|
DATE: |
October 11, 2022 |
11 |
SUBJECT
Title
ENHANCING FENTANYL EDUCATION AND STRENGTHENING HARM REDUCTION EFFORTS FOR YOUNG PEOPLE (DISTRICTS: ALL)
Body
OVERVIEW
On June 28, 2022, the Board of Supervisors unanimously directed the Chief Administrative Officer to work with the Health and Human Services Agency (HHSA) Director to develop recommendations and implementation plan to declare illicit fentanyl as a Public Health Crisis. It is important that the Board of Supervisors continue to support efforts to educate and increase awareness against the devastating and harmful impacts of illicit fentanyl especially among young people.
There are several ways the County can deliver a stronger response to stem the illicit fentanyl crisis. These responses include:
• Working with education institutions, officials, and the California State Legislature to require illicit fentanyl awareness education in the classroom for students.
• Increasing Narcan/Naloxone distributions and trainings across the County to parents and student first responders.
• Explore opportunities for additional funding to support on campus drug and alcohol prevention programs.
Accidental overdose deaths caused by illicit fentanyl have reached historic levels across the nation. The Centers for Disease Control and Prevention (CDC) estimate that over 80,000 overdose deaths caused by fentanyl occurred in 2021 alone. Data from the CDC show that accidental deaths caused by fentanyl is the number one killer of people between the ages of 18 and 45, far exceeding the number of deaths caused by car accidents, COVID, heart disease, and gun violence within this age group.
While fentanyl is the number one killer of people between the ages of 18 and 45, it is worth noting the increasing threat the drug poses to the youth in our community. In 2021, twelve children under the age of 18 died from an accidental illicit fentanyl overdose in San Diego County according to data received from the San Diego County Medical Examiner. This is more than twice the number from the year before. The youngest was only 13 years old. Even more children, some as young as four months of age, have ingested illicit fentanyl. These children have overdosed but survived due to the quick and informed action of first responders. Poisonings from illicit fentanyl are greatly impacting our already strained emergency departments and, in doing so, further harming our community at large.
Efforts to prevent substance use among youth are often hand-in-hand with efforts to improve mental health. According to the CDC and the National Alliance of Mental Illness, substance use and mental health conditions can be co-occurring disorders. Suffering from these can be especially challenging for youth. Increased feelings of loneliness and isolation resulting from poor mental health paired with the challenges of everyday life and the stigma of seeking services could drive youth to engage in risky behaviors that can include self-medicating. Improving resilience and coping skills, on the other hand, can have protective factors.
In 2019, the CDC’s Youth Risk Behavior Surveillance Data Summary and Trends Report found that more than 1 in 3 high school students experienced feelings of sadness and hopelessness, a 40% increase in the last decade. “Mental health challenges in children, adolescents, and young adults are real and widespread,” said the United States’ Surgeon General, who in 2021 issued an advisory highlighting the urgent need to address the nation’s youth mental health crisis. That same year, a coalition of medical professionals specializing in child and youth health declared this crisis to be a national emergency.
The San Diego County Office of Education (SDCOE) has recognized this intersection and has supported school districts with initiatives and resources that promote crisis intervention and improve emotional wellbeing. The SDCOE has also embarked on a concerted effort to provide substance use education by hiring a full-time expert solely dedicated to raising awareness and prevent harm.
While traditional substance-use prevention education incorporated into health class curriculum seeks to prevent substance misuse, the potentially deadly dose found in just one pill and the alarming increase in illicit fentanyl-caused deaths among youth creates an urgent need to highlight and enhance awareness on the specific deadly dangers associated with the use of this drug.
Currently, the State of California Education Code does not specifically address the dangers of illicit fentanyl. In fact, in 2009, the Federal Elementary and Secondary School Act, Title IV Part A, Safe and Drug Free Schools and Communities (SDFSC) was eliminated and the mandate for school districts to use prevention curriculum was removed and defunded. Subsequently, most prevention activities in San Diego County schools now occur during Red Ribbon Week, celebrated annually each October 23-31.
As trusted messengers, the education community is uniquely positioned to provide youth with this life saving information in a safe, structured, and supportive environment. Recommendations on this board letter create a two-step process to work with the appropriate stakeholders and community partners to prioritize, enhance, and properly disseminate this information especially when our community is living through a time of crisis.
The threat to our youth from illicit fentanyl is heightened in this age of social media. Drug dealers have taken to apps like Snapchat, Instagram, and Facebook, marketing what they claim to be legitimate medications such as OxyContin, Percocet, Adderall, and Xanax. These pills are almost always counterfeit, containing none of the actual medication, but possessing often fatal doses of fentanyl, methamphetamine, or other harmful drugs. Currently, the County is working on a youth fentanyl warning campaign across multiple media platforms to education youth and parents about the risks of fentanyl.
Further harm reduction efforts and strategies targeted towards young people should be implemented. Parents and student first responders should be trained and have access to Naloxone in times of emergencies. Naloxone is an opioid antagonist, attaching to the opioid receptors in the brain, blocking and removing fentanyl from those same receptors and capable of reversing an otherwise fatal overdose. Survival from an accidental illicit fentanyl overdose is most often attributable to a timely administration of Naloxone. Additionally, equipping those who work with and around youth with the tools and training can and will save lives. This board letter will direct the Chief Administrative Officer to work with the five members of the Board of Supervisors, the District Attorney, the HHSA Director, and the Sheriff to enhance harm reduction outreach, efforts, and implementation in San Diego County and secure additional units of Naloxone to support this effort.
Another component of educating our youth to the harmful effects of illicit fentanyl is to secure funding to pursue partnerships to maximize impact. These partnerships will secure highly trained and skilled subject matter experts who can work with stakeholders, NGOs, parent, teacher, student associations and school officials to effectively present evidence-based illicit fentanyl and substance use awareness information.
Investing in the wellbeing of youth is an investment in the future of our overall community health. We hope that you can support these efforts by directing the CAO to work with staff and report back in 90 days with associated costs.
RECOMMENDATION(S) SUPERVISOR JIM DESMOND, SUPERVISOR TERRA LAWSON-REMER AND DISTRICT ATTORNEY SUMMER STEPHAN
1. Direct the Chief Administrative Officer to work with the California Department of Education, the California State Board of Education Instructional Quality Commission, the California Superintendent of Public Instruction, the San Diego County Office of Education and the San Diego District Attorney’s Office to draft and propose immediate administrative modifications to state curriculum framework and instructional materials mandating San Diego County schools to provide enhanced substance use prevention and mental health education during the county’s declaration of a public health crisis caused by illicit use of a substance such as fentanyl.
2. Direct the Chief Administrative Officer to work with the San Diego County Office of Education and the District Attorney’s Office to add an item to the County’s 2023 Legislative Program Sponsorship Proposals seeking state legislation that amends the California Education Code to mandate enhanced substance use prevention and mental health education during the county’s declaration of a public health crisis caused by illicit use of a substance such as fentanyl. This recommendation should go into effect if efforts to reach the proposed administrative solution are unsuccessful.
3. Direct the Chief Administrative Officer to schedule and promote outreach events to distribute Naloxone to parents and student first responders, in collaboration with Board of Supervisors offices, the District Attorney, and Sheriff
4. Direct the Chief Administrative Officer to secure additional harm reduction funding for Naloxone to enhance distribution and training efforts amongst parents and students in the five Supervisorial Districts and report back in 90 days with associated costs and staff time.
5. Direct the Chief Administrative Officer to secure ongoing funding to support implementation of fentanyl awareness in schools within school-based Substance Use Disorder (SUD) prevention and life skills curriculum in San Diego County and report back in 90 days with a funding opportunity.
EQUITY IMPACT STATEMENT
The County of San Diego is committed to achieving the highest standards in establishing the safest environment for all our residents. Fentanyl is responsible for a disproportionate number of deaths among 18-45-year-old residents of San Diego County. People of all race/ethnicities, genders, and socioeconomic backgrounds can fall victim as fentanyl does not discriminate. The County has the responsibility to address the importance of this alarming epidemic as it is detrimental to the fabric of our society.
SUSTAINABILITY IMPACT STATEMENT
The proposed action to enhance fentanyl education and strengthening harm reduction efforts for young people will positively impact youth in San Diego County by providing knowledge and harm reduction tools to sustain health and well-being.
FISCAL IMPACT
There is no fiscal impact for today’s recommendations. There may be future fiscal impacts based on recommendations from today’s action. Staff will return to the Board of Supervisors in 90 days with recommendations for consideration and approval. Funding for the costs will need to be identified by the department to secure Naloxone and support on campus illicit fentanyl awareness programs and activities and will proceed once identified. Health and Human Services Agency, Sheriff Department, and District Attorney will monitor their budgets and return to the Board with mid-year action to adjust the budget if necessary and/or incorporate in future budget as funding becomes available. At this time, there will be no change in net General Fund and no additional staff years with today's recommendations.
BACKGROUND
According to the Drug Enforcement Administration’s (DEA) website, prescription fentanyl is a synthetic opioid typically used to treat patients with chronic severe pain or severe pain following surgery. Fentanyl is a Schedule II controlled substance that is similar to morphine, but, about 100 times more potent. Under the supervision of a licensed medical professional, fentanyl has a legitimate medical use.
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 increasingly pressed into pills made to look like legitimate prescription medications. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.
There is significant risk that illegal drugs have been intentionally contaminated with fentanyl. Because of its potency and low cost, drug dealers have been mixing fentanyl with other drugs <https://www.dea.gov/factsheets/fentanyl> including heroin, methamphetamine, and cocaine, increasing the likelihood of a fatal interaction.
Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage. DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet. The DEA found that 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose. One kilogram of fentanyl has the potential to kill 500,000 people.
In 2021, the United States Customs and Border Protection (CBP) Office of Field Operations (OFO) seized 6,354 pounds of powder fentanyl at the San Diego County Ports of Entry (POE) San Ysidro, Otay Mesa and Tecate. The balance of the Southwest Border Points of Entry in Arizona, New Mexico and Texas combined seized 3,230 pounds of fentanyl.
Over 66% of all powder fentanyl that was seized along the Southwest Border of Mexico in 2021 occurred in San Diego County. This is a staggering amount of fentanyl that has entered our region, and this is just the amount that has been seized. The Drug Enforcement Administration estimates that it takes two milligrams of fentanyl to kill the average adult. The amount of fentanyl seized in our County/region is enough kill an estimated 144 million individuals. Additionally, this does not include illicit fentanyl pressed into pills.
San Diego County has not been spared from this crisis. The number of people in our community dying from accidental fentanyl overdoses has increased exponentially over the past several years. The San Diego County Medical Examiner reported 33 fentanyl caused deaths in 2016 and the provisional number of fentanyl caused deaths for 2021 exceeds 800, an increase of over 2300% in only five years. Preliminary numbers indicate accidental fentanyl overdose deaths in 2022 will likely exceed those from 2021. The number of fentanyl overdose deaths is far greater than some public health emergencies that have been previously declared. These figures ignore the hundreds of individuals who overdose on fentanyl and survive but who suffer long-term physical and mental damage as a result.
The Board of Supervisors has supported many efforts to address this deadly trend including action by the District Attorney and Health and Human Services Agency to launch an education and prevention campaign called The San Diego Opioid Project. This campaign reached millions of people in San Diego County using social media and other targeted avenues. However, a more comprehensive strategic plan that can urgently increase prevention and treatment while continuing to support prosecution and accountability of drug dealers and cartels is needed.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
N/A
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Community Initiative of the County of San Diego’s 2022-2027 Strategic Plan by making health, safety and thriving a focus of all policies through internal and external collaboration and pursuing policy and program change for healthy, safe and thriving communities.
Respectfully submitted,
JIM DESMOND terra lawson-remer Summer Stephan
Supervisor, District 5 Supervisor, District 3 District Attorney
ATTACHMENT(S)
N/A