Can anything be done to stop the scourge of fentanyl? Here’s what some are trying in Sonoma County

V’s daily routine revolved around fentanyl for two years before she got treatment for an addiction that frequently kept her alone in her “dark and depressing” bedroom, she said.

She was shy of 20 when she’d travel to San Francisco’s Tenderloin district for street drugs and a few years passed before she began using heroin and fentanyl.

Recognizing she needed help, V, who asked to be identified only by her first initial to avoid being stigmatized by her past, registered at Santa Rosa Treatment Program, where patients are treated for opioid use disorder.

She doubted herself over the first couple days, but was committed to ridding herself of drug dependency and leaving her mother with better memories of her.

Counselors went over V’s condition.

She received doses of methadone to minimize fentanyl’s effect on her and eliminate cravings.

Daily visits took place for a year.

On June 10, the 29-year-old restaurant worker will have been in recovery for two years and her days are now spent hitting the gym, walking her dog and enjoying morning coffee with her mom.

“Little did I know, it’s a whole ‘nother world,” said the Petaluma woman.

V was treated by one of multiple Substance Use Disorder facilities in Sonoma County helping those who suffer from fentanyl use, which has become rampant across the North Bay over the past few years.

Since 2017, Sonoma County has tracked more than 500 overdose deaths, including 173 in 2020. At least 70% of those deaths were linked to fentanyl, according to county data.

From February to December in 2017, the opioid was present in 14 overdoses in Sonoma County. In 2018, fentanyl deaths rose to 31 and hovered around that number in 2019.

In 2020, 111 deaths were linked to fentanyl, according to county records.

Lawmakers react

The drug has been the subject of a number of legislative efforts at both the state and national level. Last year, the House of Representatives passed HR 2364, also known as the “Synthetic Opioid Danger Awareness Act,” which is awaiting action in the Senate. It calls for efforts to raise awareness of opioid dangers and availability of substance abuse and mental health services. Another House bill, the Stop Fentanyl Act of 2021 was introduced last fall and has been assigned to committee.

Earlier this year, California lawmakers introduced an Assembly bill that increases the punishment for anyone selling fentanyl.

Under Assembly Bill 2246, anyone possessing at least 2 grams of fentanyl may face at least two years in prison. Anyone selling fentanyl on social media may face at least three years in prison.

Fentanyl’s toxicity makes it 100 times more powerful than morphine and even a trace amount can be deadly. It can be absorbed through the skin or inhaled when in a powder.

That’s all the more reason for treatment facilities to work with those looking for help, said Jesse Collins, a counseling supervisor at Santa Rose Treatment Program.

“There’s urgency, for sure,” she said. “It’s like, get them in, absolutely.”

One size does not fit all

Sonoma County partners with a dozen treatment facilities, mostly in Santa Rosa, but independent centers also are available.

A list of treatment facilities is on the website for the county’s Department of Health Service’s Behavior Health Division. People may also call the Substance Abuse Mental Health Services Administration’s hotline at (800) 662-HELP (4357).

Comparing the number of active fentanyl users with treated patients is difficult since little is known about exactly who’s using opioids in their private lives, experts say.

Collins said her facility has around 350 clients and about one-third of them were admitted for fentanyl, though their current levels of usage and treatment stages vary.

But of those who’ve been admitted into Santa Rosa Treatment Program over the past 2.5 years, she added, about 98% sought treatment for fentanyl use.

Given the differences among fentanyl users, experts say treatment weighs heavily on patients’ needs and concerns.

Furthermore, overall treatment opportunities continue to evolve amid the growing fentanyl emergency, which not only affects chronic users but also those consuming other drugs laced with the opioid.

These may include Xanax, Adderall, Vicodin, cocaine, methamphetamine and heroin.

“This is a really big crisis. It is hard to get ahead of it and that’s the reality of it. We get a handle on one thing and something else pops up,” said Melissa Struzzo, who works as a manager in substance use disorder services for the county’s Behavioral Health Division.

Naloxone, an overdose reversal drug, is pertinent to helping people suffering accidental overdoses of fentanyl and its availability is a key component in the battle against the opioid, Struzzo said.

Ideally, she said, it would be available the same way fire extinguishers and defibrillators are.

“When you go there, it’s there. It’s part of that first aid,” Struzzo said.

Recently, Petaluma Police used naloxone after a local man, believing he was using cocaine, snorted a substance now thought to be fentanyl.

And on April 3, a Mendocino County sheriff’s deputy used naloxone to help a man who became unresponsive after he was smoking an unspecified substance in Ukiah.

Sheriff’s deputies have used naloxone 11 times since April 2019, the agency reported.

It’s not unusual for law enforcement agencies to carry naloxone in case they need to help someone overdosing or officers who are exposed while investigating incidents.

The California Department of Healthcare Services is among the distributors of naloxone through its Naloxone Distribution Project. It has distributed over 1,000,000 units and recorded 57,000 overdose reversals since October 2018, though it wasn’t clear how much of that involved law enforcement.

Experts appear to agree on one thing: The first step is getting fentanyl users to recognize they need help and be willing to ask for it.

“Individuals are stigmatized for having a substance abuse disorder and that can be a barrier for people to access our services,” Struzzo said.

Those seeking assistance shouldn’t be concerned about diving in right away and becoming clean in short order, Collins said.

They’re welcome to call treatment facilities to engage in conversation and discuss their conditions and what services are available, she said.

And if they decide to pursue treatment, they have the option of using facilities that support abstinence or others that use Harm Reduction treatment, which relies on methadone or suboxone to minimize the effects of fentanyl.

“You can imagine that’s a lot more difficult to abstain from your drug of choice if you can still feel it,” Collins said.

Harm Reduction treatment is becoming more common in the medical industry, but Collins added the process still has skeptics who argue against using drugs to fight drugs.

At the end of the day, experts say, patients need to recognize they need help.

‘Enough was enough’

V used narcotics like oxycodone and heroin before trying fentanyl, which “made my high last longer,” she said.

It wasn’t long before she found herself going to sleep each night and telling herself that she needed to stop.

“I was so tired and I remembered looking at myself one day and I was so disgusted with myself,” V said. “I got to my breaking point. Enough was enough and I knew I had to change.

She agreed an important step to get everyone off fentanyl is helping them understand they deserve help.

“A lot of people who use are very smart and it’s a lack of love for themselves they feel,” V said.

You can reach Staff Writer Colin Atagi at colin.atagi@pressdemocrat.com. On Twitter @colin_atagi