Santa Clara County Offers Lifesaving Treatment to Combat Rise in Opioid Overdose Deaths

Jamie Foberg walked into the methadone clinic looking for something more productive to do than anxiously check her phone for signs of life. Her friend had confided in her about wanting to kick a heroin habit, which had already brought her several times to the brink of death. But early last month, her friend suddenly stopped calling.

“I’m really worried,” said Foberg, 31, a local activist and advocate for the homeless. “But that’s also why I’m here: to learn how to save her life, if it comes to that.”

In a small room at the central San Jose addiction clinic, she joined a handful of other attendees to find out how to administer Narcan, the brand name for naloxone, which blocks opioid receptors in the brain to reverse the effects of an overdose.

Dan-Wen Tsai, the clinical nurse leading the training, opened a pink-and-white box and pulled out one of the applicators.

“What you do is use your two fingers like this,” she said, holding up one of the small plastic nozzles. “You insert into the nostril and push.”

Unlike the old naloxone kits, Tsai explained, the new ones are needle-free and easy to use. Up until a year ago, the overdose antidote came in glass ampules that had to be administered injected into a vein or muscle with a one-inch needle.

“Most people aren’t medically trained,” Tsai said, “so they might not be comfortable using a needle. But this is very easy.”

According to the Centers for Disease Control, more than 52,000 Americans died of drug overdoses in 2015, which comes to roughly one person every 10 minutes. That’s the highest count on record. Driving the increase is the soaring abuse of prescription painkillers and heroin, a category of drugs known as opioids.

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Jamie Foberg and Sachin Radhakrishnan review Narcan brochures at a recent training session. (Photo by Jennifer Wadsworth)

Santa Clara County saw a 126 percent jump in the number of heroin poisonings from 19 in 2011 to 43 in 2015, according to the California Office of Statewide Health Planning and Development. Preliminary data from 2016 show a continued upward trend—and that’s just for heroin.

The county has also seen an uptick in overdoses from other opioids, including fentanyl, which is 50 percent more potent than heroin. The statistics for 2016 are expected to be released by July, according to county officials.

The epidemic traces back to the boom in prescribed pain pills from the 1990s through early 2000s. Prosecutors didn’t start criminalizing physicians for opioid overdose deaths until recent years.

In 2012, police arrested a Los Gatos doctor accused of running a “pill mill.” Dr. Jasna Mrdjen dispensed powerful painkillers with little regard for whether patients abused them or shilled them on the black market, according to prosecutors, who charged her with involuntary manslaughter. But until recently, pill mills operated with relative impunity. Meanwhile, throughout the nation, doctors paid by pharmaceutical giants relentlessly pushed brands like OxyContin, Percocet and Norco.

Now, it’s up to local health officials to push the antidote.

Paramedics have carried naloxone kits since the medication was patented in 1961 and approved as an overdose treatment a decade later. But health and safety concerns kept it out of the hands of some frontline workers. Since the intranasal spray became available a year ago, however, local governments have been trying to get Narcan in the hands of as many people as possible.

Last fall, Santa Clara County began distributing the two-dose naloxone kits, which typically go for about $70 at pharmacy, free of charge to anyone who walks in for an hour-long training at one of a few local methadone clinics. In August, the Foothill-De Anza Community College District Police Department took a page from San Francisco and a growing number of other law enforcement agencies by requiring cops to carry Narcan while on duty.

“Anyone who comes into contact with people who use [opioids] should learn how to administer Narcan,” said Mira Parwiz, an addiction specialist and clinic director for Santa Clara County’s Department of Behavioral Health Services. “Police are often the first ones to arrive at the scene of an overdose, so we’re trying to spread the word that this treatment is available to them.”

As the number of pain pill prescriptions rose to new heights in the early aughts, so did their potency. When states finally created prescription monitoring programs to crack down on unscrupulous doctors, patients who had become addicted turned to cheaper street drugs, like heroin.

From 2014 to 2015, heroin deaths rose 23 percent to 12,989. Deaths from synthetic opioids, such as illicit fentanyl, ticked up 73 percent to 9,580. Prescription painkillers claimed the most lives—17,536—but saw the smallest increase at 4 percent.

By the latest count, opioids caused two-thirds of the nation’s drug overdose deaths. More people die from opioids than car crashes and guns. Although the toll is far worse in rural states and big cities, the South Bay has seen a steady uptick this past decade.

“It’s taking a little bit longer to come here compared to other parts of the state,” Parwiz said. “But it’s still a very serious problem. And the effects are primarily on the younger people. We’re seeing more and more young kids get addicted, and more of the elderly. The young kids, a lot of them play sports, get injured, get prescribed pain pills, and the next thing they know is that they’re hooked. It snowballs from there.”

Amy Cooper, who sat in on the Narcan training session with Foberg last month, said she wishes someone had been there to administer the treatment to her son, Jon Gottlieb. It was on a Fourth of July getaway in 2014 when she got the dreaded call from San Jose police. Her son was 26 years old when he died from a toxic cocktail of alcohol and Norco, which, as she found out later, was prescribed by a dentist.

“If it happened to my family, it could happen to any family,” said Cooper, who has since volunteered her time with the National Coalition Against Prescription Drug Abuse to raise awareness about the dangers of opioids. “We really need to spread the word, not only about the dangers of prescription painkillers, but also about this treatment that can basically bring people back to life during an overdose.”

Dr. Deborah Stephenson, who works for the county’s public health department and specializes in preventative and addiction medicine, urged anyone who uses opioids to never use alone.

“People tend to want to isolate when they go use,” she said. “That’s the danger, that they lose consciousness and there may not be anyone there to help. But what we’re seeing in other cities, including San Francisco, is that the people who are saving the most lives are people who have addiction issues themselves, because they know the signs and they’re around other users.”

Foberg said she’s also concerned about what happens after someone administers Narcan, which sends the user into sudden, gut-wrenching withdrawal. It may save their life, but because it empties the opioid receptors of their drug of choice, it also intensifies cravings.

“We need more places for people to detox,” said Foberg, who wound up giving her Narcan doses to someone in a local homeless camp. “If people want to get clean, that’s a narrow window and you want them to have somewhere to go or they’ll just use again.”

But relapse—often repeated relapse—is part of recovery for so many people, she added. And that shouldn’t be fatal.

For more information, contact Amy Cooper, the South Bay contact for the National Coalition Against Prescription Drug Abuse, at 408.724.0140. To get trained in how to administer Narcan, walk-ins are welcome at 1pm each Friday at the Santa Clara County methadone clinic at 2425 Enborg Lane in San Jose. There’s also a smartphone app, available here, that tells users where to find the nearest supply of naloxone. 

Jennifer Wadsworth is a staff writer for San Jose Inside and Metro Newspaper. Email tips to [email protected] or follow her on Twitter at @jennwadsworth.

10 Comments

  1. Police officers diagnosing symptoms and administering powerful drugs? In the same communities where school nurses can’t administer aspirin?

    Police officers trained and equipped to save drug addicts but not heart attack victims (thrombolytic meds, defibrillators)?

    Police officers expected to do act as paramedics in the same communities where they’re not even trusted to act as police officers?

    BS

    For you cops out there, before diagnosing anyone’s medical ailment I suggest you wait for your sergeant, the police auditor, and a representative from the DA’s office. Also, double-check that your body cam is working, take note of the race and gender of all parties involved, and get a signed consent form to be on the premises. Also, keep your fingers crossed that this will windup a coroner’s case and you’ll be quickly freed up to get back out on the streets for some good old-fashioned profiling.

    • Aside from being shocked and appalled by Finfan’s cynical insensitivity, I think this whole Narcan program doesn’t go far enough. In addition to using Narcan as a lifesaving means of preserving drug addicts so they can continue to contribute to the community through their ongoing criminal endeavors, we must also consider the side effects.

      One of Narcan’s common side effects is nausea. Whereas cannabis, or “medical marijuana” is touted as an effective anti-nausea drug, then every cop who is required to carry and administer Narcan should also be required to have marijuana on hand as well; either cigarettes or brownies, the latter for those who don’t smoke. Upon administering the Narcan, a police officer should then also be required to administer marijuana to the unfortunate “opioid victim”.

      Another extremely common side effect of both Narcan and opioid use is constipation. In addition to Narcan and marijuana, every police officer should be trained in the administration of an approved laxative. However, since many “opioid victims” may be found in an unconscious or semi-conscious state, thus making oral administration of the laxative contraindicated, each officer should be issued an enema kit. No special training in administering of the enema kit will be required since cops have all become so accustomed to having the City stick it up their bum for so many rears, they already know what to expect and how to deal with it.

      The “Narcan Program” is the perfect government program. It establishes a new victim class, the “opiod victim” (formerly the junkie; or dope fiend); It provides a government solution , free Narcan, that allows the “opioid victim” to escape responsibility for his actions (irresponsible overdose); and places, on the cops, the burden of administering yet another ridiculous program.

      In consideration of the potential side effects mentioned, a new pharmaceutical can be produced; a mixture of Narcan, marijuana and Ex-lax. Perhaps the new drug could be called “NarcanWeedanDump”.

      • So what you’re saying is that there is no value in saving a person’s life? You are comparing the side effect of nausea to death and saying it isn’t going far enough. Sarcasm or not, your viewpoint is flawed.

  2. If this is the prevailing attitude of the cops in San Jose? No wonder they don’t give a rats ass about our 911 calls. God forbid they find a worthless life in trouble. Damn that is just a waste of their time. They left the donut shop for this? The nerve! And we want to support measures to bulk up our police staff???? Are these the kinds of people our tax dollars are going towards? Screw them. Yet have the police done a single thing to tame the problems in my area. Maybe they just assume everyone in the SUN area is a junkie not worth their time. I’ll keep that in mind the next time the city wants funds for cops. We don’t want bigots that feel superior to all the residents. We want compassionate human beings that see value in every life. Even If it means getting off your overweight ass and helping a person in need.

    • Who are the cops whose attitudes you’re criticizing? There’s nothing in either the article or the comments to warrant a rant against the police but plenty to justify one against you. I understand that crime problems in your area may have aggravated to your baseline hysteria, but by getting so carried away you managed to make a fool of yourself.

    • > We don’t want bigots that feel superior to all the residents. We want compassionate human beings that see value in every life.

      Kim:

      Sounds like you don’t need any cops in your area. I’m sure your neighborhood is just full of compassionate people who see value in every life.

      Handle the problem yourself.

  3. Sachin,

    No. What I am saying is that society’s resources are finite and there is no value in going out of the way to save the life of some overdosed junkie so he can continue on supporting his drug habit by committing crime.

    Let’s direct resources toward scholarships to help kids who are trying to make something of themselves rather than wasting money on dope using losers who never will.

  4. News Flash-those “dope using losers” are someone’s kids. Addiction is not bad behavior, it is a bad disease. We need more compassion on this site and in this world.

    • If you want to liken a junkie to a patient with a disease, consider that rabies is also a bad disease, whatever the cause, but even “Ol Yeller” had to accept the consequences of his actions, and unlike the junkie, Ol’ Yeller had some redeeming qualities..

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