The scourge of fentanyl-related overdose deaths has steadily grown within Riverside County since 2020—but Riverside University Health System (RUHS) data shows that those numbers may finally be leveling off.
In some communities—particularly Cathedral City and Palm Springs—and within certain younger demographic groups, the tide has either slowed or turned within the last year. However, fentanyl overdose deaths have increased in older age groups and among Latinx residents, particularly in the eastern end of the Coachella Valley.
According to the RUHS Riverside County Overdose Data to Action dashboard, 543 people died due to fentanyl overdose deaths in 2023, a small increase from the 528 in 2022, but nearly twice the number of 283 deaths in 2020. Meanwhile, in the 15-24 age group, deaths have dropped from 66 in 2021 to 43 in 2023. In the 25-44 group, deaths went from a high of 276 in 2022 to 260 in 2023.
But the number of deaths among people 45 and older is on the rise. In the 45-64 age group, deaths jumped from 110 in 2021, to 175 in 2022, and 209 in 2023. Among county residents in the 65-74 age group, fatal overdose numbers have gone from 22 in 2021, to 19 in 2022, and up to 28 in 2023.
“When we look at the last couple of years, there’s been about a 20% decrease in overdose deaths in the younger age demographics for those people (under) 35 years old,” said Wendy Hetherington, the RUHS chief of epidemiology and program evaluation, during a recent phone interview. “It is concerning, though, that (deaths in) the older age groups continue to increase, particularly those over age 35. And when we look at age groups from 35 to 44, and then 45-60 years, overdose deaths have increased by more than 20%.”
Hetherington also addressed a concerning trend among the Coachella Valley’s Latinx residents. “When we look at overdoses cumulatively for 2021 through 2023, Coachella Valley had 663 overdoses during those years total, of which 41.5% were in the Hispanic-Latinx group. When you compare it to the county as a whole”—which shows 36.2% of deaths occurring in the Latinx community—“that’s a higher percentage.”
Dr. Conrado Barzaga is the vice president and chief project officer at Innercare, a nonprofit health organization that provides primary and specialty medical care in eastern Riverside and Imperial counties.
“This is a very complex issue,” Barzaga said. “It requires a multitude of strategies and very heavy investment. No. 1, the health-care infrastructure is important, because we need to work on prevention. We need to have more access to therapy and other tools that will help people cope with anxiety and depression in the early stages, rather than living with them for many, many years until they find a rather drastic coping mechanism, like using drugs or alcohol and other substances.”
Barzaga mentioned the recent death of Brian Nestande, a former local member of the state Assembly who died due to an overdose of fentanyl and cocaine, according to an autopsy.
“Those things elevate the visibility of addiction, and it makes us realize that addiction is around us,” Barzaga said. “Many times, we see the person, but we don’t know that they’re suffering from this disease. As a first step, I think we need to eliminate the stigma of drug addiction and realize that this is an issue that we are dealing with in our society, and it affects all (regardless of) socioeconomic status. It’s often more visible in resource-strapped communities, because they’re the ones who are using the cheapest forms (of drugs), and those are typically the ones that come laced with fentanyl. That’s why we see the increase in morbidity and mortality in areas like Imperial County, the eastern Coachella Valley, and in the corridors of Hemet and San Jacinto.”
Indio Police Chief Brian Tully told the Independent that the emergence of fentanyl has had a devastating effect.
“It is so potent and so powerful that it’s killing our community … more particularly, our Latino community, which is very relevant here in Indio, because we have a population that’s about 70% Hispanic,” Tully said. “What’s different about fentanyl is that it does target our more challenged communities for a number of reasons. But it’s also a different type of drug in that it is affecting all drug users. In the old days, you had opiates, which were downers, and there was a particular group of people who preferred that type of drugs. And then you had the uppers, like speed or meth, MDMA and hallucinogenics. They each had their own community. Now fentanyl has somehow connected all these drug users—because it’s in all their drugs.”
What can be done?
What steps can local government, health providers and community leaders take to combat the spread of fentanyl-related overdose deaths? Hetherington echoed Barzaga by citing stigma reduction as a strategy.
“Addiction is a disease that is chronically relapsing, and it’s never a straight path,” Hetherington said. “(We’re promoting) harm reduction, because it’s just a matter of fact that people use drugs. Whether you’re a chronic addiction case, or you experiment, or you’re a social user, people use drugs. Using some of the harm-reduction practices and services can help to prevent overdoses in those groups of people who use drugs.
“There are things like drug-checking, for instance. There are fentanyl test strips that someone can use to test the substance that they’re taking to see if there’s fentanyl within that drug. … A downside to the test strips is that they can tell you (fentanyl) is in there, but they can’t tell you what amount is in there.”
“As a first step, I think we need to eliminate the stigma of drug addiction and realize that this is an issue that we are dealing with in our society, and it affects all (regardless of) socioeconomic status.”
Dr. Conrado Barzaga, vice president and chief project officer at Innercare
Hetherington also encouraged people who use drugs to confide in someone.
“Have someone else who’s sober aware that you are using drugs,” she said. “Also, there are different online services where people can sign up and have a message that says if they don’t check this button, or do something within a certain (amount of time), the service will text a friend or do something.”
Hetherington said the increasing availability of Naloxone/Narcan has been vital in decreasing overdose deaths.
“I think there’s some good news out there. It may be contributing to some of the (overdose death) declines in certain populations,” she said. “When we look at Naloxone administered to someone with a suspected overdose prior to EMS arrival, those numbers have been going up for the last couple of years. What’s really heartwarming to me is that, most of the time, it’s law enforcement (officers) who are the primary people who administer Naloxone prior to EMS arrival. … The family and bystander numbers are going up for this year, too.”
Chief Tully agreed that having his officers armed with Narcan has yielded life-saving results the state began distributing Narcan to police agencies.
“Oftentimes, our officers are the first emergency services on scene,” Tully said. “… The officers will look at all the signs and symptoms, and if necessary, they’ll apply Narcan. I can tell you that we documented 30 uses of Narcan in 2022, and we had 21 documented uses of it in 2023. … I would say that those are lives saved.”
Neil Gussardo is the harm-reduction supervisor at DAP Health’s campus in Palm Springs.
“DAP Health does have a vending machine,” Gussardo told the Independent during a recent interview. “We only have one at this point, but we’re looking to get more. In that vending machine, two of the multiple items are fentanyl test strips and Narcan. We’re actually working with a local bar (Hunters in Palm Springs), and it’s really terrific. They’re allowing us space to have our vending machine; the machine is available to the patrons whenever the bar is open.”
Gussardo said he hopes DAP Health will soon have an always-accessible vending machine placed outdoors, to expand outreach.
“We’re looking at a machine at a price of around $10,000 to $11,000 that is going to have the ability to dispense a few less items than the one that’s in Hunters, but will be refrigerated,” he said. “Funding a vending machine for $10,000 is far less expensive than funding a whole program, and it’s also far less expensive than having people go to the emergency ward, or people having to go to the morgue. So I think it’s great, and a really good use of funds.”
From Jan. 1 to June 6 of this year, the vending machine at Hunters dispensed 400 fentanyl test strip kits and almost 600 Narcan boxes. Over all of DAP Health’s distribution avenues, the organization has handed out 2,500 boxes of Narcan (containing two doses in each, or 5,000 doses total), including some to hotels, and close to 2,000 fentanyl test-strip kits so far this year, Gussardo said.
“Not only are we handing (test kits) out,” Gussardo said, “but we’re educating people about what to look for, what drugs to test with it, what it looks like and how to cope with it if you find fentanyl.”
What advice is given to users should the kit confirm that fentanyl is present?
“Certainly, first and foremost would be to not use it,” Gussardo said. “But sometimes that’s not something that somebody can do. Sometimes they are going to use it anyway, and then the next steps would be to (advise them) to start slow; don’t use a lot. Try it out. See how strong it is. Always have somebody with you, so don’t use alone. And always have Narcan with you.”
The law enforcement aspect
Another tool being used by the Indio Police Department, in coordination with community partner organizations, is educational outreach and communication.
“One of the things that’s real important is that your police department has to be engaged in the community,” Tully said. “Our officers have to have relationships with the people they deal with on a regular basis. You don’t realize how important school-resource officers are, and our quality-of-life officers and our regular patrol officers who are connecting with the community every day. … We train our officers to be aware of the signs, the symptoms and the resources that they or other people can use, because you never know what you’re going to run into.
“Our school-resource officers do presentations to bring awareness to our young people of the dangers, and (drug) identification issues and what to stay away from. … Oftentimes, those students are going home and talking to their brothers and sisters and family members about what they learned. We’re also feeding all the information that we get from our sources into our investigation team, so that they can shut down whatever operation is affecting the part of the community that we received that information from.”
Tully said his officers work to get people who need help into treatment.
“Those in our community who have insurance, they’re using their HMOs or their health insurance to get to treatment centers,” he said. “But most of our people are uninsured, so we are working through our nonprofits, like the Coachella Valley Rescue Mission and the ABC Recovery Center, to get those people the resources there.”
Chief Tully also emphasized the enforcement aspect of what his department does.
“For that, we partner with the Riverside County District Attorney’s Office,” he said. “District Attorney Mike Hestrin has been a big proponent of prosecuting the dealers … and they’ve been really helpful in providing assistance in our prosecutions. I have an investigative team we call our Street Crime Unit. I have a group of detectives and a sergeant assigned to that, and they continually seek out investigations that involve narcotics. Like I said, every (type of) narcotic that we’re dealing with has fentanyl. Mostly, what we’re recovering are pills. … (The drug-dealing) is connected to our gangs.”
Tully said that what he calls “gangs” are different today than what they used to be.
“Gangs today are people who don’t necessarily have tattoos, and they wear regular clothes. They are in our high schools, and they can be anywhere from age 13 to 60-something,” Tully said. “… Today’s drug dealer is connected to a bigger network of drug distribution coming out of mainly Mexico, and they look like regular people.”
Stopping addiction before it starts
Back at Innercare in the east end of the valley, Dr. Conrado Barzaga said he’s focused on more comprehensive strategies to save community members from the threat of fentanyl addiction—and potential death.
“We see those community members who are dealing with high levels of anxiety and depression, and sometimes more complex pathologies,” Barzaga said. “We are strengthening our behavioral-health department and implementing a number of initiatives to increase the number of behavioral-health providers in our region. Right now, we’re actually writing … a grant (application) to the federal government to bring more resources into the region, and we’re also partnering with other local entities to bring in telehealth so we can do tele-psychiatry. We have tele-psychiatry already inside, but we need more of that.
“Eisenhower Health is also working on developing a psychiatric residency program that is going to bring psychiatrists as faculty to the region, and also psychiatrists in training. They’re going to be educating 12 psychiatrists—three per year, and it’s a four-year program. … Our hope is that those psychiatrists will stay in the region and become part of the workforce and the health-care infrastructure of the Coachella Valley.”
Finally, Hetherington pointed out one crucial aspect of drug overdoses: While fentanyl is getting a lot of attention, drug overdoses can be deadly, regardless of the presence of fentanyl.
“About 90% of overdoses in Riverside County are fentanyl and/or methamphetamine,” Hetherington said. “But there are still a lot more methamphetamine-only overdoses. … There’s this big focus on fentanyl, which is very appropriate, because it is very dangerous, and a lot more dangerous than methamphetamine—but you won’t be able to completely address the fentanyl crisis unless you also address methamphetamine. That is my point.”