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 6^th. 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.

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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:

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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!

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:

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 →

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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!

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.

Learn more:

Opioid Data Dashboard

www.coastventuracounty.org

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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

www.coastventuracounty.org/media

Coast Data Dashboard

www.CoastVenturaCounty.org