With ‘anyone’ at risk from fentanyl, more action needed to cut Stanislaus deaths, expert says

Dr. Bernardo Mora has watched the fentanyl crisis and guided efforts to reduce the suffering in Stanislaus County.

Mora, the medical director of county Behavioral Health and Recovery Services, provides guidance for the county Opioid Safety Coalition’s education and prevention efforts around fentanyl.

The synthetic opioid street drug was responsible for 128 overdose or poisoning deaths in the county last year, a number that could be surpassed in 2023. According to a preliminary count, illegal fentanyl has accounted for 100 fatalities, or 62% of the county’s 161 total drug overdose deaths to date this year.

Mora participated in an interview Thursday as The Modesto Bee continued its coverage of the fentanyl crisis.

Q: It seems illegal fentanyl can harm any family and it’s taking a toll on the Stanislaus County community. Can you talk about how this drug has such a broad impact on families, social services, mental health, the community and even businesses?

A: “It really is unprecedented in this sense, but the synthetic opioids including fentanyl, meaning those made in a lab, are so easy and cheap to make that (traffickers) are making counterfeit pills that look like regular medications. You may have folks who are seeking opiates for whatever reason, but you have folks who are not looking for opiates and they are getting them anyway because the pills are fake.

“That is why anyone could be at risk. We talk about overdoses, but with fentanyl we also talk about poisonings. You can’t say a person is overdosing on something if they don’t know what they are taking.

“That is the scary part for someone who not only is a medical doctor but lives in the community and has family. People will make mistakes when their judgment is not good, and unfortunately this drug has lethal consequences.”

Q: Are businesses impacted in terms of people using opioids and stealing in order to buy drugs?

A: “I would say that isn’t new for fentanyl use. But it’s the classic story of people who are trying to feed an addiction may resort to criminal activity, sure.”

Q: Where specifically is fentanyl use happening in Modesto? In San Francisco, the Tenderloin district has those images of addicted people on the sidewalks. Philadelphia has the Kensington neighborhood.

A: “We are still trying to get all of our local law enforcement agencies to report for the OD Map program, showing where overdoses are happening.”

Mora said the 95354 ZIP code in southeast Modesto has been identified for a high incidence of overdoses, but part of that is the denser population in the area.

He said reports on 911 responses tend to show fentanyl use in Modesto’s downtown and the McHenry Avenue corridor. But it’s not as visible as in large cities and many overdoses have occurred at private parties and in homes.

Coalition tries to reduce fentanyl’s threat

Q. What is your role with the county opioid safety coalition and what is that group trying to do to address the fentanyl crisis?

A: “I am one of the facilitators of the meetings and part of the executive leadership of the coalition, which is a partnership of county behavioral health and public health. We don’t lead the coalition so much as we try to guide it. We have resources to bring folks together and help educate each other, to help people network to find strategies that work.

“We are just trying to learn from each other. There is a (fentanyl) education component and, hopefully in the near future, there will be more action. Clearly some action needs to happen because the incidence of death continues to increase.”

Mora cited 2022-23 data on a rising tide of overdose deaths in the United States. The 111,355 fatal overdoses in the 12 months ending in April were a 2% increase over the period ending in April 2022. The 77,415 deaths nationwide from synthetic opioids including fentanyl were a 5% increase, while fatal cocaine ODs were up more than 10%.

The opioid safety coalition has held or supported town hall meetings around the county to warn residents about fentanyl’s lethality — only 2 or 3 milligrams can be fatal. The coalition has also promoted harm reduction and prevention activities, while distributing overdose-reversing naloxone and fentanyl test strips.

Q: Are you getting results?

A: “These efforts are part of the strategy to minimize the impacts, but as I said, when you look at the stark numbers, the trend is still increasing, so that tells us we will continue the education and efforts to reduce stigma. But something has to be added, whether it’s more access to services and more treatment.

“There are barriers because folks in the community may have outdated ideas about what substance use treatment is like, or they may not be open to it. There needs to be more of that education piece, so that when they get to the point of realizing ‘I need to change,’ there are services available to help them.”

The strategy for combating the crisis

Q: What is the overall strategy for combating the fentanyl crisis in Stanislaus County?

A: “We are primarily trying to provide or urge groups in the community to provide access to more kinds of (drug) treatment and continue that education. The Aegis medication-assisted treatment centers expanded and BHRS has its own medication-assisted treatment at the Stanislaus Recovery Center campus.

“Over the last couple of years, the emergency departments at hospitals have started to provide what they call the bridge program. They have substance use navigators in their ERs. They will reach out and help people (who suffered an overdose or poisoning) to link them with (addiction) treatment services.”

Q: Is the county formally part of the Bridge Program in California? The state program tries to convince hospitals to treat substance use disorder as a life-threatening condition and start suboxone treatment in the hospital for overdose patients who may be frequent visitors.

A: “Yes. Some hospitals have committed to it and some hospitals are not sure. We continue to talk to hospitals trying to get them to commit.

“There are other pieces of the (county) strategy. One of the risky scenarios is when folks have been incarcerated, they are forced to be abstinent (from drug use). But then they leave jail and without some support and without education, if they go back to using the same dose, there is a big risk they will overdose. That increases the chance they will die of an overdose because their tolerance, which maybe was high before, is now low. They could die if they resume the same dose.”

The county is trying to improve on education and connections to substance use treatment for those leaving incarceration, Mora said. County BHRS has in the planning stages an integrated care center where anyone, regardless of insurance, will be able to start drug treatment, he noted.

How to reach the ‘drug culture’

Q: What else needs to be done to get a handle on the fentanyl epidemic and reach people we’re not reaching now, those in disadvantaged communities, people in the drug culture, the homeless?

A: “We can build on current strategies. There is outreach like the (Community Health and Assistance Team). We can piggyback on their efforts and try to help them make sure to add substance use treatment and provide them with resources like referrals. We believe stigma may be lessening a little bit, but it still exists. People have the attitude that those being poisoned by this drug are doing it to themselves. Sometimes, folks are victims of circumstances.

“We know there are neurochemical changes in the brain (tied to) substance use, and when you talk to people at first they may not seem motivated to enter treatment. But maybe we need to work with them for awhile. If someone is willing to start treatment, that will help them to be engaged and continue to get better.

“It does take time and manpower (to work with hard-to-reach communities). It takes time to figure out the best way to do that.”

Q: Do we need more drug treatment services?

A: “I would say yes. It’s not just a need in Stanislaus County. I don’t think in any place in the country people would say, ‘OK, we are good,’ when there is a rising tide of overdose and poisoning deaths and people are suffering.”

Q: How did the fentanyl problem grow out of the opioids crisis?

A: “What I said in the beginning. People figured out a cheap way to make it. My understanding is it does not require exotic chemicals. Just really cheap ingredients. An old story goes around that drug dealers used to not be interested in having their clients die on them. They are their customers. Clearly, the folks making synthetic opioids don’t care about that anymore.”