Drug deaths spike in SLO County as fentanyl use continues to spread

Editor’s Note: This is part one of a two-part series looking at how SLO County has been impacted by the national fentanyl crisis. The second part of the series examines how harm reduction strategies can prevent overdoses and save lives.

San Luis Obispo County is coping with a spike in drug-related deaths unlike anything it’s seen before, as the spread of fentanyl and other highly potent, synthetic opioids exacts a devastating toll.

Since 2018, total drug deaths here have roughly tripled in a trend line that mirrors the rise of fentanyl as a public health threat.

It’s become a common tragedy in cities across the country, which saw more than 56,000 people die from synthetic opioid use in 2020, according to the Centers for Disease Control and Prevention. That’s 18 times the number of deaths from synthetic opioids recorded in the United States in 2013.

This January alone saw about half the number of drug-related deaths as SLO County recorded in an entire year as recently as 2018. And experts say synthetic opioid use is the driving factor in the increase.

In that month, the Sheriff-Coroner’s Office recorded 22 suspected drug-related deaths — a sharp rise from similar counts in the past. Prior to this year, the month with the next highest number of drug-related deaths was January 2021 with 13, which ushered in the year with the most drug-related deaths seen in the county to-date.

“It was pretty high,” San Luis Obispo County Sheriff-Coroner Sgt. John McDaniel said of January’s numbers. “(We had a) two- to three-week period where we had almost one a day.”

Most of the deaths occurred in the first three weeks of January, McDaniel said, and sometimes, two individuals were found dead at the same location.

“We had a pretty busy couple of days,” he said.

That many suspected drug-related deaths so early in the year is staggering compared to the statistics from previous years.

Two people were arrested when San Luis Obispo police found substances believed to be fentanyl and methamphetamine on Sept. 3, 2022. Fentanyl seizures have exploded in SLO County in the last couple of years, and the Sheriff's Office is seeing more deaths from combinations of opioids and stimulants like cocaine and meth.
Two people were arrested when San Luis Obispo police found substances believed to be fentanyl and methamphetamine on Sept. 3, 2022. Fentanyl seizures have exploded in SLO County in the last couple of years, and the Sheriff's Office is seeing more deaths from combinations of opioids and stimulants like cocaine and meth.

From 2016 to 2018, the average number of confirmed drug-related deaths were in the low to mid-40s for the full year, McDaniel said.

In 2020, that number jumped to 88, and by 2021, it had ballooned to 123.

Although the underlying causes in the recent deaths have yet to be determined, the Sheriff’s Office noted a major increase in the amount of fentanyl, fentanyl analogs or similar opioids circulating in the county.

“If (the deaths) are fentanyl-related, it depends — is it a bad batch?” McDaniel said. “If a hot load of fentanyl comes through and it’s really potent, it can cause a lot of deaths.”

The toxicology reports could take anywhere from four to eight weeks to process and will help investigators determine the type and quantity of substances in the deceased’s systems at the time of death. The toxicology reports will also determine whether the substances can be identified as the primary cause of death.

But whatever the tests reveal, the resulting fatalities are alarming.

San Luis Obispo County Sheriff-Coroner’s Sgt. John McDaniel stands in the room where autopsies are conducted, on Feb. 16, 2023. “You can’t enforce your way out of a drug problem,” he said. 
San Luis Obispo County Sheriff-Coroner’s Sgt. John McDaniel stands in the room where autopsies are conducted, on Feb. 16, 2023. “You can’t enforce your way out of a drug problem,” he said.

SLO County fentanyl deaths grew 722% between 2019 and 2021

The data from the past three years show the key culprit behind many of these deaths is fentanyl and the combination of stimulants and fentanyl.

From 2019 to 2021, the total number of drug-related deaths in San Luis Obispo County grew by nearly 123%, according to data supplied by the SLO County Sheriff-Coroner’s Office. Data on drug-related deaths for 2022 in SLO County is still being analyzed as of early 2023.

Meanwhile, deaths involving fentanyl leapt 722%.

Jenn Rhoads, coordinator with the SLO County Opioid Safety Coalition, said two things stick out to her when looking at the numbers: the presence of fentanyl across the deaths, as well as stimulant overdoses.

Fatal cocktails of multiple drugs are also becoming more prevalent.

For example, stimulants such as methamphetamine and cocaine were involved in roughly 29% of drug deaths in 2019, 69% of deaths in 2020 and 64% in 2021, according to coroner data.

“A lot of times what we’re seeing is a stimulant, like methamphetamine or cocaine, with fentanyl,” Rhoads said.

The number of deaths where both stimulants and opioids are involved also increased exponentially between 2019 and 2021, from 5 to 58. Fentanyl makes up the vast majority of those deadly opioid deaths.

Rhoads said the increase in deaths from a combination of stimulants and opioids is not exclusive to San Luis Obispo County — it’s been reported statewide as well.

“I think that’s indicative of what we’re seeing anecdotally from clients of the syringe exchange program,” Rhoads said. “They’re self-reporting that there’s fentanyl in everything.”

What to know about the drug supply in San Luis Obispo County

The data from the San Luis Obispo County Sheriff’s Office drug lab offer a glimpse into the illicit drug supply in the county.

Law enforcement sends confiscated illicit substances to the Sheriff’s Office drug lab, where a representative sample is taken from the seized substances and tested, McDaniel said.

The data from the drug lab do not represent the volume of a particular drug seized, but rather a count of the number of samples tested from drugs seized by law enforcement.

Two pounds of fentanyl were seized and two people arrested after a traffic stop in Nipomo on April 22, 2022. That much fentanyl is enough for 500,000 lethal doses.
Two pounds of fentanyl were seized and two people arrested after a traffic stop in Nipomo on April 22, 2022. That much fentanyl is enough for 500,000 lethal doses.

The statistics from the Sheriff’s Office drug lab tell a story of the changing composition of the illegal drug supply in the county.

From 2017 to 2021, meth was the most commonly seized drug locally.

The data shows heroin seizures peaked in 2019 with 938 recorded samples, fell in 2020 to 796 samples and then plummeted in 2021 to 389 samples.

But as heroin seizures went down, fentanyl seizures exploded.

In 2017, there were only 18 recorded fentanyl samples from seizures in San Luis Obispo County, followed by 27 in 2018. That jumped to 110 seizures in 2019, 449 in 2020 and 933 in 2021, according to the data.

The drug lab counts are still being finalized for 2022, but sheriff’s deputies said fentanyl seizures in SLO County continue to climb.

“There’s going to be more fentanyl samples tested in our lab than ever before in 2022,” McDaniel said.

Based on current trends, McDaniel said, the final 2022 fentanyl counts could be roughly 1,100 samples.

Comparing seizures from the drug lab with substances identified in toxicology reports from local drug-related deaths shows the trends mirror each other, McDaniel said.

“You see the same patterns for drug deaths,” McDaniel said. “You can see it goes along the same lines as these statistics.”

More potent synthetic opioids emerge in SLO County

Although fentanyl has been the primary driver of the national opioid crisis for the past few years, other synthetic opiates and fentanyl analogs are starting to crop up throughout California, including in San Luis Obispo County.

New drugs are typically introduced on the East Coast and make their way west, McDaniel said. These new drugs often hit major metropolitan areas before arriving on the Central Coast.

Alongside fentanyl, two new synthetic opioids are currently emerging as drugs of concern: xylazine and isotonitazine.

Xylazine is a synthetic opioid typically used in veterinary medicine. The drug has similar effects to morphine or heroin and is commonly detected in combination with fentanyl, according to the U.S. Drug Enforcement Agency. The drug is used legally by some veterinarians but also is produced illicitly in laboratories abroad and sold for the low price of $6 to $20 per kilogram.

People who use xylazine in combination with fentanyl or other drugs risk decreased respiratory function, making the effects of an overdose more lethal, according to the DEA.

A drug arrest in San Luis Obispo on Feb. 3, 2022, netted a huge cache of illegal narcotics, including fentanyl, cocaine, meth, LSD, opiods and more. The seized drugs have a street value of more than $1 million, the Police Department said.
A drug arrest in San Luis Obispo on Feb. 3, 2022, netted a huge cache of illegal narcotics, including fentanyl, cocaine, meth, LSD, opiods and more. The seized drugs have a street value of more than $1 million, the Police Department said.

Even more worrisome: Because xylazine is not an opioid, the medication naloxone — commonly administered to reverse opioid overdoses — does not work, according to the DEA.

McDaniel said the drug has begun popping up more in San Luis Obispo County.

“Xylazine is starting to make a blip on the radar,” he said.

In the past, xylazine may have been detected by the sheriff’s drug lab in one to three samples seized per month, McDaniel said.

Now, it is detected in seven to 10 samples a month. The increase is notable enough that the toxicologist at the lab is going to start tracking it as its own individual category, McDaniel said.

“It is starting to make its way here, but it’s not as popular as all this other stuff,” he said.

The drug lab data show that meth and fentanyl have been the most commonly seized substances in San Luis Obispo County since 2017, with fentanyl surging in the past two-and-a-half years. The increase in fentanyl seizures corresponds with the uptick in fentanyl-related deaths.

Another synthetic opiate of concern is isotonitazine, also called ISO or nitazene.

The DEA warned of the dangers of isotonitazine in summer 2022 after it was associated with multiple overdose deaths in the Washington, D.C., area.

In early February, the San Francisco Standard reported that drug users interviewed by the publication said they were using isotonitazine, although the local DEA chapter and the San Francisco Public Health Department have not reported finding the synthetic opioid yet.

Isotonitazine will allegedly respond to naloxone, but experts said multiple doses may be needed to reverse an overdose.

McDaniel said he is not aware of isotonitazine being identified in San Luis Obispo County, but that it is just a matter of time until the synthetic opioid reaches the Central Coast.

“I haven’t seen ISO in the reports that I’m approving yet, but it’s good to know that it’s coming,” he said.

McDaniel added that it is unclear whether emerging synthetic opiates like xylazine or isotonitazine contributed to the uptick in January 2023 suspected drug-related deaths.

Tools used to conduct autopsies are laid out in the room where autopsies are conducted at the San Luis Obispo County Sheriff-Coroner’s Office, seen here Feb. 16, 2023.
Tools used to conduct autopsies are laid out in the room where autopsies are conducted at the San Luis Obispo County Sheriff-Coroner’s Office, seen here Feb. 16, 2023.

SLO County groups scale up distribution of life-saving overdose treatment

The numbers are still unofficial, but based on what he’s seen so far, McDaniel said he thinks the total number of drug-related deaths for 2022 will be slightly lower than in 2021.

He said that’s possibly due to the amount of naloxone — which often is known by the brand name Narcan — available locally.

“If we got rid of Narcan, we’d be really busy,” McDaniel said.

In 2022, SLO County organizations like the SLO Bangers Syringe Exchange and Harm Reduction Services and the San Luis Obispo County Opioid Safety Coalition aimed to scale up their distribution of naloxone.

Naloxone, sold under the brand name Narcan among others, can be used to save the life of a person who has overdosed from opioids.
Naloxone, sold under the brand name Narcan among others, can be used to save the life of a person who has overdosed from opioids.

SLO Bangers conducted 769 naloxone training sessions with community members between June 2021 and July 2022. During those trainings, 2,771 naloxone kits, representing 6,264 doses, were distributed, according to data provided by SLO Bangers.

SLO Bangers program coordinator and grants manager Candace Winstead said the organization has distributed more naloxone than it ever has in the program’s history.

In January 2022, the Opioid Safety Coalition launched Naloxone Now, a web application that delivers naloxone directly to anyone who orders it.

Data analyzed by the San Luis Obispo County Opioid Safety Coalition calculated an average of 38 lives were saved each month by naloxone in SLO County for the first eight months of 2022.

What is being done to help prevent drug-related deaths in SLO County?

While using illegal substances is never considered safe, the contamination of the drug supply with fentanyl and other highly potent, synthetic opioids has made using drugs riskier than ever, Rhoads said.

To help mitigate that risk, the Opioid Safety Coalition is prioritizing two key groups for drug education, outreach, prevention and intervention, Rhoads said.

The first group is illicit drug users.

“They need more of those supportive resources to help them get to a point where they can use less, they can use differently (and) they can use some of those risk-reduction tools,” Rhoads said.

Connecting drug users with harm-reduction resources such as sterile syringes, alcohol swabs and naloxone are vital to reducing the spread of infectious disease and death by overdose.

These materials are available through the health agency’s Opioid Safety Coalition and the SLO Bangers program.

Jenn Rhoads, coordinator of the SLO County Opioid Safety Coalition, said fatalities from fentanyl are on the rise in San Luis Obispo County in 2023.
Jenn Rhoads, coordinator of the SLO County Opioid Safety Coalition, said fatalities from fentanyl are on the rise in San Luis Obispo County in 2023.

The second priority group is transitional-age youth — typically older teenagers or young adults — who are opioid-naive and not connected to harm-reduction resources, Rhoads said.

Historically, the people who died from drug-related overdoses were typically active drug users, but the contamination of the drug supply with synthetic opioids means casual users and those inexperienced with opioids are also overdosing.

“They’re very much still in the phase of ‘I’m a teenager, I’m partying, and I got this pill from my friends, because I’m just really stressed out or been having a hard time with school or my parents or my family,’” Rhoads said.

Oftentimes, these experimental drug users don’t intend to use an opioid and don’t realize that they might need naloxone on hand to reverse an overdose.

The proliferation of counterfeit pills and illicit substances that contain synthetic opioids have led to tragic consequences for youth in San Luis Obispo County.

Atascadero teenagers Emilio Velci and Dylan Cruz-Sarantos died from fentanyl poisoning in 2020 in two separate instances after taking counterfeit pills they thought were one thing, but were actually fentanyl.

“He took a pill for a toothache and he died,” Emilio’s mother Cammie Velci told The Tribune in 2021.

Tragedy struck again in February 2021, when Atascadero teenager Reidly Varner died after taking a pill that looked like a benzodiazepine, but was actually just fentanyl.

Cases like that have spurred the Opioid Safety Coalition to work increasing the distribution of naloxone in schools and other gathering spaces for teenagers and young adults.

“I think that group is going to be a little bit more difficult to reach because we have got to go where they’re at, but they’re not probably accessing any kind of resources yet,” Rhoads said.

‘You can’t enforce your way out of a drug problem,’ sheriff-coroner sergeant said

The spike in drug-related deaths in San Luis Obispo County coupled with the increasing prevalence of fentanyl and synthetic opioids in the drug supply challenged local law enforcement agencies and public health organizations to come up with a solution to the crisis.

“This world is ever-changing,” McDaniel said. “One month it’s this, the next month it’s that. ... It’s not just fentanyl, there’s all kinds of analogs of fentanyl that we see.”

The use of illicit substances is often framed as a victimless crime where the drug user bears the brunt of the consequences, McDaniel said. But illicit drug use and substance use disorder has been associated with violence, theft or driving under the influence, he said.

These are problems that impact the broader community.

“It’s a victimless crime in a way, but the symptoms of that (crime) are not victimless,” McDaniel said.

San Luis Obispo County Sheriff-Coroner’s Sgt. John McDaniel stands in the room where autopsies are conducted, on Feb. 16, 2023.
San Luis Obispo County Sheriff-Coroner’s Sgt. John McDaniel stands in the room where autopsies are conducted, on Feb. 16, 2023.

To treat the opioid crisis in San Luis Obispo County, there must be collaboration and education across law enforcement and county public health agencies, and health and harm-reduction organizations, as well as conversations about the realities of drug use within families, he said.

“You can’t enforce your way out of a drug problem,” McDaniel said.

He compared the production, sale and use of illicit substances to the housing crisis.

The factors behind the housing crisis are multi-faceted and complex, McDaniel said. Enforcing laws about loitering and encampments by ticketing people is hardly a solution to homelessness, he said.

It also comes down to how drug cases are prosecuted.

McDaniel said law enforcement and the District Attorney’s Office often struggle to connect a specific substance that caused a drug-related death to a particular distributor for arrest and prosecution.

In 2021, the DA’s Office pursued a case against Timothy Clarke Wolfe, a Paso Robles man accused of selling fake prescription pills that contained fentanyl. Wolfe allegedly sold Emilio Velci the fake Percocet pill that led to the Atascadero teen’s death by fentanyl poisoning.

In summer 2022, federal prosecutors took over the case against Wolfe and the DA’s Office dismissed the local charges in light of the federal case.

A cabinet stores supplies for autopsies at the San Luis Obispo County Sheriff-Coroner’s Office, seen here on Feb. 16, 2023.
A cabinet stores supplies for autopsies at the San Luis Obispo County Sheriff-Coroner’s Office, seen here on Feb. 16, 2023.

Federal, state and local law enforcement agencies are beginning to adapt their investigative strategies to account for the proliferation of encrypted social media applications such as Snapchat, Facebook Messenger, Venmo and others that are used to sell drugs.

But legislative bodies need to write laws that keep up with the new frontier of illicit drug sales, McDaniel said.

“The enforcement aspect is one part of it — enforcement, prevention and treatment are how you have to handle it,” he said. “You can’t just arrest every person that uses drugs or sells drugs — you just can’t. Getting a collaborative effort is what’s important.”

For organizations like SLO Bangers and the Opioid Safety Council, keeping people who use substances alive is the most vital component of their work.

“People are going to make the choices that they make,” Rhoads said. “We shouldn’t stop caring about their life because they’re starting to use substances.”

Coming tomorrow: How harm reduction strategies have prevented overdoses and saved hundreds of lives in San Luis Obispo County.