.Opioid Crisis: Harm Reduction Comes to Santa Cruz

In a county that was once almost as well-known for drugs as it was for anything else, statistics show that many drug-related deaths have decreased in recent years. That means Santa Cruz County is bucking a larger trend—in much of the nation, things are moving in a more troubling direction.

There were 63,600 drug-related deaths in the U.S. in 2016, the most recent year with data available. Around 66 percent of those Americans—some 42,000 people—died from opioid use, making it the worst year on record, according to the Centers for Disease Control. Those deaths were a major part of the fact that 2016 was the second consecutive year that Americans’ life expectancy fell, and the first time since the early 1960s that the United States had seen life expectancy drop for two years in a row.

As health officials continue to see the opioid crisis take its toll, the Trump Administration held a summit last month to discuss how to combat it. Meanwhile, a new local coalition has joined a larger effort to create a safety net and hopefully save lives.

Opioids include a variety of substances, like heroin, prescription painkillers, and synthetic opioids such as fentanyl, a new drug on the market which can be 50 times stronger than heroin. Fentanyl is often used by dealers to cut street opioids, in order to make as much profit from their product as possible. However, dealers are now also using it to cut other drugs, including stimulants like cocaine, law enforcement officials say. Connecticut has seen a 420 percent increase in fentanyl-laced cocaine over the last three years.

At this point, however, fentanyl seems to be more of a problem on the East Coast. Dr. Stephany Fiore, the sheriff forensic pathologist, says that while Santa Cruz County does see fentanyl overdoses, “it’s very minor compared to everything else.”

In defiance of national trends, Fiore says, the county has actually seen a decrease in both overall drug deaths and opioid-related ones. In 2017, there were 32 accidental drug-related deaths, down from 56 in 2014. But the county’s overdose rate is still more than three times the state average. Nineteen of last year’s drug deaths were stimulant-related, which is the highest number in the last five years—as far back as the county’s data goes.

The Midwest and East Coast have been hit harder by fentanyl imported from China, the number one producer of the drug, Fiore explains.

“We’ve always had a difference in drug use on the different coasts,” she says. Black tar heroin has always been found primarily on the West Coast, Fiore adds, whereas “China white” has been more popular in the Eastern U.S. Still, she says there were nine cases of fentanyl deaths in the county in 2015, spread between various forms of fake prescription pills—like street-made versions of Xanax—along with cocaine and heroin.

Fentanyl testing is one of the services a new partnership called the Harm Reduction Coalition of Santa Cruz County will be supporting, along with syringe access, drug treatment methods, mental health counseling, and housing assistance. Harm reduction also includes ensuring access to naloxone, a substance that prevents fatal overdoses.

Grey skies and the threat of rain didn’t stop a group of roughly 30 people from gathering outside the Santa Cruz County Courthouse steps on Thursday, April 5 to announce the newly formed coalition. “Harm Reduction understands a particular behavior will occur, regardless, and we take steps to minimize impact on individuals and the community,” said Denise Elerick, one of the coalition’s founders.

Teaming up with similar harm-reduction chapters throughout the state and around the world, the local partnership wants to “promote evidence-based approaches” to supporting those suffering from substance disorders. Elerick hopes it will be an inclusive group, offering a space for anyone concerned about opioid issues—both legal and illicit—and their impact on the community. The larger Harm Reduction Coalition, founded in 1993, is now an international organization. Last month, Elerick and other locals met with representatives from Oakland who showed them the steps to launching the Santa Cruz chapter. Elerick, a dental hygienist, says that harm reduction is not a new concept, and that the group is “not trying to reinvent the wheel.”

City and county health officials attended the announcement, which was held during National Public Health Week, as did state Assemblymember Mark Stone and County Supervisor John Leopold.

“Too often we try to solve a complex problem with a simple solution,” Stone told audiences. “A Harm Reduction Coalition and a multi-jurisdictional approach is the right way to educate the community.”

Some elements of harm reduction best practices have seen their share of opposition. A few years ago, needle exchange practices came under fire from public safety activists, largely out of a concern that they create an environment where syringes end up strewn about. Many called for either abolishing the practice or the creation of a strict one-for-one exchange, where intravenous drug users get only as many needles as they give back, instead of the “needs-based” model that’s in place in counties like San Francisco and Los Angeles. But studies have shown that neither model results in more hazardous waste or drug use than the other.

“In fact, the California Department of Public Health is no longer issuing permits for programs that are not needs-based,” Elerick says. “They do not advocate or support one-for-one exchange.”

Elerick remembers Austin, Indiana making headlines in 2015, while under the leadership of then-Gov. Mike Pence, who opposed needle exchanges. With a population of 5,000—just slightly larger than Felton—an HIV outbreak among intravenous drug users left more than 200 people infected with the disease, and 95 percent of the infected also tested positive for Hepatitis C. After a long struggle with Pence, public health experts and state legislatures were able to convince him to lift the state’s ban on the program.

The data supports the trend too. A recent study by the Centers For Disease Control (CDC) found that the number of people who shared syringes has dropped 52 percent since the exchange was implemented. The study also found proper disposal of used syringes went from 18 percent to 82 percent.

But the debate over drug-use services isn’t over. Last year, many residents were shocked to learn that Santa Cruz County had been placed on a list of eight counties marked for possible “safe injection sites.” These are supervised facilities where users can have access to a clean facility to inject with clean materials, minimizing the spread of disease and personal damage. It’s a practice found throughout Europe and one that was instrumental in drastically reducing heroin use and harm in Portugal, once a capital in Europe’s drug consumption.

Authored by Assemblywoman Susan Talamantes Eggman of Fresno and Senator Scott Weiner from San Francisco, AB 186 stated that the program was completely voluntary, not mandatory, but it, too, ignited local concern over public safety, prompting the county’s removal from the bill.

Assemblymember Stone—who voted for the bill, which failed to pass the senate—is hopeful it will be revised and reintroduced.

“The messaging from the backlash was very one-way,” he tells GT. He believes Santa Cruz should take another look at safe injection sites, possibly once more data has been collected. “I think having a broader conversation about the complexities of the issue is what the Harm Reduction Coalition is all about. Looking at real solutions.”

The Harm Reduction Coalition of Santa Cruz County’s next meeting will be at 7 p.m. on Thursday, April 19 in the Capitola City Hall community room and is open to the public.