Stanislaus County ERs get more fentanyl overdoses than some larger counties. Why is unclear

Stanislaus County has more emergency room visits than larger counties when it comes to overdoses caused by opioid drugs including fentanyl, another sign of the deadly impacts of the illegal drug epidemic, according to state and local data.

In 2021, when COVID-19 dominated the headlines, hospitals in Stanislaus County had 392 emergency department visits due to opioid drugs including prescription painkillers, heroin and illegal fentanyl. That’s more than what was recorded in four Bay Area counties with much larger populations.

Stanislaus County’s rate of opioid-related emergency department visits, 72.3 per 100,000 people, was four times higher than the rate in Santa Clara County (with 326 ER visits) and twice or three times higher than in Alameda, Contra Costa and San Mateo counties.

The dashboard that tracks California’s opioid epidemic shows 108 fatal overdoses in Stanislaus County in 2021, for a death rate of 19.6 per 100,000, which was higher than the 18 per 100,000 statewide mortality.

San Joaquin County’s opioid mortality of 18.66 per 100,000 also was higher than the statewide rate. San Joaquin had 327 emergency department visits for opioid overdoses in 2021, a rate of 42.1 per 100,000 residents.

No one had an explanation for the large number of overdoses affecting emergency rooms in Stanislaus, the state’s 16th largest county, other than the county has not avoided the nation’s problem with opioid addiction.

Other opioids are killing, too

Tony Vartan, director of Stanislaus County Behavioral Health and Recovery Services, released more detailed info on fentanyl mortality in the county. The county recorded 95 fentanyl deaths and 28 deaths due to other opioids in 2021 — a total of 123 opioid fatalities.

The fentanyl crisis worsened in 2022, when 127 fentanyl deaths were recorded in Stanislaus. There were 14 deaths from other opioid drugs.

The nation is in the tight grip of a fentanyl crisis as major drug cartels mix illegal fentanyl with counterfeit pills that look like prescription painkillers. The fentanyl is so potent that 2 or 3 milligrams are lethal for the sometimes unwary buyers.

A medical director for Memorial Medical Center in Modesto said it regularly sees patients felled by fentanyl overdoses.

When the culprit is fentanyl pills purchased on the street, the overdose victims delivered by ambulance are usually younger adults, said Dr. Kanthi Kiran, medical director of Memorial‘s emergency department.

The fast-acting fentanyl, a synthetic opioid, quickly can go from creating a high for the user to overdose and death, Kiran said.

Emergency responders often give Narcan (brand name of naloxone) to an unconscious person at the scene to reverse the overdose. “If they are breathing and in the hospital, we can usually reverse it,” Kiran said. Most fatal overdoses occur in the field when a drug user is alone or no one calls for help in time.

Some overdose patients in the emergency department get a second dose of Narcan or are admitted to a hospital room on a Narcan drip, especially if they have other opioids in their system, Kiran said.

Hospital staff watch those patients for the effects of other drugs, such as oxycodone, that have lasting effects for 12 hours or longer. “You have to watch them. You can’t just reverse it and say goodbye,” Kiran said.

If a victim of fentanyl poisoning has lain unconscious for hours and survived, the patient may suffer a breakdown of muscle tissue and kidney failure, requiring a longer hospital stay.

How medical centers help survivors

Kiran said patients are sent home with Narcan nasal spray or a prescription for the lifesaving medication. But Memorial and Doctors Medical Center, also of Modesto, are using substance use navigators to connect discharged patients with medication-assisted addiction treatment in the community so they don’t return to the hospital or worse happens.

“What we really want to do is prevent overdoses in the first place and actually help people with their dependency,” Kiran said. “If someone comes in with an overdose and recovers, it is a time in their disease when they are receptive to getting help. We want to be there for them in that moment and offer them help.”

Stanislaus County is closing its Genesis narcotic treatment program, removing an option for referring recent overdose victims to medication-assisted treatment to help with breaking addiction. Genesis has been treating and counseling around 225 clients for substance use disorder and they may be vulnerable to relapse and fentanyl poisoning if they’re not successfully transferred to other services, advocates for the program said.

Vartan, the county director for BHRS, said the department assesses available services and plans for expansion to meet community needs. He said in an email that people in the Medi-Cal program can access medication for substance use disorder through a support line.

Vartan said services are available at Aegis Treatment Centers in Modesto and Ceres, Evaluation & Medication Access Clinic for adults and youth, and Recover Medical Group via telemedicine. His email said Golden Valley Health Centers, Livingston Community Health and the county’s McHenry Medical Office have medication-assisted treatment for substance use disorder.

In 2021, the highest occurrence of opioid overdose deaths in Stanislaus County was in adults ages 35 to 39; the second most impacted group was adults 40 to 44 years old. Another significant group suffering overdose deaths were adults 65 to 69 years old, most likely related to long-term use of opioid medication.

It gets even worse

The county could face challenges with another synthetic opioid called Isotonitazene, or ISO, a newer street drug recently identified in San Francisco. The illegal drug is reportedly 20 times stronger than fentanyl and creates a high that’s compared to the euphoria of first-time heroin use, said Stanislaus County Deputy District Attorney Patrick Hogan, who has prosecuted fentanyl cases.

Stanislaus authorities are in favor of legislation to close loopholes in criminal law and support prosecution of dealers who sell fentanyl pills. But public safety committees in the state Legislature have rejected fentanyl legislation in the past two years.

Assemblyman Matt Haney, D-San Francisco, is chairing a select committee on fentanyl and opioid addiction. A staff member for Haney said Monday that the committee will hold a first general hearing on the drug epidemic in May and plans to hold quarterly hearings.

Stanislaus County Behavioral Health and Recovery Services said Medi-Cal beneficiaries can inquire about medication services for substance use disorder by calling the Access, Crisis, and Support Line at 888-376-6246.