Deaths from fentanyl overdoses in San Mateo County have gone up in recent years and show further signs of increasing, public health officials told the county Board of Supervisors at a study session on the issue Tuesday, May 30.
Representatives from the county Health Department gave the board an update on the trends of opioid use in the county over the past several years and the state of the county today for opioid deaths, which have been driven in recent years by fentanyl use that is thought to be both intentional and accidental, and that is impacting children as young as 10 years old.
A current trend that is troubling health officials is the mixture of fentanyl and stimulants, a phenomenon that they said was driving a fourth wave of addiction trends since 1996, the year OxyContin was introduced as a synthetic opioid.
"It is definitely assured that youth use and youth death will increase and I believe that the continued use of mixing opioids with stimulants, primarily meth, will also grow, and that has huge implications as far as the treatment because it's very difficult to treat this combination," said Dr. Scott Morrow, the county's health officer.
In 2017, 90 people died in the county from non-prescription or "illicit drug" overdoses. About 10% of those deaths involved fentanyl. In 2021, 120 people died from such overdoses, with 50% of those attributed to fentanyl use, according to Morrow.
Fentanyl is a synthetic opioid that is prescribed for extreme pain, often after surgery or during cancer treatment. It is extremely potent and can be deadly in very small amounts. It is 50-100 more powerful than morphine, according to the National Institute of Drug Abuse.
In addition to abuses of prescriptions, fentanyl powder manufactured in China and base ingredients shipped from China to Mexico are increasingly finding their way into street drugs, often combined with other drugs or innocuous substances without the user knowing, according to the U.S. Drug Enforcement Agency and U.S. Department of Justice.
County health officials recommended that the board continue to invest in prevention and harm reduction tools, increase the use of a suite of continuum of treatment services, and invest in expanded data gathering and monitoring. Department representatives also recommended supporting state and federal legislation that address the issue, including the state's Senate Bill 641, which would make drugs like naloxone available to several locations, like schools and libraries, for free.
"This is not an epidemic of long term, chronic street users," said Mary Taylor Fullerton, a Behavioral Health and Recovery Services division representative.
"One pill can kill. One dusting of that fentanyl can be a lethal dose that someone's mixed into a substance that someone's obtaining unknown, it can cause overdose death. And so this is why we're here talking about fentanyl, because fentanyl poisoning is happening, it is happening in our community, and it is a national crisis," Fullerton said, echoing the language of a public awareness campaign supported by state lawmakers.
Fentanyl is often compressed into counterfeit pills that look real, according to the county Health Department and the DEA.
State lawmakers held a hearing last week during which they heard more about the crisis, which has seen statewide overdose deaths attributed to the drug rise from 786 in 2018 to 5,961 in 2021.