COAST Interview with Dan Hicks, Prevention Services Manager
COAST began as a collaboration of Agency Leads from across the County, including Public Health, Emergency Medical Services, Sheriff’s Office, Medical Examiner’s Office, and the Health Care Agency’s Ambulatory Care.
Tell us about your educational and work background.
Dan: My work in Prevention started decades ago after graduating from Princeton and moving to Southern California. I thought I'd get some experience as a counselor on the way to an advanced degree in clinical psychology. I was working an internship at Capistrano by the Sea Psychiatric Hospital, when I began to realize how economic and social forces were shaping what drugs were causing so much trouble, common themes about how clients got started with abuse, and who was coming in for treatment with insurance coverage (and also who was not). I decided to take a step back, asking myself if I really wanted to "keep pulling people out of the deep water, or go upstream and keep them from falling in."
I studied with experts from UC Berkeley and UCLA, and took a position funded by the US Dept. of Education focused on alcohol and drug prevention for commuter college students. My direction completely changed. I started working on policies with the City of Irvine, the County of Orange, and then the State Department of Alcohol and Drug Programs, and I've been in prevention work ever since.
When did you start with Ventura County Behavioral Health?
Dan: I actually came to VCBH by way of San Diego, working at the Institute for Public Strategies. Picked to lead the Ventura office, I started as a contracted technical assistance provider to community coalitions concerned with underage drinking, impaired driving, and a wide range of drug-related problems. Soon I was asked to lead a grant-funded effort to reduce alcohol-related problems in both retail and social settings countywide. I accepted a fixed-term position as a County employee in 2005. I've moved up a few ranks, but my passion remains prevention for Ventura County.
How did COAST get started?
Dan: Around 2010, we had implemented some impressive policies and programs to reduce underage and binge drinking in Ventura County, but we started to see big changes in the scale and severity of prescription drug misuse. We didn't fully realize it then, but the Opioid Crisis was already well underway. There was liberal pain-killer prescribing, limited consequences for "dirty doctors," and rising levels of heroin use. We teamed up with the Sheriff's Office like never before to address opioid availability and enforcement, forming the Prescription Drug Workgroup. This ultimately became our much larger Opioid and Illicit Drug Workgroup.
Realizing we didn’t have a centralized dashboard for inter-departmental efforts, and building years of collaboration, we pursued Department of Justice funding and the County Opioid Abuse Suppression Taskforce (COAST) was born. It initially launched as a three-year grant, but it continues to expand even after funding.
What have some of the challenges been?
Dan: The two biggest challenges have been 1) the dynamic nature of the crisis, and 2) the complications of the COVID 19 pandemic. COAST multi-agency efforts began in earnest just as fentanyl was displacing a lot of heroin use and getting added into the wider drug supply. That was, and still is, a major challenge. We’ve entered the synthetic age, and it is so, so much easier for people who use a drug to accidentally overdose. Of course, this was hugely compounded by a pandemic. But County leadership recognized overdose prevention and opioid suppression as essential services, and we’ve really adapted in huge ways-- our community messaging, engagement and training—all have changed to meet growing needs.
What value do our contractors bring to the work that we do?
Dan: I think it’s safe to say that we could not have achieved everything we have—including more than 3,000 documented overdose reversals—without the dedicated work of our contractors. Clearly there is passion and purpose behind the work of agencies who are in the business protecting our communities and saving lives. If people want proof, just take a look at www.VenturaCountyResponds.org !
Board of Supervisors Meeting – June 6, 2023
A presentation by the County Opioid Abuse Suppression Taskforce (COAST) on the multi-agency effort to combat the opioid crisis in Ventura County was given to the Board of Supervisors on June 6th. County Behavioral Health Director Scot Gillman, and Substance Use Services Manager Dan Hicks, laid out the history of the heroin, opioid and now, fentanyl crisis in our county, as well as the decades long effort by Behavioral Health Department to address them.
It was a united front by all COAST Leads: Public Health’s Associate Public Health Officer, Dr. Uldine Castel, Medical Examiner Dr. Christopher Young, Assistant Sheriff Victor Fazio and District Attorney Erik Nasarenko, on what their individual offices are doing toward this effort as well as the power of the combined efforts by COAST. The Board members had numerous questions and lauded the COAST Leads for all being done in our county around this ongoing health and law enforcement crisis in Ventura County, as well as the country.
Facing Down Fentanyl
See highlights from the presentation to the Ventura County Board of Supervisors on June 6, 2023:
Interview With Assistant Sheriff Victor Fazio
COAST has enjoyed the collaboration of COAST Leads from agencies within Ventura County, including Public Health, Emergency Medical Services, Medical Examiner’s Office, Health Care Agency and Ventura County Sheriff’s Office.
Tell us about your background. How long you’ve been with VCSO and what your role is?
I started my career with the Ventura County Sheriff’s Office in 1994. I worked a variety of assignments throughout the agency spending a large portion of my career investigating narcotics related offenses. During my 16 years assigned to the narcotics division, I commanded two multi-agency task forces. One task force focused on the proliferation of pharmaceutical drugs and the surge of heroin and opioid related overdose deaths. The other task force was dedicated to identifying and neutralizing drug trafficking organizations at the highest level.
I was proud to also serve the City of Moorpark – which contracts law enforcement services with the Sheriff’s Office – as Chief of Police for nearly four years from 2019-2023. In January of 2023, Sheriff Fryhoff appointed me as one of his four Assistant Sheriffs. I have the honor of leading the Special Services Division which includes Major Crimes, Narcotics, Bomb and Arson Unit, Criminal Intelligence, Crime Analysis, Crime Lab, Air Unit, Crime Scenes Investigation Unit, SWAT, Tactical Negotiations Unit, Technical Services Unit, and Sheriff’s Systems Bureau which is responsible for hardware, software, and new technology.
What can you tell us about FOCUS?
The Ventura County Fentanyl and Overdose Crimes Units (VC FOCUS) is the rebranding of the Ventura County Interagency Pharmaceutical Crimes Unit. The mission of VC FOCUS is to actively address overdoses and fentanyl related crimes in Ventura County through enforcement, prevention, education, and partnerships. Investigations by VC FOCUS will create accountability, education supports prevention, and public partnerships assist in fostering increased awareness of this epidemic. VC FOCUS is comprised of two units of law enforcement representation from the east and west side of Ventura County.
VC FOCUS will be relentless in making communities safe from fentanyl and other opioids. Through partnerships with COAST, Federal, State, and Local Law enforcement, the Justice System and the Community, VC FOCUS will strive to eliminate the root cause to addiction and deaths caused by illicit opioids.
What do you think readers should know about the opioid crisis in Ventura County currently?
Without bold action, the opioid crisis isn’t going anywhere soon. Unless we work together, we will never solve the problems related to opioid misuse and abuse. We have a seemingly endless supply of fentanyl coming from Mexico and sourced by China. Unfortunately, there is a long-standing appetite for opioids in our county which continues to poison our residents. We must be united in education and prevention efforts, understand the importance of harm reduction, and maintain a desire to hold drug dealers accountable. This isn’t solely a law enforcement problem, a behavioral health issue, or a public health responsibility, it is an all of us problem that needs all of us to solve it.
Tell us one thing about you that helps us get to know you better?
I enjoy teaching and have instructed well over 10,000 law enforcement officers, health care providers, and community members throughout the nation on various law enforcement related topics. Additionally, I am an Adjunct Criminal Justice Professor for the University of Southern California as well as Arizona State University in both graduate and undergraduate programs. I also like learning, researching, and writing. I have a bachelor’s degree from UCLA in political science, a master’s degree from ASU in criminal justice, and a doctorate in education from USC where my research was focused on reducing harms caused by opioids through physician education.
Thank you, Victor, for sharing your valuable experience with us!
Real Talk: Fake Pills, 100% Danger
National Fentanyl Awareness Day was recognized with numerous events to different demographics in the county. The Ventura County Office of Education teamed up with Ventura County Behavioral Health and invited all county high schools to participate in National Fentanyl Awareness Day on May 9.
The Behavioral Health Department prepared a 32-minute video presentation that spoke directly to youth in our county in a first-ever Youth Summit on this topic. “Real Talk: Fake Pills, 100% Danger,” was made available to every high school in Ventura County, and by the end of the week (May 12) had over 1,300 downloads by school districts and parents. This is the first in what will be an annual event to educate students in the dangers of illicit opioids and fentanyl.
See the presentation below:
Prescribers Care May 9th Event
Continuing with the Prescribers Care Discussion Series in 2023, Ventura County Behavioral Health provided education and resources to Behavioral Health clinical staff, including therapists and physicians, during a morning presentation that also shared information about the growing fentanyl problem in our county.
It was followed by a lunchtime presentation that was championed by our own Dr. Joseph Vlaskovitz, a psychiatrist and director of the Behavioral Health Department’s Substance Use Treatment Services, again targeted to physicians throughout the county. In the evening, a special panel presentation at Las Posas Country Club, which featured Medical Examiner Dr. Christopher Young, VCMC’s Addiction Specialist Dr. Tipu Kahn, VCSO’s Sergeant John Hajducko and Addiction Specialist Dr. Matthew Lamon, on the very real effects of the fentanyl crisis they see in their work.
Learn more about Prescribes Care →
National Fentanyl Awareness Day is May 9.
National Fentanyl Awareness Day is May 9. Raising awareness about an urgent national problem: people are dying at alarming rates due to illicit fentanyl, a dangerous synthetic opioid. Get the facts and share them widely. Learn about our efforts to raise awareness and see our campaigns at www.venturacountyresponds.org and www.fentanylventuracounty.org. View more resources www.fentanylawarenessday.org.
Insight from COAST Leads
COAST has enjoyed the collaboration of COAST Leads from agencies within Ventura County, including Public Health, Emergency Medical Services, Medical Examiner’s Office, Health Care Agency and Ventura County Sheriff’s Office.
We asked the COAST Leads “What are you optimistic about related to the Opioid Crisis in 2023?”
Chris Rosa, Deputy EMS Administrator, VCEMS Agency: I’m optimistic about the future of the COAST task force. Meeting in-person in November for the first time since 2020, was great, and you could feel the energy in the room. People are ready to get back on track and do some good work with regard to opioid abuse and response.
Dr. Theresa Cho, Ventura County Health Care Agency, Ambulatory Care CEO: I am inspired by VCHCA's battle against the opioid crisis through addiction medicine treatment, with plans to launch a detox unit at our county hospital. Opiate use disorder is a frequent challenge for those served by our Backpack Medicine team, who meet patients where they are at as we try to save lives from this disease. The Whole Person Care team's intensive case management for persons with substance use disorders gives me hope that they will get the treatment and support they need.
Sgt. John Hadjucko, VCSO Special Services Division-Narcotics: I am hopeful that the flow of information and dialogue continues between government agencies and community / education groups on just how dangerous fentanyl is and the scope of the epidemic we face. There can be no change without first recognizing we have a problem, then working together to confront it. I think this past year we finally really started seeing what we are up against and admitting it is entrenched in our community. I see positive change as we continue to make that output of information and resources a reality, and there seems to be an overlying community interest in working together to solve this problem.
Interview with Chris Rosa, Deputy EMS Administrator
Tell us about your career with Ventura County EMS: when did you start, what was your first role and is it different from what you’re doing now?
I was hired as the EMS Deputy Administrator in May of 2010. Prior to that I was a Paramedic Supervisor with American Medical Response and a volunteer flight paramedic with the Ventura County Sheriff’s Aviation Unit / SAR Medical Team. In all, I have spent my entire 23-year EMS career here in Ventura County, starting as an EMT with American Medical Response in September of 1999.
It’s been great seeing the EMS system develop from where we were in the late nineties to now. It makes me feel happy to know that I’ve played a role in helping the system grow and adapt to the changing needs of not only the community, but also to the changing needs of our prehospital personnel.
What year did EMS response begin seeing fentanyl overdoses in Ventura County?
It was 2017, where we began to hear more about fentanyl and other powerful synthetic opioids that were in our communities. There were anecdotal reports coming to us from prehospital personnel advising that there were situations they were using more naloxone on individual patients. At the same time, we were seeing and hearing the same types of reports in our opioid task force meetings during briefings from law enforcement and behavioral health leaders.
What was a key indicator that fentanyl was surpassing heroin as the most common street opioid?
The easiest way to tell is the number of repeat naloxone administrations we see by personnel in the field. In some cases, we are seeing five or six or more administrations, versus prior cases where one or two administrations was enough to bring respirations above 12 per minute – a key threshold for prehospital personnel.
The highest number of administrations that I have seen to date is 15+ doses for a single patient. Prior to fentanyl being introduced into the community, that situation would be unheard of. It’s also important to note that this number doesn’t take into account the incidents in which law enforcement or members of the public administered naloxone prior to EMS/Fire arriving on scene.
The graph below highlights the number of incidents in which prehospital personnel administered 3 or more doses of naloxone to a single patient.
What percentage of EMS calls are attributed to overdose response in 2022 vs previous years?
Overall, the number of incidents being dispatched with a call type of overdose/poisoning is relatively low (about 2%) when compared to all other types of incidents. Also, there are many ODs that are dispatched with a variety of other call types as well (cardiac arrest, altered level of consciousness, behavioral emergency, unknown medical problem, etc.). It’s also important to remember that due to the nature of emergency medical dispatch protocols and call-types, there are other types of overdoses in this category, in addition to cases of poisoning or accidental ingestions. This makes it somewhat difficult to determine a true number of opioid overdoses just using call-type alone, which is why we usually try to stick to a more definitive data point related to understanding the opioid problem. That data point continues to be naloxone administration. Going back to your original question, the number of incidents dispatched with a call type of overdose/poisoning YTD, versus prior years, is outlined below:
With the advent of COAST, what are some elements you have found beneficial that weren’t available prior to the collaboration?
For me, it’s been the increased sharing of information and ideas from one discipline to another. When we first started, it seemed that everyone in the room knew there was a problem, but nobody really knew what was being done to combat the issue or what resources were available. Having the ability to get everyone on some sort of common ground - whether it be elected officials, agency heads, or members of the public, is one of the greatest things we can do as a group. If the folks who are tasked with trying to decrease this trend don’t have a strong understanding of the problem at hand, how are we supposed to educate others on how to do the same?
EMS is saddled with many responsibilities including mass casualty response, natural disaster response, and day to day medical calls. What are a couple of recommendations you would give the public to prevent opioid/other substance overdose?
I think awareness is so important. Awareness of resources (COAST dashboard, Naloxone rescue kits, needle exchange sites, BH access line) that are available to any person or family/friend that is dealing with addiction. Awareness that this problem is not going away anytime soon. Awareness that there are teams of dedicated professionals doing what they can to help combat these problems and get people the help they need.
Interview with Tipu V. Khan, MD, FAAFP, FASAM; Addiction Medicine Fellowship Director, VCMC
Tell us about your background: education, residencies, and career path.
I attended the University of Washington where I got a certificate in underserved pathways, caring for the underserved, on top of my MD degree. I came back to southern California and did a residence at Harbor UCLA and trained in the county hospital. l then went to USC and did high- risk OB fellowship. Then at a FQHC in full spectrum primary care, mix of all underserved. In 2014, I joined VCMC.
What is your current role and what was your initial role with the county, if different?
I always wanted to go back to academics, wanted a couple of years under my belt and I had real world experience after two years. I realized I liked full-spectrum care, all of it, high-risk OB, and began looking for jobs for this and there wasn’t a lot. There were two, one in Riverside county and one at VCMC. VCMC had name recognition, and a stellar reputation. I had three children who were 9, 6, and 3 years old at the time, and it felt like the right place for us to be.
What was it that interested you in this work?
For me, growing up I saw the lack of care for patients who had limited medical access. Friends who wouldn’t get diabetes check-ups until they were in dire need of foot care. One friend didn’t get proper care and that led to a bad outcome. The underserved need more high-level care. That’s why I went down that pathway. The ability to be an advocate for those who need a voice in the system was what interested me in this work.
Is there a ‘typical’ patient who comes to see you?
That’s what I love about my job, every week is different. One week I’m on the addiction consult service and it’s intense, high intensity. Then I’m in the ER, then a delivery, and the next week on primary care. The breadth and scope of practice is very different. Literally cradle to grave.
What do you see as the most urgent issue in the world of addiction at this time?
That’s a tough question: Fentanyl, if I had to put it into one word. That’s why the Prescriber’s Care Discussion Series for medical providers in Ventura County is a great approach. It’s not going to happen with just law enforcement. It will require a complete revision on how we approach the issue of addiction, with fentanyl overdoses. Every person or a family member knows at least two people who have overdosed or died. Not just one avenue to care will work here. We need to look at this in a different way. We’ve tried increasing access to care; addiction is not something like small pox that comes and goes away. We’ve struggled with this issue since the beginning of time. It will never be entirely gone. We need to learn to live with it, with as little impact as possible.
What (if anything) do people most misunderstand about a person addicted to substances?
People who haven’t experienced an addiction, don’t understand it’s not under their control. We want to say, ‘Just say no’, or ‘let god, let go.’ They have a disease; it’s disconnected from the pleasure pathway. You’ve got an adolescent brain running your entire life. That’s the neurobiology of the disease/brain. When I have that conversation with patients about the disconnect from the front of their brain, it clicks. A good amount of it is out of their control. A lot of these people have a lot of underlying trauma from when they were much younger, and you’re not going to fix those pathways. They don’t have that executive function. They need education to help with skills to learn to cope without the use of substances. Not a simple task. In the world of addiction care there’s medication care and addiction medicine, which we approach from the medicine side; we use a lot of pharmacy care, medications Suboxone and Buprenorphine, along with all the behavioral part of it. We have a good relationship with drug court and primary care, public health nurses, and for years we were the only addiction medicine group in the county; now we are the largest, though there are others in the county. We take all insurance, self-referral from Gold Coast, word of mouth.
Tell us about the team you work with at VCMC?
We have five faculty and fellows, docs in trainings, and a strong behavioral health team in the clinic and great nurses. Also, a good Substance use navigator at the hospital. It’s the whole team and picture, great relationship with VCBH, we work with a woman and children residential treatment center, a house for women to detox and stay with their children. This treatment center is the only such medical place in the county.
What do you feel is the most beneficial aspect of the Prescriber’s Care Discussion Series you recently facilitated?
What I really appreciated from the first one is that you’re not hearing one side of the story, it’s really encompassing all sides of the substance abuse scene. Law enforcement, coroner, we’re all trying to do the right thing but everyone approaches it from a different lens. We don’t all see things the same way. Sgt. Hadjucko from VCSO might say, put more people in jail; that’s how they approach it from their lens. The second series we talked about safely prescribing.
Anything else you’d like us to know about you and the work that you do?
We’ve built a community presence and even if someone hasn’t met with us they have heard about it. Depends on where they are in their process. Where they are in their change. Some are not ready to have a discussion. But it is easier to have those conversations now than, say four years ago. And that’s a win.
National Fentanyl Awareness Day May 10, 2022
The first ever National Fentanyl Awareness Day launches tomorrow, Tuesday, May 10, 2022. The purpose is to raise public awareness about the growing fentanyl public health crisis. People are dying at alarming rates due to illegally made fentanyl, a dangerous synthetic opioid. Founded by parents who have lost loved ones to the drug overdose epidemic, National Fentanyl Awareness Day is supported by a group of subject matter experts, corporations, nonprofits, schools, families, and elected officials who are coming together to amplify the issue via social media. The date was purposely set during Mental Health Awareness Month to amplify the warning message about self-medication at a time when counterfeit pills have flooded the illicit drug market. The goal is to leverage as many organizations and communication channels as possible to reach the most vulnerable demographics.
Interview with Dr. Renee Higgins, COO, Administrator, Ventura County Medical Examiner’s Office
What year did you start with the county Health Care Agency and what was your role?
In January 2013, I started working for the County’s Health Care Agency as the Chief Hospital Operations (CHO) for the Ambulatory Care department. My role, along with my fellow (CHO) colleague, was to oversee the operations of the county’s vast clinic system. At the time, this included public private partnership clinics which were Federally Qualified Health Centers, Specialty clinics and county campus clinics onsite at Ventura County Medical Center.
Did you come to the agency from the private sector?
Yes, I worked in the private sector as a health care administrator for many years prior to becoming a public servant. I worked in the fields of elder care, home health, home care and medical transportation. Becoming a public servant was something that I had desired to do for many years.
How (and when) did you transition to the MEO, and describe your role?
I started working for the MEO in 2015, in tandem with my role in Ambulatory Care for three years. I eventually came to work fulltime at the MEO in 2018. My current role is Chief Operating Officer for the Medical Examiner’s Office.
What’s the most gratifying part of your work?
There are many gratifying parts of my job. Being a leader in this agency is both challenging and rewarding. I was able to be a part of the counties inaugural LEAP program (Trailblazers) which honed my Servant leadership style and better prepared me to face the challenges and sorrows that the MEO faces every day. I honestly enjoy coming to work each day and being a part of a team that cares so much about their jobs. Our team has integrity and strength. People do not necessarily want to encounter our office; we interact with individuals on the worst days of their lives. If I can help a family member either directly or indirectly, in some way during this time of grief, it is very gratifying.
What are your observations about the increase in overdose deaths in your time with the MEO?
Out of the four manners of death: Natural, Accident, Suicide and Homicide, I recall when natural deaths accounted for most of the deaths in our jurisdiction annually. This has been replaced by Accidental deaths mainly due to the opioid crisis. I recall when the drug fentanyl was a problem on the periphery of our county, but we knew it was coming. The good thing is, we had the COAST and Rx Drug and Heroin Work Group teams already in place to help combat this dangerous drug when it hit our county. These collaborative teams led by Behavioral Health and composed of many partners, have been key in strategizing prevention initiatives to combat this crisis. A few observations are that the opioid crisis does not discriminate. It crosses all socioeconomic, race and ethnic lines. Also, the drug fentanyl can come in many forms, our Chief Medical Examiner called it “the great imitator” thus, a person taking the drug may not even be aware of it. Very concerning.
What would you like people to know about the work done at the MEO? What might surprise people?
For one thing, our work helps the living. The findings learned from the work of our investigators and forensic pathologists can contribute to public health questions and offer insight into medical practice and specific disease processes that otherwise would not be explored. A wealth of data is generated by our office. We were selected along with five other counties in the state to partner with CDPH to provide data on violent deaths as well as overdose deaths in real time. This data is sent to the state within 30 days of death. This helps to provide information that can be analyzed earlier to see trends and plan prevention strategies. In order to prevent deaths in our county, we have to accurately identify what is causing the deaths.
Anything else you’d like to share?
I am honored to work for the County of Ventura and more specifically the Medical Examiner’s Office. I recently was sworn into the California State Coroner’s Association as a board member. Although Ventura County is only one of six Medical Examiner systems in our state of 58 counties, this board represents all three types of forensic death investigation offices: Medical Examiner, Coroner, and Sheriff/Coroner. Working together to ensure best practices and representing the ME systems in our state is an honor.
Interview with Dr. Christopher Young, MD, Ventura County Medical Examiner
COAST has enjoyed the collaboration of COAST Leads from agencies within Ventura County, including Public Health, Emergency Medical Services, Medical Examiner’s Office, Health Care Agency and Ventura County Sheriff’s Office. Today we are talking with Christopher Young, MD, Ventura County Medical Examiner.
Tell us about your background. Where did you grow up and where did you receive your education/training?
Dr. Young: I was a California kid. I grew up in Topanga Canyon and the San Fernando Valley and graduated from Chaminade High School in West Hills. Although I wasn’t from Ventura, I spent a great deal of time in the county surfing and boating. My undergraduate degree in biology was earned at Pepperdine University.
After graduating from Pepperdine, I left California for many years. Medical school was at UT in Houston, Texas. My residency training was at Oregon Health and Sciences University in Portland, Oregon. My forensics fellowship was in Dallas, Texas at the Southwestern Institute of Forensic Sciences. After completing my training, I lived in Portland, Oregon where I served as a forensic pathologist for the Oregon State Medical Examiner’s Office for 13 years. I was hired as the Chief Medical Examiner for Ventura County in July of 2017. After spending 23 years training and practicing in other states, it felt great to return home to California.
Ventura County is one of only a small number of California counties with a Medical Examiner rather than a Coroner. Explain the difference and why having a Medical Examiner is beneficial.
Dr. Young: Within the United States, there are two systems of death investigation: coroner and medical examiner. The coroner system dates to feudal England and the medical examiner system started in the early 1900’s in the U.S. While both offices employ forensic pathologists to perform autopsies, a coroner’s office is usually run by an elected person with no formal medical training while a medical examiner’s office is overseen by a physician, usually a forensic pathologist. While there are few federal regulations pertaining to death investigation, for the past 100 years, the federal government has repeatedly recommended replacing coroner’s offices with modern, independent medical examiner’s offices.
Of California’s 58 counties, Ventura County is one of only six counties with a modern medical examiner system of death investigation. Ventura County is especially progressive, having switched from coroner to medical examiner way back in 1974. Although only six counties have a medical examiner’s office, almost half of the state’s population is served this modern system of death investigation. It is the larger, more progressive counties that have made the change to a medical examiner system. The total combined population of the six medical examiner counties of Ventura, Los Angeles, San Diego, San Francisco, Santa Clara and San Joaquin comprise nearly half of the population for California.
Forensic pathologists play a vital role in communities and in the justice system concerning matters related to death. For death investigation to be done properly, investigations must be performed in an objective, neutral and independent setting. The investigation of deaths can become the focus of political or legal pressures by individuals or offices seeking to influence a pathologist’s findings.
Two of the primary reasons for the federal government to recommend the medical examiner model of death investigation are independence and medical oversight. Independence is critical as potential and inevitable conflicts of interest arise in offices run by elected officials and law enforcement. The most obvious and glaring example of conflict of interest occurs when in-custody death or police shooting death is investigated by the same law enforcement agency involved in the death.
Another distinguishing feature of a medical examiner office is that these offices are run by physicians with specialized training. An example where death investigation oversight by a physician is especially important is the opioid epidemic. In order to understand the opioid epidemic, the drugs which caused the death must be identified. In some California, non-medical examiner offices, a pathologist may conclude that a death is the result of a “combined drug overdose”. In these offices, the death certificate is often completed by a non-medical deputy investigator.
For these overdose cases the death certificate may indicate an overdose with no drugs listed or, alternatively, the deputy may attempt to include every drug listed in the toxicology report on the death certificate (including many drugs not related to the death). In Ventura County, every death certificate is certified by a physician. When the death is the result of an overdose, only those specific drugs that contributed to death are listed on the death certificate. Medical opinion and certification are necessary to accurately identify and characterize individual overdose deaths; but are also critical to accurately define and understand the opioid epidemic as a whole. The Ventura County Medical Examiner’s Office has been complimented by state California Department of Public Health for the detailed information included on death certificates for overdose deaths.
COAST has focused on the opioid crisis in our county. What have you seen over the past three years?
Dr. Young: The opioid crisis is a complex and ongoing problem throughout the United States which has also affected Ventura County. Over the past three years, we have seen an unprecedented numbers of overdose deaths. The majority of these deaths were the result of opioids and methamphetamine. Opioid deaths include prescription opioids like oxycodone or codeine, but a large percentage of these deaths in Ventura were due to heroin and fentanyl. Prior to 2020, fentanyl overdoses were less common than heroin deaths. Overdose deaths increased dramatically in 2020 and the increase was almost entirely due to fentanyl. Comparing deaths from 2019 and 2020, the total number of overdose deaths in Ventura increased from 149 to 217. Comparing these same years, the number of fentanyl overdose deaths went from 33 to 87.
Fentanyl is an extremely potent opioid drug which causes respiratory depression. Historically, the illicit form of the drug was recognized as a white powder. Death investigations in Ventura over the past year and a half have shown that fentanyl can have many forms. In some instances, illicitly manufactured, counterfeit pills appear to be Xanax or Oxycontin but are, in fact, fentanyl. In other cases, tan, sticky material resembling heroin also turns out to be fentanyl. While many of the individuals who overdosed on fentanyl may have known that they were using fentanyl, many other people may have overdosed and died unknowingly.
COAST helped your office produce an ‘Overdose Do’s and Don’ts’ video to educate first responders in helping you do your job when there’s an overdose death investigation. What other support has Behavioral Health/COAST provided to the MEO in the past few years?
Dr. Young: The opioid epidemic is a community problem which affects people throughout our county. The only way to approach the monumental issue of opiate addiction, treatment and prevention is through teamwork. Behavioral Health and COAST have facilitated communication and cooperation between agencies and departments so that we can fight the epidemic as a team. The educational video for first responders at overdose scenes is just one example of how resources have been used to improve the county approach to the epidemic.
In addition to helping promote best practices at overdose scenes, the COAST team has also helped our office promote safe prescribing. COAST provided staffing resources to help our office identify prescribers whose patients died, and the prescribed drug contributed to the death. Oftentimes, a physician may not be informed about a patient’s death. For this group of overdose deaths, the physician receives a letter from the Medical Examiner’s Office. The purpose of these courtesy letters is to inform the doctor about the death and to provide resources for safe prescribing. The focus of these letters is not punitive, but the goal is to promote best practices and improve communication with providers.
Regarding the opioid crisis, I get especially excited to work with our partner organizations to prevent overdose deaths; work I like to refer to as “medical examiner prevention”. One way that the COAST team facilitated collaboration is through sharing data. Along with other agencies and departments, the Ventura Medical Examiner’s Office is sharing data with the COAST epidemiologists. Death investigation information like location of overdoses and location of death will be combined with location data from other sources to generate maps which will help guide our county's response toward prevention and treatment. If I start to feel discouraged by the increasing number of overdose deaths within the county, I find solace when I think about the hard work of caring individuals and organizations within our county working to prevent these deaths and I think about the lives saved by supplying naloxone.
How many investigators do you have on staff?
Dr. Young: The Ventura County Medical Examiner’s Office employs seven full time medicolegal death investigators. Over the past year, our office has seen a steady increase in caseload, in part due to both the COVID-19 pandemic and the opioid epidemic. In response to the increased workload, we have utilized one of our Forensic Pathology Technicians to assist in investigations. During the COVID-19 spike, the county provided our office with a disaster worker from human resources. She quickly integrated with our team and helped us through these tough times.
What prompted you to go into this field?
Dr. Young: My father is a physician, specialized in treating people with burn injuries. As a pre-med, undergraduate student, I accompanied him to the hospital operating room and the county courtroom. In the operating room, I observed a team of physicians as they repaired life threatening and disfiguring burn wounds. In the court room, I observed my father as he provided expert medical testimony in child abuse burn cases. These experiences would play a large role in my decision to become a forensic pathologist years later.
I started medical school planning to become a family practice physician or surgeon and knew nothing about the specialty of forensic pathology. Like my fellow classmates, I knew that I wanted to use my abilities to help others and serve the community. I was drawn to surgical pathology because it required observational, deductive and hands on skills. Like others considering this field, I had reservations about becoming a surgical pathologist because most of the job is spent looking through a microscope, with little patient interaction. During a medical school surgical pathology rotation, I was invited to visit the medical examiner’s office in Houston, Texas. This was my first encounter with forensic pathology and almost instantly, I recognized that this was my calling.
After exploring this specialty further, I realized that my talents were well suited to this type of work. Forensic pathology requires hands on and observation skills but also requires communication skills to explain findings to others. The conclusions that I make as a forensic pathologist are based on autopsy observations, microscopic specimen evaluation and toxicology interpretation. The most rewarding aspect of the job is the interactions with other people. Clearly explaining findings and conclusions to family members, law enforcement officers, attorneys, jurors, insurance companies, reporters and other physicians requires communication skills, empathy, and patience.
At the end of the day, I became a doctor to help others and the community and forensic pathology fulfills these goals. The information generated from our investigations and autopsies can provide closure for family members, but this information can also save lives, for example when an inherited medical condition is identified. Providing physicians with details about how their patient died can help improve their practice of medicine. Medical expert testimony can help resolve criminal and civil issues within our justice system. Regarding the opiate epidemic, my hope is that information learned from our investigations and autopsies will help guide efforts to prevent future addiction, overdoses, and deaths.
Do you have any tips/advice that the general public could benefit from knowing in regard to opiate/fentanyl overdose?
Dr. Young: I think the best advice I can offer is to take action. The opioid crisis potentially affects everyone in our community, and we need to acknowledge the problem and take measures to protect our friends and family. Openly talking with our youth about the dangers of drug use and experimentation can go a long way toward preventing future addiction and deaths. Safely disposing of unused prescriptions will help prevent drug diversion where the drug is sold or used by someone else. If you or someone you know has an addiction or uses illicitly obtained drugs of any sort, there is always the possibility that the drug might contain fentanyl. Because any illicit drug might contain fentanyl, knowing the signs and symptoms of opioid toxicity and having naloxone on hand could save a life.
What else could benefit residents of Ventura County to know about the Medical Examiner's Office?
Dr. Young: I am proud to be the Chief Medical Examiner for Ventura County. The staff in my office have a difficult job to do and they are hardworking and care about the community that we serve. The county has shown our office a great deal of support allowing us carry out our duties in a timely, accurate and compassionate manner.
Thank you, Dr. Young, for sharing your valuable experience with us!
By Sheila Murphy, COAST Administrator
In October 2018, the Ventura County Behavioral Health Department was notified that its application for the Comprehensive Opioid Abuse Site-based Program, federal funding provided by the U.S. Department of Justice to combat opioid misuse, had been granted. The amount of the award was $935,401, and just under the $1 million maximum. The three-year grant was the largest award of two California county grants in the category.
The COAST Program – County Opioid Abuse Suppression Taskforce – has worked to address opioid abuse in Ventura County exclusively during the past three years, though Behavioral Health has been working tirelessly on this effort when the Ventura County Rx Abuse & Heroin Workgroup was launched in early 2012 to tackle the newly-identified opioid crisis.
COAST has worked closely with our stakeholders – the Ventura County Sheriff’s Office, Ventura County Medical Examiner’s Office, Ventura County Public Health and Ventura County EMS. With the creation of a Data Management Coordinator position earlier this year, COAST has been taking a deep dive on analyzing trends and targeted efforts to reduce local impacts.
The U.S. Department of Justice grant funding of COAST ended in October 2021, but the work, even more important during the past two years, continues, as a stand-alone program under the Substance Use Services division of Behavioral Health. The COAST Opioid Data Dashboard was developed to inform the public on important data such as opioid-related deaths over a five-year period (2016-2020), lives saved with naloxone (2014-2019), and prescriptions for opioids in the year 2018, among others. The Dashboard will be updated annually.
The emergence of fentanyl as the leading cause of overdose deaths, both in Ventura County and nationally, has taken the work of COAST to greater collaboration with the Ventura County Sheriff’s Office. We will continue to look for innovative ways to educate and inform residents of our county about the very real dangers of illicit drugs, and how they can keep themselves and their families safe and healthy. To learn more, www.coastventuracounty.org.
COAST Newsletter - October 2021
Every quarter we send out COAST Newsletters to keep you informed about our COAST grant efforts to address the Opioid crisis in Ventura County. Through the COAST grant, Ventura County agencies are working together to reduce illicit opioid supply, decrease opioid demand, and save lives. By sharing and comparing data, we can leverage information, analyze trends, and target resources to respond to this evolving public health crisis. In this newsletter, see the Interview with Dr. Christopher Young, MD, Ventura County Medical Examiner.
COAST Newsletter - July 2021
Every quarter we send out COAST Newsletters to keep you informed about our COAST grant efforts to address the Opioid crisis in Ventura County. Through the COAST grant, Ventura County agencies are working together to reduce illicit opioid supply, decrease opioid demand, and save lives. By sharing and comparing data, we can leverage information, analyze trends, and target resources to respond to this evolving public health crisis. See the July 2021 Newsletter and learn about recent efforts being made by our team.
A Conversation with Sergeant John Hajducko, new COAST LEAD from the Ventura County Sheriff’s Office
What is your role within the VCSO?
I am currently assigned as the sergeant in charge of the Pharmaceutical Crimes Unit of the VCSO Narcotics Bureau. I supervise a team of detectives who are primarily tasked with the investigation of sales, possession and transportation of illegal or counterfeit pharmaceutical drugs and fentanyl. Our unit is also tasked with the investigation of all accidental drug overdoses that occur within the Sheriff’s Office jurisdiction.
How long have you been doing this work?
I have been assigned to my current role since May 2021, however I previously worked in a Narcotics as a detective from 2014 to 2018. I have been with Sheriff’s Office for 26 years. In addition to Narcotics, I have held assignments in the Jail, Patrol, Field Training Officer, Crime Suppression Unit, the Sheriff’s Academy and SWAT.
What do you believe the most meaningful work of the COAST Grant has been to date?
I believe its education and really working to pull the opioid crisis out of the dark for the community. Unfortunately, not a lot of people truly know, or even want to know, the devastating effects that drugs have on the community. Many times the feeling is that “if it doesn’t affect me, than why should I care.” But the fact of that matter is that crisis affects us all whether directly or indirectly, and it’s not going away any time soon. From what I have seen so far, I think the COAST grant does a good job of bringing that “invisible” information from the drug overdoses and law enforcement activity behind the scenes, and converts it into searchable data and public education so that the entire community can realize just what a huge problem it is and that it does affect them in some way.
What do you think residents of Ventura County need to know about the opioid crisis in our community?
I think the most important thing to realize is there is not a one dimensional approach that is going to solve this issue. Law enforcement cannot arrest this problem away; the medical field doesn’t have any medicine that is going to cure this; behavioral health cannot change everyone’s thought process and understanding to turn everyone away from drugs; and families don’t always have the support structure and communication skills in place in order to help their loved ones through an issue like this. The only way to get through this crisis is a community approach where all these entities cooperate and mutually support each other in their missions.
Do you want to share anything personal about yourself?
My wife is a high school math teacher and we have a blended family of 6 kids, with the oldest at 20 and the youngest at 5! Prior to joining the Sheriff’s Office, I served in the US Marine Corps. I’m an avid football and hockey fan, and my hobbies include camping, hiking, and motorcycle riding.
COAST Newsletter - April 2021
Every quarter we send out COAST Newsletters to keep you informed about our COAST grant efforts to address the Opioid crisis in Ventura County. Through the COAST grant, Ventura County agencies are working together to reduce illicit opioid supply, decrease opioid demand, and save lives. By sharing and comparing data, we can leverage information, analyze trends, and target resources to respond to this evolving public health crisis. See the April 2021 Newsletter and learn about recent efforts being made by our team.
Interview with Brad Friday, COAST Grant
Today we are talking with Brad Friday, Implementation Coordinator for the County Opioid Abuse Suppression Taskforce (COAST) Grant, Ventura County Behavioral Health, Substance Use Services - Prevention.
Hi Brad. Please describe your work with the COAST grant.
Brad: My work with COAST includes collection, dissemination, and publishing of pertinent County Opioid-related data via Public and Internal Dashboards, as well liaising between the requirements of the grant and our key stakeholders/partners.
How did you get interested in the field of prevention?
Brad: While serving as an Active-Duty Hospital Corpsman in the Navy, I was assigned to Marine Corps ground forces as a Field Medic. The prevention bug first bit while preparing/educating Marines prior to operational deployments rather than being strictly reactionary. After that tour I became a “Preventive Medicine Technician” within Navy Medicine which specialized in overall safety, health, and wellness of deployable forces within the Navy and Marine Corps.
What is your passion for working in the community?
Brad: It’s validating to contribute toward providing our diverse population a safe place to live and grow despite the challenges we face. This only happens by being at the ground level and interacting with the community along with our multi-agency partners who are working hard to achieve this mutual goal. My passion is to keep these threads tied together, to enhance these relationships and to maintain a unified front in suppressing the opioid crisis.
What are the areas that you hope to make changes in?
Brad: My goal in working within the COAST Project is to act as a conduit toward reducing opiate abuse, overdoses and overdose deaths via immediate communication of real-time data. This communication will then guide prevention, health care, and community leaders who join us in tackling the opioid crisis toward making more informed decisions.
Tell us one thing about you that helps us get to know you better?
Brad: I am originally from the Midwest but felt deeply connected to Ventura County upon being stationed in Port Hueneme some 20 years ago. While my career took me out of the county for a while, the attachment to this area never left. I’m not only happy that I get to live in this amazing area with so much to offer; I’m also increasingly proud I’m able to serve this community in this capacity.
Thank you Brad for sharing your experience with us. Your commitment and passion is inspiring.
Opioid Data Dashboard
Ventura County Launches COAST Opioid Data Dashboard
Fewer Overdoses and Increased Access to Care Are Priorities
Ventura County agencies are working together to reduce illicit opioid supply, decrease opioid demand, and save lives. By sharing and comparing data, we can leverage information, analyze trends, and target resources to respond to this evolving public health crisis.
On September 1st, The Ventura County Behavioral Health Department (VCBH) launched a public-facing data dashboard that provides the community with important statistics around opioid involved drug use. The public can access this user-friendly dashboard by visiting www.coastventuracounty.org.
“Local trends and resources, including addiction treatment locations, prescription drug drop-off locations, and overdose prevention strategies are featured. This is a one-stop site."
— Dr. Loretta Denering, Chief, Substance Use Services Division
As a response to the opioid crisis, VCBH has prioritized increased access to care for opioid users. In October of 2018, VCBH was awarded a federal grant, that in collaboration with multiple agencies, including Public Health, Emergency Medical Services, Ambulatory Care, Sheriff’s Office and the Medical Examiner’s Office, has allowed for more innovative ways to address the crisis. One of the grant deliverables was to create this dashboard for the community, in addition to tracking the nature and extent of the crisis locally, as well as providing more services to the public, especially those with an opioid use disorder.
VCBH provides a continuum of care for substance use and addiction problems, with six locations and access to a range of treatment services for achieving and maintaining recovery.
“Getting help for addiction starts with taking fifteen minutes to call the Access Line, or visiting our dashboard. We want people to get to the help they need."
— Dr. Sevet Johnson, Director, Ventura County Behavioral Health
If you believe you or a family member may be struggling with addiction, talk to your healthcare provider or call the confidential 24/7 Access Line: 1-844-385-9200.
View Promotion Resources
Coast Data Dashboard