BY ZOE GARDERET
When Austin Kava suffered a back injury in the Marine Corps five years ago, he was sent to a hospital, supplied with morphine and quickly became addicted. His addiction sent him to rehab, but it was there that he was introduced to heroin.
Kava’smisuse eventually got him hooked on fentanyl, a deadly synthetic opioid 100 times stronger than morphine.
“Fentanyl-laced heroin is nasty stuff,” he says. “If I ever got my hands on fentanyl patches, that was a huge score.”
The 32-year-old Pacific Grove residentdiscusses his experience with the devastating effects of fentanyl, describing a specific instance after overdosing where, after lying unconscious in his apartment for two days, he spent three hours trying to remember who and where he was.
Kava’sstory is not uncommon.
The Monterey Peninsulahas seen a dramatic rise in fentanyl-related overdoses since the summer, causing the death of a local 16-year-old girl and more than30 other close encounters. From doctors to law enforcement, authorities throughout the county have been scrambling to solve this problem before more fatalities occur.
“We are seeing a huge increase in overdoses, both fatal and nonfatal,” says Dr. Casey Grover, an emergency physician at the Community Hospital of the Monterey Peninsula. “Overdose deaths from opioids in 2019 are already three and a half times higher than in 2018.”
Monterey’s fentanyl problem mirrors the larger opioid crisis sweeping the nation, and emergency physician Reb Close acknowledges that the epidemic has impacted a broad demographic—all races, genders and ages have been affected.
Close and Grover lead an organization called Prescribe Safe that has worked to reduce opioid-related deaths and addiction in Monterey since 2014. The recent spike in overdoses has been a primary concern for the doctors.
“We’re communicating to alert each other and our patients and trying to increase access to naloxone,” Close says.
A synthetic drug that blocks opiate receptors, naloxone serves as an opioid antagonist and can partially or completely reverse overdoses.
Reaching out to the rest of the community for a comprehensive approach is a top priority for Grover and Close, as they note the importance of collaboration with law enforcement, drug treatment programs and public health agencies.
“We have been sending out messages through the media to warn the public, we’ve been providing education in schools, and we’re organizing a naloxone distribution event,” says Grover of Prescribe Safe’s recent initiatives.
The doctors assembled an emergency meeting with agency representatives Oct. 22, organized a naloxone distribution and community information event Nov. 18 and held a Monterey County interagency convention Nov. 22. These have been just a few bullet points in Prescribe Safe’s long list for a new plan of action.
The organization is also focusing on the impacts on the youth: Since October, the doctors have already spoken at, are scheduled to speak at or are planning events at schools including Carmel High School, Seaside High School, Pacific Grove High School, Rancho Cielo and Chartwell.
From a law enforcement perspective, both the Monterey Police Department and the District Attorney’s office are working to tackle the fentanyl problem. Amy Patterson, a deputy district attorney who founded Prescribe Safe with Close and Grover, explains the DA’s role in this issue.
“The goal is to get these people court-ordered drug treatment where they might not otherwise be able to afford drug treatment or have the desire to do treatment themselves,” Patterson says. “We want to get them help, so hopefully we can fix the problem before it gets to the point of overdosing.”
Patterson traces the roots of the issue to healthcare fraud, pharmaceutical companies and clinicians: Many people who shouldn’t have access to certain medications get their hands on powerful drugs because some doctors overprescribe medications or prescribe without a legitimate purpose.
“In these ‘pill mill’ situations, people come in to get pills and the doctors don’t do a full evaluation,” she says.
According to Patterson, other forms of fentanyl like Subsys, an under-the-tongue spray, and Actiq, fentanyl lollipops, were medically approved and given to patients who didn’t need them.
“It’s interesting how easy and fun they make it seem to get this fentanyl drug,” Patterson notes. “It’s extremely concerning.”
Pharmaceutical companies and clinicians throughout both the Monterey Peninsula and the U.S. are now being prosecuted for excessively marketing the drug.
The Monterey Police Department has adjusted its protocol based on the rise in fentanyl, discarding NIK kits—small plastic pouches containing color-changing chemicals that identify a specific narcotic—to ensure a safer approach.
“With the increase of the prevalence of fentanyl and the dangers of it, we stopped using NIK kits,” says Jake Pinkas, an officer with the MPD. “Now if we suspect a certain drug based on our training and experience, we seize it and send it to the Department of Justice lab for testing.”
When police are called to the scene to use naloxone on someone having a suspected overdose, they rarely know if the abused substance is, in fact, fentanyl.
“We just know it’s an opiate,” Pinkas says. “When we send it to the DOJ lab, it will come back positive for controlled substances, but that can take a year.”
Monterey’s police department is actively collaborating with Close, Grover and other doctors to better facilitate communication between the public and law enforcement.
“If a person intended to use a particular drug and found out it was actually fentanyl afterward, they may want to talk to the police,” Pinkas explains.
As a result, the department and Prescribe Safe developed cards with contact information for nurses to give to overdose victims, with which the victims can offer anonymous information to the police.
Both Patterson and Pinkas emphasize the risk of fentanyl-laced drugs for youth.
Patterson says the results of pill parties, high school parties where students draw from a common container of randomly assorted pills, are often catastrophic.
“Just because you think something is a particular prescription pill does not mean it’s safe,” Pinkas adds. “There’s a very real chance that in this day and age what you’re taking is counterfeit and not what you intended to take at all.”
Austin Kava has now been sober for 18 months and is helping others around the peninsula recover. He leaves a striking message of hope for those struggling with addiction: “You don’t have to live like this. It isn’t who you are. You can find joys in life in so many other things.”
For anyone struggling with addiction, Kava encourages visiting his recovery program at www.tbrm.org for help.