Forum: Facing Down Fentanyl
Ventura County is viewed statewide and nationally as an innovative leader in prevention work. So while the serious issue of the Fentanyl crisis has touched us here in our community, we are probably better positioned than many in dealing with it.
On September 27, 2023, our County CEO, Dr. Sevet Johnson, Ventura County Behavioral Health Interim Director, Dr. Loretta Denering, and County Supervisors Matt LeVere and Jeff Gorell, welcomed attendees to learn more about the fentanyl crisis in our county and what we are doing about it.
See the video of the forum:
Audience Questions and Answers:
Q: Doctors – All – So many people moved from heroin to fentanyl in recent years. Do you worry that there is something worse coming after Fentanyl? What’s next?
Fentanyl mixed with Xylazine is an emerging threat in the United States. Xylazine is an animal tranquilizer that is increasingly being found in the US illicit drug supply and linked to overdose deaths. We have seen only a handful of these cases in Ventura County to date.
Q: For D.A. – What can parents do and what can you do to change how easy it is for kids to use social media? Why can’t Snapchat be prosecuted or stopped?
It’s very important for parents to talk to their children on a regular basis about the dangers of drugs and the immediate threat in buying illegal drugs like fentanyl online. The United States Justice Department (DOJ) and the Federal Bureau of Investigations (FBI) announced earlier this year that they were investigating Snapchat over the possible use of their platform for drug sales, specifically targeting fentanyl-related instances. Snapchat has said it’s made operational improvements to detect and remove drug dealers from the platform and works closely with law enforcement and other groups in raising awareness of drug issues, fentanyl and counterfeit drugs. They say they have blocked search results for drug-related terms, redirecting Snapchatters to resources from experts about the dangers of fentanyl. People are still able to purchase these drugs online because drug dealers are creative in how they ‘outreach’ to users, including the use of emojis.
Q: What does Fentanyl look like? What are different types of use?
Powdered fentanyl looks just like many other drugs. They are available in different forms, including pills, powder and liquid. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs are laced with fentanyl.
[source, CDC Fact Sheet]
Q: I need to know how to find recovery houses that state insurance covers? Also need to hear how to find sober living houses so they can work and live there.
Recovery Housing is not an insurance benefit. However, VCBH currently contracts with Khepera House, who provides recovery housing for participants who are participating in outpatient SUD treatment. We have 14 beds for males and are hoping to expand this service in the next year to add beds for women as well.
Q: What population demographic is the most impacted by the use of Fentanyl and what is the % or whole number of deaths in said impacted population we know it impacts everyone, but what is the most impacted, and what steps are being taken to provide favorable outcomes?
Of the Opioid related deaths from 2022 and the first 6 months of 2023, the top 3 demographics in Ventura County by percentage are:
- Non-Hispanic White – 59.6
- Hispanic – 36.9
- Non-Hispanic African American – 3.5
Steps being taken for favorable outcomes include:
- Town hall outreach events
- SUS/Prevention Outreach with Schools
- Public Health/VCBH Collaboration for high-risk populations via Syringe Exchange Program and naloxone distribution/education
- Increased availability of naloxone across the county through VCBH Overdose Prevention Program and VCBH Access Line
- COAST Leads meetings which enhance interagency collaboration regarding this crisis
- Rx and Illicit Drug Workgroup meetings which folds multiple organizations working on the front lines of the opioid crisis into the broad initiative of preventing overdose across the county
Q: How much are people paying for Fentanyl? What is driving people to purchase/use Fentanyl? How can the faith community entity support in fighting Fentanyl? Where is Fentanyl being purchased/locations. You mentioned it’s growing in China or is it also being grown here?
Prices for fentanyl are broken down depending on weight and the area it is bought. Typical prices we see in Ventura County are approximately: $100 for a gram, $1000 for an ounce and $22,000- $24,000 for a Kilogram brick. Fentanyl pills vary on the amount bought, but generally it is about $1-$4 per pill when bought in bulk.
Q: We are at VCOE with all of you in the panel. I believe that prevention is one tool that could help many young people to stay away of drugs. We need the collaboration of VCOE and any agent to promote prevention. What is a strategy plan that our county is building for prevention?
The County of Ventura Behavioral Health has a Strategic Plan in place, and a division dedicated solely to Prevention. Our Prevention efforts are numerous, including outreach teams that are present in the community at health fairs and events throughout the year, distributing information about resources and naloxone kits. The strategic plan can be found at www.vcbh.org/VCBH_Strategic_Plan_At-A-Glance-English.pdf. They’re also out in the community giving presentations at schools on a regular basis.
We host community events, such as the ‘Facing Down Fentanyl,’ event at VCOE. As the liaison to Ventura County Schools, VCOE also has adopted a fentanyl prevention curriculum developed by “Natural High” that includes engaging lesson plans for students of all ages to learn about the current scientific findings on youth behavior, brain development, social norming, and substance abuse prevention. The latest research on prevention speaks to the power of “positive example” of engaging influential people (Tony Hawk, Kelly Slater and other professional athletes, musicians, artists) to share their story and how their true passion (healthy activities that uplift, motivate, and inspire) creates a “Natural High”. The curriculum includes opportunities for student storytelling, positive alternatives to drugs, tools for effective engagement, and the skills to a happy and successful life.
VCOE has been providing Natural High’s Fentanyl Toolkit to schools to learn about the lethal effects of fentanyl and illicitly manufactured pills.
Q: Why can’t someone go to mandatory rehab, if they can die?
Currently there is no law that allows for involuntary placement in an SUD residential program.
Q: Here in Ventura County, where is our greatest need? Where is our weakness and what can a person do to help alleviate that weakness?
Our greatest immediate need is to support high-risk populations across the county. This includes the unsheltered all over the county as well as zip-codes with disparities in social determinants of health. The long-term need is to increase awareness in parents and youth regarding the dangers of fentanyl and other illicit drugs.
Q: For Erik Nasarenko – Prosecution seems too lenient on drug dealers. What can be done to the smaller dealers, they seem to pay bail and be released.
While a defendant on sales cases can receive sentences of up to five years, the majority of “low level” dealers are not given the maximum sentence because aggravating factors do not exist when the quantity of drugs is “low.”
Typically, first time dealers will receive a sentence from a court of 180 days in jail and be placed on felony probation. Defendants can receive up to 50% credit on cases such as these because the crime is not a strike for “third strike” purposes.
Certainly recidivists and those who commit an additional crime while on probation will receive longer sentences and a court will take into consideration the circumstances of each case when imposing additional custody time.
Q: What barriers does the Sheriff’s department face in fighting our counties current crisis and what can the community do to help?
The biggest barrier to law enforcement in fighting this issue is our own state legal system. While law enforcement recognizes drug addiction and the behavioral and medical issues that go along with treating it, the current system allows for drug dealers to face very little if any consequences when they are arrested for selling these substances. Even when these individuals are arrested and prosecuted when they are selling narcotics or possess it for sale, the penalties are very minor, and they are usually back to their old ways of selling very soon.
The best thing the community can do is be aware and educated on the issues that law enforcement faces. If you see something, reach out and report it. Often we serve search warrants at residences and are approached afterwards by people who thought things were “suspicious” but never brought it up to law enforcement. The other thing is to make sure you are talking with your children about the dangers of drugs. Make sure you are aware of the people they hang out with and monitor who they are contacting on social media.
Q: San Francisco and other cities have utilized ‘street teams’ to go to where behavioral health and substance use disorders are highly prevalent. Are there any ‘teams’ in Ventura County? For example, if you know someone who is suffering, any team available to go to the individual as it is often difficult for the individual to ‘go get help.’?
Through our addiction medicine team, we have a program called Backpack Medicine. This involves medical and behavioral health doctors that fan out into the community – largely homeless encampments – to treat people abusing drugs and direct them to services.
Q: Is Fentanyl the same as crystal or is it different? What are the symptoms so I can see for kids?
Illegally made fentanyl is available on the drug market in different forms, including liquid and powder.
Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs are laced with fentanyl. NOTE: typically, ‘crystal’ refers to methamphetamine, to which fentanyl can be added, but the terms ‘crystal’ and ‘fentanyl’ refer to different drugs.
Q: Does Ventura County have inpatient rehabilitation places for people to go to if they are using opioids or Fentanyl?
Currently, VCBH has a contract with a residential and withdrawal management (detox) treatment provider located in Ventura County. Prototypes is a perinatal residential and withdrawal management treatment provider offering services to women and children. Currently, males that are assessed to need residential or withdrawal management levels of care, receive services at Tarzana Treatment Center in Los Angeles county. VCBH is actively seeking opportunities to contract with additional residential providers in county.
Q: Why as parents are we not allowed to obtain information or help find treatment for our children, 13 and older? Please help us parents not lose our children and the rights as parents to be able to help them get into treatment for substance use. Why do some schools ignore parents when we want to report drug use or drug incidents?
There should be no barrier to parents obtaining information or treatment for children 13 and older. The county website www.venturacountyresponds.org has information for parents and everyone interested in learning about treatment options, medication safety and more.
Q: Why is it so easy to get dangerous drugs and so hard to get the M.A.T. you just talked about? Can I just get it from my regular doctor?
There are many ways for individuals to receive MAT. All VCBH clinics and contracted residential programs provide Medications for Addiction Treatment (MAT). If an individual is already in treatment, they may ask to see a doctor to be assessed for which medication is right for them. If someone is not already in treatment and would like information or speak to a provider about MAT they can call the Access Line at 1-844-385-9200.
VCBH also contracts with Narcotic Treatment Providers (NTP), that dispense Methadone and Suboxone. They are Aegis Treatment Centers and Western Pacific. To get connected with a NTP, they may call the NTP provider, or they can call the access line at 1-844-385-9200 and a care coordinator can assist with connecting you to the provider.
There is an Addiction Medicine Clinic through Ventura County Medical Center that offers MAT to patients that generally have a co-occurring secondary mental health or physical health complication. In addition, because the x-waiver requirement to prescribe buprenorphine (the primary ingredient in Suboxone) has been lifted, ANY active medical doctor or psychiatrist can prescribe MAT in an outpatient setting.
Q: For Sheriff – What happens in the schools when children bring drugs to school? Or to the parents? Is anyone charged or in trouble for it?
If children are caught in school with drugs, they can be arrested, and the investigation will probably reach back to the household with Child and Family Services involved. Juvenile justice is a sensitive topic, with the focus on rehabilitation. That said, the criminal consequences are never severe. If the investigation shows that adult members of the household are the ones supplying the juvenile with drugs, they will be arrested. This is one case where California law does provide enhancements for prosecution.
Q: Are drug addiction places treating fentanyl?
Yes. As a powerful synthetic opioid, a fentanyl use disorder is typically treated with MOUD—Medication for Opioid Use Disorder. Several local providers offer services which include a treatment protocol using buprenorphine, along with counseling and other services which depend upon the level of care needed. Visit www.VCBH.org for our clinic service locations.
Q: How easy or how hard is it to get into treatment for any type of substance?
To access VCBH substance Use Treatment Services, call our Access Line at 1-844-385-9200. Individuals interested in receiving services will be given a brief screening related to current and history of use with alcohol and/or substance use. The screening will provide a pre-determined level of care and an appointment will be scheduled at a VCBH outpatient clinic or with an assessor if the screening indicated that withdrawal management (formally known as detox) or residential services may be warranted. VCBH Substance Use services offer a continuum of care, and through the screening and assessment process, medical necessity and Diagnosis is established to determine level of care and treatment needs for each individual.
Recovery Services is also a Drug Medi-Cal benefit for individuals who have completed treatment or immediately after incarceration and designed to support substance use recovery and prevent relapse with the objective of restoring the beneficiary to their best possible functional level. Individuals interested in receiving services can call the Access Line at 1-844-385-9200, or visit www.VCBH.org.
Q: How can parents join the VC Focus? Do you have a program at the high school level?
VC Focus was formed In January 2023, when all Ventura County law enforcement agencies and the District Attorney’s Office joined together and created the Ventura County Fentanyl Overdose and Crimes Units (VC FOCUS). This task force has enabled the Ventura County Sheriff’s Office and the county’s municipal police departments to mutually support each other with personnel and resources to investigate the sources of fentanyl supply to Ventura County, as well as the dealers responsible for selling this deadly product within our community. This partnership allows VC FOCUS to conduct investigations on recent fatal and non-fatal overdoses and is a law enforcement only task force.
VC FOCUS does go out and speak with many community groups, schools and other citizen organizations who are interested in learning about current drug trends and dangers. We do not contact known drug users since there are professionals in behavioral health and the medical field far more qualified to talk to them about addiction, treatment, and health concerns due to their drug use. We are also narcotics detectives, so our expertise is in drug investigations and enforcing the law.
Q: I work with high schoolers with substance use problems. They tell me all types of drugs are available, used on campus. They talk about being loaded at school with little being done by authorities. We must begin educating our youth, and it’s sad when our schools cannot keep our youth safe. Is this serious problem being addressed?
This past May 9, on National Fentanyl Awareness Day, the Behavioral Health Department, in partnership with the Ventura County Office of Education, featured a 30-minute presentation in all area high schools called ‘Real Talk: Fake Pills, 100% Danger’ to educate youth on the dangers of fentanyl. This will be an ongoing effort annually.
The Ventura County Office of Education (VCOE) has adopted a fentanyl prevention curriculum developed by “Natural High” that includes engaging lesson plans for students of all ages to learn about the current scientific findings on youth behavior, brain development, social norming, and substance abuse prevention.
Q: Is there any way that we can have dogs to find drugs out of our high schools? Can we start doing more or given more information to elementary schools?
The Sheriff’s Office will use K9’s at schools if there isa specific incident where drugs are suspected, and an investigation has been initiated. The K9’s do not do routine or administrative checks for narcotics at our county schools. Depending on where you live, there may be K-9 units used for drug detection. Start by asking your school administration about local needs and policies.
Q: Are doctors and pharmaceutical companies also being prosecuted for mis-prescribing opioids?
Yes, pharmacies and physicians have faced consequences with regard to the opioid crisis. The largest three US pharmacy chains, CVS, Walgreens and Walmart have faced more than 3,000 lawsuits claiming they contributed to the opioid epidemic by dispensing opioid drugs despite obvious red flags. Individual medical providers who prescribed opioids without a legitimate medical purpose, or over-prescribed opioids to individuals, have also faced legal consequences. The Opioid Settlement Funds recently distributed to all counties and state jurisdictions that applied and will continue to be distributed over the next two decades in an effort at restitution.
Q: Have we seen Xylazine in our county? Is this going to be the new crisis? What are the educational programs looking like for our school systems in Ventura County?
Fentanyl mixed with Xylazine is an emerging threat in the United States. Xylazine is an animal tranquilizer that is increasingly being found in the US illicit drug supply and linked to overdose deaths. We have seen only a handful of these cases in Ventura County to date.
Q: Are there inpatient detox options in Ventura? We often hear that police take a person’s Narcan kit. Is there a reason for this?
Yes, there is a withdrawal management (or detox) provider for women called Prototypes in Ventura. Very soon there will be an impatient detox at VCMC which is projected to open in November 2023. In addition, a men’s detox facility is planning on opening in Ventura early 2024.
As for police seizing naloxone kits upon arrest, the general reason this is performed is that the arrestee is also carrying their illicit drugs and paraphernalia in the same bag/container.
Q: As a concerned citizen, how can I have naloxone or where can I get one?
Residents of Ventura County can obtain naloxone anonymously by calling (805) 667-6663 and receive training on how to use it. Visit www.FentanylVenturaCounty.org and click on ‘get naloxone’ for locations near you.
Q: If opioids are so dangerous then why are doctors still allowed to prescribe them so freely?
Opioids are a legitimate drug for serious pain issues, such as for cancer patients and people who have undergone surgery, when prescribed by a doctor. What’s dangerous is illicit opioids – those not prescribed by a doctor but illicitly manufactured in a lab – and sold by drug dealers, often on the internet. The only safe drugs to take are prescribed by a physician, and even then, there is education to the patient about appropriate use.
Q: Is it not true that the pharmaceutical companies were pushing opioids and doctors were being encouraged to prescribe opioids? Which, in turn created this problem?
Prescription opioids have always been used to alleviate serious pain, such as after surgery. The opioid crisis, that is the rise in opioid overdose deaths, can be outlined in three distinct waves. The first wave began with increased prescribing of opioids in the 1990’s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999. The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills and cocaine.
Q: What do you believe is the root cause of the issue? Thoughts on patients and long monopolies of drugs? People self-medicate when existing medicine doesn’t work. How do you determine the success of current programs? Do you use metrics? Can those be reported publicly to our community? Measuring, reporting, transparency and accountability: How does VC compare globally? This is a global issue, not local so are we, and who is that work to benchmark? Do we have all stakeholders at the table? No. Should we have a user speak too? Or patient?
Addiction is a complex and much-studied societal issue. Research demonstrates a strong link between exposure to traumatic events and problematic substance use. Many people who have experienced child abuse, assault, war, natural disasters, or other traumatic events turn to alcohol or drugs to help cope with emotional pain, sleep disturbances, intrusive memories, anxiety, or terror. People with substance use problems are more likely to experience traumatic events than those without these problems. The county has an Opioid & Illicit Drug Workgroup, which meets six times a year and has numerous county agencies and community partners, such as non-profits like Give-an-Hour and Nate’s Place, to name a couple, to discuss everything from law enforcement strategies to deal with drug dealers, to education in schools to vulnerable teens. The original COAST funding supported dashboard visualizations showing various local data to provide trend information and insights on opioid abatement opportunities. This involved creating a dashboard receiving data securely from various agencies, including naloxone administration by all pre-hospital care providers as well as the VCBH rescue kits issued to county residents. These data are used to monitor trends and assist in enhancing outreach and targeting prevention services. For an example, please see www.coastventuracounty.org/news-updates. Additional data is available at www.coastventuracounty.org.
The County Behavioral Health Department does plan on hosting a number of these Town Halls in the coming year and will be inviting speakers including those with lived experience.
Q: How is Fentanyl created? What chemicals are in it that make it so dangerous? How is it processed?
Illicit fentanyl, primarily manufactured in foreign clandestine labs and smuggled into the United States through Mexico, is being distributed across the country and sold on the illegal drug market. Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays and increasingly pressed into pills made to look like legitimate prescription opioids. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.
Q: If you take Fentanilo, does it take just a little bit to die? If I take this drug with other ones will I die of an overdose?
Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl, or 10-15 grains of table salt, can be lethal depending on a person’s body size, tolerance and past usage. The Drug Enforcement Agency (DEA) has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet. In reviewing medical examiner data for opioid-related fatal overdose, fentanyl is a contributing factor in multiple “poly-drug” overdoses.
Using Data to Better Serve an Underserved Community
Learn how listening and collaboration led to responsive change in the community.
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 →
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!
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