what I do is try to educate folks on addiction, in general, in the community — the fact that treatment is available and accessible. The fact that treatment is not a scary thing."

Outreach and support

As CEO of the Bakersfield American Indian Health Project, Angel Galvez has seen how the rising danger of opioids has caused problems in the community.

He noted there's a lot of advocacy and interest for harm reduction for the Indigenous population, and said his organization's main focus is helping residents address what he referred to as the "disruptions" that addiction can cause in daily life.

"Most of the folks that we serve, they're either asking for housing support, they're asking for (help with), really the day-to-day," he said.

Part of the reason for his organization's strategy, he said, is the funding required for a comprehensive solution is not in the budget.

"We have centered our services around that need and so, for us, we treat it a little bit differently than maybe other organizations who might offer services to provide harm reduction," he said. One recent harm-reduction program, Narcan for Natives, seeks to educate community members on the importance of naloxone, the generic drug name for the nasal spray that can rapidly reverse the effects of an opioid overdose.

"It's difficult," he said, "to get all of those funding resources to collaborate in a way where you provide the essential need for targeting opioid addiction and those individuals who suffer from opioid addiction."

Systemic concerns

While cultural differences might deter many from seeking treatment, there's also a problem in Kern with how many "on the other side" view the problem and solutions, according to Crompton.

"I think part of the problem is, the people that really know, who've been through the problem, are not at the table when the answers are trying to be developed. These people are broken, they need help and we offer them a cage," he said, referring to incarceration rates. "I mean, they've been through a lot already. Love doesn't seem to be on the menu for them."

From Audrey Chavez's experience, cultural resistance to a harm-reduction program was not only coming from the intended targets. While outdated attitudes and funding resources might be a big part of the challenge in improving the situation for the addict, she sees a prevailing perspective that has denied the scope of the problem historically.

She shared a sentiment similar to Crompton's when telling the story of how the organization she founded, Bakersfield'sAIDS Project, lobbied for years to bring a needle-exchange program to Kern. Ultimately, the funds were secured through a state grant, she said. When she tried to use the exchange on behalf of clients who were refused services at several well-known pharmacy chains, a pharmacist tried to shame her, she said, telling her she'd be responsible for the damage done by the needle usage.

She feels that a racial inequality in local representation has exacerbated a disconnect that exists between policymakers and the people they're trying to serve, which also shows up as a misunderstanding of how to tackle a problem as pervasive and overwhelming as addiction.

"Are we really being able to use authentic methods of resources — and the cost of a needle versus the cost of treatment? The cost of care? The cost of death? The cost of life?" she said. "I find that it's hard to help people adjust their attitudes, behaviors and beliefs around harm reduction and what's happening within our families, within our communities of faith, within our schools, within our cities."

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