As cartels distribute killer drug, clinic workers aim to reduce demand in Stanislaus County

About 90% percent of new admits at the Aegis drug treatment clinic in Modesto test positive for fentanyl, a drug that’s driving a fatal overdose crisis in the United States. That’s a dramatic shift since the COVID-19 pandemic, a clinic spokesman said.

The office on McHenry Avenue once was commonly known as “the methadone clinic,” where adults hooked on heroin or prescription painkillers received medication assistance to reduce cravings for the drugs.

Pinnacle, with treatment centers from Eureka to Southern California, acquired Aegis in 2020 and now also has a Ceres clinic and a medication unit that opened this month in Turlock.

“The switch (to treating fentanyl addiction) started four to five years ago and has just accelerated since the pandemic,” said Frank Silva, patient navigator and communications director for the local clinics. “The numbers basically flipped and now it’s mostly fentanyl we are seeing.”

The other 10% of the clientele are adults using heroin or prescription narcotic pain medication.

Pinnacle’s private drug-treatment services are one tool for combating the fentanyl scourge on the demand side, as Mexican drug cartels bring counterfeit pills and drugs laced with fentanyl into the country for distribution.

Silva is a fount of information on what’s happening with illegal fentanyl in Stanislaus County, while promoting awareness and Pinnacle’s services and participating in the county’s Opioid Safety Coalition.

He said the majority of clients are treated for polysubstance use disorder; that is, people taking fentanyl in combination with other drugs, usually methamphetamine.

Fentanyl, which is 50 times stronger than heroin, has brought changes to the treatment at Pinnacle clinics. “The individual may need extra time to stabilize on their medication,” Silva said. “We frequently follow up with patients to see if the dose is holding and adjust the medications as needed.”

Medication-assisted treatment, using methadone or suboxone, long has been an option for drug addiction because of the failure rates of counseling only or 12-step programs. Silva said some patients addicted to fentanyl respond well to suboxone, but methadone is more effective in some cases.

An illegal drug combination of fentanyl and an animal tranquilizer, xylazine, could spark another public health nightmare, because of severe skin abscesses caused by the drug mixture, called “tranq.” The fentanyl and xylazine mix also increases the likelihood of fatal overdose.

Silva said the Pinnacle clinics here have not seen many individuals using tranq. The clinics have not begun testing patients for xylazine, he said, but he’s among those in the substance use treatment field who expect to see cases of tranq addiction.

“The biggest issue with tranq is going to be the lethality of overdoses,” Silva said. Xylazine has depressive effects on the respiratory system and the overdose can’t be reversed with Narcan nasal spray.

The clinics will refer any patients with skin sores caused by tranq to primary care doctors or other outside physicians, Silva said.

The spokesman said there are some health problems associated with long-term fentanyl use, some depending on how the drug is self-administered. As an example, smoking fentanyl can lead to chronic obstructive pulmonary disease or other lung damage.

In addition, use of dirty syringes to inject fentanyl or xylazine may cause abscesses and bacterial infections and increase the risk of HIV infection and hepatitis, Silva said.

Displays offer Narcan and testing strips

Silva and other clinic staff are working on outreach, including fentanyl education and harm reduction displays placed in the community. The five-foot displays have free Narcan, as well as fentanyl and xylazine test strips, and also refer people to Pinnacle’s drug treatment services.

One display was placed last week at the Rainbow Resource Center, at 1202 H St., and another is planned at the Modesto Junior College West Campus.

Gerad Amore, executive director of the Rainbow center, said the organization has done fentanyl outreach to the homeless and education at bars, and it wants to give free access to harm reduction tools. The fentanyl crisis has some impact on the LGBTQ community owing to a disproportionate rate of substance use as people struggle with mental health or social acceptance, Amore said.

“This is our way of giving back to the community and giving them the tools and resources so they can navigate their way to a path of wellness,” Amore said.

The director said people going to a music festival may stop at the Rainbow center for Narcan and test strips because “they know they’re going to partake or someone around them may.”

Amore noted that a man who received a Narcan dispenser at the center always kept it on him. At the center’s recent Halloween party, the man said he had suffered an overdose and a friend used the dispenser to revive him.

Stigma is a barrier to drug treatment

Silva talked about the need in Stanislaus County to reduce the stigma around substance use treatment so there’s not as much demand for illegal fentanyl. “We need more people to understand addiction is a disorder that can be treated,” he said.

Cultural stigma makes drug addiction a taboo, something not to be discussed. Childhood trauma also can predispose someone to substance use disorders, Silva said.

According to Silva, many patients in drug treatment have co-occurring disorders such as anxiety, depression or post-traumatic stress. Clinic staff use research-based practices such as dialectical behavior techniques to assist those clients.

He said Pinnacle works closely with substance use navigators at local hospitals to get overdose survivors in emergency departments referred to drug treatment services.

“We have regular meetings to discuss ways to improve getting them from the ER to treatment,” Silva said. “It’s that crucial time when someone is scared they had an overdose and that is a time when they are willing to accept treatment services.”

Silva added that more substance use treatment options — especially an increase in residential treatment beds — could help as the death toll rises in Stanislaus County. He said some people need a higher level of care than outpatient service.

Information about Pinnacle clinics

Those struggling with opioid use may consider medication-assisted treatment using suboxone or methadone in combination with counseling. To reach a Pinnacle clinic call, 800-782-1520 or visit pinnacletreatment.com/aegis.

Pinnacle said most major insurances are accepted at its medication-assisted drug treatment clinics. Insurance plans dictate the amount of any co-payments and deductibles. Medi-Cal covers 100% of treatment costs for patients. For people paying out of pocket, there is a sliding fee scale based on income.

Pinnacle’s Modesto clinic has a state opioid response grant through June covering out-of-pocket costs for those with private insurance or not qualifying for Medi-Cal. To learn about substance use treatment options in Stanislaus County, visit the county Behavioral Health and Recovery Services website, or call 888-376-6246.