The opioid crisis is at what many people would hope is its peak. However the war on drugs is slowly but steadily assembling a solid army.

Opioid overdoses—specifically related to the extremely potent drug fentanyl—are now the leading cause of death among adults in the United States. The problem, sadly, has not bypassed Nevada County.

One ray of hope is the introduction of naloxone, more commonly known as Narcan.

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“Narcan is an opioid overdose reversal drug, and what’s great about Narcan is there’s really no harmful effects,” said Toby Guevin, Program Manager for the Health and Wellness division of the Nevada County Public Health Department.

“So if somebody looks like they might be overdosing and they aren’t responsive to touch or sound, you can give them Narcan whether you know it’s an opioid overdose or not; it can’t hurt them. It doesn’t get people high. It’s not a controlled substance. It is readily available. And it can be used on dogs. Anything with a mucus membrane, essentially, and so that is one of the things that’s great.”

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Guevin has been instrumental in organizing the county’s naloxone initiative, an effort dubbed Know Overdose, which seeks to prevent deaths from overdose and keep people safe when using drugs.

Guevin went on to say that naloxone, or Narcan as it is more commonly known, is totally safe and legal for anyone to carry in the event that they encounter someone overdosing on opioids. Even children, he said, are safe to carry the reversal which is administered by a nasal spray.

Additionally, he identified common opioids that may better be known as heroin, morphine, opium, fentanyl, oxycodone, Percocet, and Vicodin, but the list is not limited to just those drugs.

“At the state level there’s a standing order that allows anybody of any age to carry (Narcan),” Guevin said. “If you do research you can find programs that teach second and third graders how to use Narcan. It’s unique in that it’s an opioid reversal drug but also the fact that anybody can carry it. It’s simple to use; if you’ve used Flonase or any type of nasal spray it’s the same idea.”

Lieutenant Brian Blakemore of Grass Valley Police Department said that naloxone (Narcan) has been employed by his department for a few years now. Having used the opioid reversal in his duties, Blakemore said that each situation is different and that one must carry multiple doses of Narcan in order to make a significant difference.

“I would say probably five years ago now we were first trained on internasal naloxone doses and that is the first exposure that anybody in our department was getting to this reversal drug,” Blakemore said. “The exposure being we had medical professionals come in and explain this drug (fentanyl) was becoming more available but there was a ‘wonder drug’ to use in the event of opioid overdose. We were all skeptical.

“We were initially told that if we had anybody who was using heroin or opioids and they begin to overdose if you arrive on scene you can take this internasal drug out of your medical pouch and it will instantly reverse the effects of the drug on the brain and it will bring them back. That ended up being inaccurate information. Initially it was, ‘be ready for the reaction of this person when you take away their high.'”

What Blakemore and his colleagues have found is that people being resuscitated weren’t violent or aggressive; it wasn’t like poking a sleeping bear. Instead, he found that more doses were needed than anticipated.

“An officer is given say two packs and each pack has two (Narcan dosages),” Blakemore said. “You arrive onto a scene with typically four. With fentanyl being such a potent drug, when there is an overdose and fentanyl is involved it is taking up to seven, eight, nine doses in order to (revive). It’s not a one and done. Somebody having one dose on hand is never bad but it’s more than likely not going to be effective in preventing an overdose from happening.

“If somebody is down you give them six doses; there is a half-life of the Narcan where they need a sustained environment where they can continue to give people a Narcan drip or they will overdose again. We’ve had to use medical restraint devices on people on gurneys at Sierra Nevada (Memorial Hospital) so that they didn’t leave and flee because if they weren’t connected to the continuous drip (of naloxone) they could overdose and die. It’s not, hey I went to this call and I gave them Narcan and the ambulance came and gave them a lollipop. The more potent drugs get, the more these Narcan packs are needed. It’s upward of almost double dig Narcan doses, which is responsible. If this is a pure heroin overdose one dose isn’t going to do you any good. This is not a drug that one administers themselves. When an overdose sets in, from my experience, it’s never the person that’s overdosing who calls. It’s their friends, it’s their family members.”

Guevin of Public Health put the crisis in perspective.

In 2019, Nevada County saw 18 overdose deaths. None of them involved fentanyl. In 2022, 34 overdose deaths were reported with half of those being related to fentanyl consumption. So far this year, of the 11 accidental overdoses reported, nine have involved fentanyl.

Since March 2020, 192 non-fatal naloxone administrations were performed by first responders in Nevada County.

“March 2020 is when we first saw fentanyl enter the drug supply in Nevada County, which is kind of a seminal point in terms of a dramatic increase in accidental overdose deaths,” continued Guevin. “We’ve essentially seen a double of the overdose death rate locally because of fentanyl. So about half of overdoses since that time have been fentanyl-related. Fentanyl is a very strong synthetic opioid, 58 to 100 times as strong as morphine so just a little bit of it can make someone go into overdose and die.

Guevin stated that fentanyl is increasingly found in nearly any drug on the streets, far from any type of regulations.

“We’ve found it locally in counterfeit pills, in cocaine, in meth, in ecstasy; it’s pretty much widespread throughout the drug supply so a lot of people don’t even know they’re using it. They may say, ‘I am going to use some cocaine’ and they have no clue that they’re going to be consuming an opioid at all, and it’s in there. So they have no tolerance. Maybe they’re not carrying Narcan because they’re like, I am not using an opioid. That’s one of the uniquely challenging things about fentanyl is that it can cross pretty much all of the drug supply.”

“I think over the past year and a half, it’s bigger than we’ve ever seen before,” said Kelly Miner-Gann, a Program Manager with Nevada County’s Behavioral Health department. “We had a significant amount of overdoses related to fentanyl. I would say the increase started when fentanyl made it here to town. Definitely fentanyl is stronger and faster than any other opioid out there right now. So it’s bumped up our numbers in terms of what was normal to see in Nevada County.”

Further, if one were to call 911 at the scene of an overdose there the Good Samaritan law that protects the caller and the person who is having the overdose. Guevin said it isn’t uncommon for a person to be worried about contacting authorities if they are having or experiencing an overdose out of fear they will be met with the long arm of the law.

Bethany Wilkins is the co-founder of Yuba Harm Reduction Collective, a local organization whose mission it is to offer low-barrier, judgment-free support for folks who have found themselves with a drug problem.

“(Yuba Harm Reduction Collective) was founded because of the spike in overdose deaths in March 2020 and by that summer as a community we were like, what are we doing in response to this?” said Wilkins. “We need to get Narcan out in the community. So that really was the fire behind YHRC forming. For a while it was solely Narcan distribution and since then it has grown. We offer fentanyl testing strips as well, more comprehensive education on overdose reversal and harm reduction as a practice. We now offer MAT (Medical Assisted Treatment). We did a focus group in 2021 and one of the biggest needs was MAT. We’ve been able to build grants that are for these needs.”

Wilkins echoed Guevin in relaying that fentanyl initially started being more widely found on the east coast, then slowly but predictably worked its way west, infiltrating a large majority of the drug supply in California.

“It’s the new wave in the drug using era,” Wilkins said. “Fentanyl is what opioid users are predictably using. With it being so potent, we are seeing an uptick. It’s kind of like we were the last presence of fentanyl. It followed the same trajectory as other parts of the country. It’s unregulated, it’s not knowing what you’re taking. It’s not having an alternative. We offer a nonjudgmental place for them.”

Wilkins said most of the participants in the YHRC are middle-aged, white cis men.

“Harm reduction organizations formed really in the ’80s due to AIDS,” she said. “It came from community getting together and taking care of each other. I think harm reduction can get thrown around a lot; it’s important it gets kind of co-opted. I think it’s important to acknowledge the foundation of harm reduction. We are centering around the people who are using drugs and not looking at them as the issue. Within harm reduction we employ people who use drugs or are in recovery and are building programs based off their safety and health being most paramount. We’re out there five days a week on the ground giving out Narcan, and I think advocating for awareness that we

don’t have equitable access to funding or the resources Public Health does. We are doing this boots on the ground work. We are leading harm reduction in this county.”

Yuba Harm Reduction Collective participants have reported 134 overdose reversals so far in 2023, while Wilkins noted the collaboration between the agencies addressing the crisis.

“We work together but if I had a hope it would be that people know we existed.”

Guevin with Public Health acknowledges the hard work put forth by Yuba Harm Reduction Collective.

“We first learned about (fentanyl) in March of 2020. We had community members who reached out and connected with us,” Guevin said. “We started looking at the data and that’s when we started doing a training. Yuba Harm Reduction Collective; the work that they are doing is absolutely incredible. Their group was born out of the dramatic increase that happened and making sure people got Narcan.

“We started doing training for community members, we started doing trainings in Narcan distribution at Mutual Aid, at the skate park, we started training in bars because we wanted to meet people where they were. We had heard from some bars that there were overdoses in the bathroom, and things like that. Over the course of those years it’s like we’ve trained more and more people, and more people have become involved and that has grown,” Guevin said.

All who were interviewed for this article shared the sentiment that Narcan is readily available, as are trainings in how to properly administer. Know Overdose Nevada County offers training for businesses and individuals alike for those who are interested, and offers both Narcan and fentanyl testing strips free of charge. This is in response to what has become a crisis the likes we have not seen in decades.

Guevin said that although Narcan won’t harm someone who is not experiencing an opioid overdose, there are certain signs to help determine whether or not someone is overdosing.

“Shaking people, give them a sternum rub to see if they wake up, or if they respond to stimulus,” he said. “Those things can be covered very quickly and you can literally have an antidote to opioid overdose in your hands. This impacts people. The best way for us to combat it is to make everyone aware of what is happening and how they can use Narcan and how to carry it with them so they can be part of the solution and literally saving people’s lives.”

Additional ways to identify an opioid overdose include pinpoint pupils, slowing or stopping of breath, pale and clammy skin, and lips or fingernails turning blue or grey.

“Somebody going to (shop) is not expecting to save somebody’s life that day. But if someone has Narcan in that situation and you notice somebody has collapsed or is non-responsive, the beauty of Narcan is you don’t need to be a detective and go in there like, okay did they take opioids? It’s just, are they responding to stimulus? Administering Narcan, and it’s not going to hurt them, there are no negative consequences for using it. If someone has an allergy, yes. But we’ve never really seen that happen. That’s why the state has made it so anyone of any age can carry it.”

Locally, Public Health has trained and provided technical assistance to about 15 to 20 organizations which have become distributors—businesses like BriarPatch but also schools, youth organizations, health care providers, and those who work in housing.

The folks at BriarPatch Food Co-op took notice of Know Overdose Nevada County when one of its employees suggested staff be trained on administering Narcan in January 2021.

“It was a frontline staff member who came to one of the members of our HR team and said, hey, this issue of accidental overdoses is affecting our community,” said Chris Maher, General Manager of BriarPatch. “It’s affecting people we know and love—shoppers, workers—and there’s this kind of alternative approach to addressing the negative impact of drug use in our community that we should participate in.

“What came from that initial conversation with the staff members immediately recognizing that this was a need in our community. We can immediately have an impact helping Public Health and the Know Overdose team reach a large audience very quickly. We are a conduit to a wide community of consumers and staff members. We reached out and invited them to come in and those conversations ultimately led to us getting our hands on Narcan kits and fentanyl test strips and inviting staff members to come to a series of voluntary training to learn about what those things were, how they were important, how do you use. And to walk away from that training with a Narcan kit and a fentanyl test strips with the understanding that as long as we could get our hands on those supplies, we would continue to make them available. We put them in our first aid kits around the store, they are available at the front end, they are available at the HR office,” Maher said.

BriarPatch’s Narcan training will extend to its Auburn location, which is slated to open next month.

Guevin added that the state has a program called the Naloxone Distribution Project which allows any organization or any business to become a naloxone distributor. There’s a five to 10 application process, after which the state provides the Narcan for free.

He added: “We’re also part of a pilot project. We are one of seven counties in California that Department of Health Care Services is working with where we are working on rapid opioid response. So now we have data that lets us know, like OD Map, when an overdose is happening in real time, where they are happening, so we can mobilize resources quickly. That’s where collaboration between ourselves and Yuba Harm Reduction Collective, Behavioral Health; that really comes into play because we are able to rapidly respond and get Narcan where it needs to be as quickly as possible.”

OD Map is an application which links first responders and relevant record management systems to a mapping tool to track overdoses to stimulate real-time response and strategic analysis.

“It’s definitely a community effort and I think that is the only way we will be successful and we’ll continue to prevent overdoses because it’s unfortunately fentanyl is part of the drug supply now and it’s something people need to be aware of,” Guevin said.

Public Health has also held Narcan training seminars in Truckee with Spanish-speaking instructors, to further spread awareness.

“That’s one of the things that makes our response kind of unique, is the breadth of folks who are around the table and I think people have come to the table with an open mind,” Guevin said. “So many people have been impacted by the opioid crisis that oftentimes people will know someone within the community—a friend, a family member—who has been impacted so I think that’s why you see the breadth of organizations from a variety of different perspectives coming together to think about what they can do.”

For more information please visit KnowOverdoseNC.com, or visit Yuba Harm Reduction Collective at yubaharmreduction.com.

To arrange for a Narcan training please contact Know Overdose or the Nevada County Department of Public Health at 530-265-1450.