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The County’s Sitting on Thousands of Doses of Naloxone

The county won 6,600 doses of naloxone through a state grant, and has been sitting on the overdose-reversal drug since December. Officials say bureaucratic holdups like paperwork and grant requirements are responsible for the slow rollout.

Naloxone, or Narcan, comes in the form of an injection or nasal spray. / Photo by Kinsee Morlan

On the night of May 1, 2017, Anthony Calvert snorted a line of meth. Then he passed out. The 18-year-old was found dead the next day, sprawled out on the front lawn of a home in Oceanside.

The methamphetamine Calvert ingested had been mixed with Fentanyl, a powerful and often lethal opioid, according to the medical examiner’s report.

“He overdosed, and instead of calling 911, his friends drug him outside and left him in the dirt in a neighbor’s yard,” said Jennifer White, Calvert’s mother.

White has been propelled into action, joining the ranks of those working to help drug users stay alive until they can get into treatment. She thinks naloxone, a drug that reverses the effects of an opioid overdose, should be everywhere and available to everyone.

White, now a member of A New PATH, an advocacy group that has a program distributing naloxone and training people how to use it, said her son was mostly smoking marijuana up until his death. He had just started down the path of drug addiction. Getting him into treatment wasn’t on her radar yet. The one thing she keeps coming back to – the thing she said she wishes she could have done differently – is giving him naloxone.

“Had I thought for one minute that my son was doing something he’d overdose from, I would have gotten naloxone to him myself,” she said. “I guess they’re putting fentanyl in everything now.”

White thinks there needs to be a bigger, more coordinated effort to distribute naloxone.

It turns out, county officials agree – and they’ve even secured a stash of 6,600 doses of naloxone through a state grant program, or about $250,000 worth. The catch: The county has been sitting on the cache since December. None of the doses has yet made its way into the community.

The doses are the result of a grant program passed by the Legislature in 2016. The goal is to reduce the number of fatal overdoses in California – 2,031 people died from opioid overdoses in 2016, according to state health officials.

Sayone Thihalolipavan, a public health officer for San Diego County’s Health & Human Services Agency, said paperwork and grant requirements are causing the holdup. He said the groups trying to access the drug must have a medical order from a doctor, policies and procedures in place and meet other requirements before the county can give them the naloxone. The process has made the distribution of the county’s stash of naloxone take longer than he’d like.

“We want it to go out as soon as possible,” he said. “We’re just plugging and chugging along and continuing to work with these groups and help them check off these boxes before we can hand it out.”

He said the one-time naloxone grant has a better chance of becoming a steady funding stream if the counties do a good job of following the grant requirements, collecting data and reporting the program’s impact.

But the county’s reluctance to distribute the drug quickly stands in stark contrast to places like Orange County, which received 3,109 boxes of nasal Narcan spray in early December and had distributed them to a nonprofit called The Solace Foundation by January.

Aimee Dunkle, who runs The Solace Foundation, lost her 20-year-old son to a heroin overdose and has since become an advocate for getting naloxone into the hands of drug users.

Dunkle said after she got the naloxone from Orange County officials, she filled her backpack and hit the streets, handing the drug out to homeless drug users at high risk of overdosing. She goes out with a full backpack of naloxone every week. She was shocked to learn someone wasn’t doing the same thing with the naloxone grant in San Diego.

“It’s unbelievable that it’s just sitting somewhere,” Dunkle said. “That’s absolutely outrageous. People die while that’s just sitting there.”

About 30 nonprofits, law enforcement agencies like the Oceanside Police Department, addiction treatment centers, schools and other community groups have signed up to get some of San Diego County’s naloxone.

April Ella, director of operations and naloxone program manager for A New PATH, said she understands that working with the government means taking more time, but she said she’s been frustrated by the county’s slow process.

“We’re being the squeakiest wheel we can be,” she said. “It’s been pretty stagnant, to be perfectly honest.”

Thihalolipavan said A New PATH is close to signing its final contract with the county. He said getting the naloxone into the community is a priority. The nonprofit service provider Interfaith Community Services and the Chula Vista Police Department have successfully worked their way through the county’s process and are slated to pick up their naloxone in coming days, he said.

Thihalolipavan also pointed to major changes in how the county helps opioid and other drug and alcohol addicts that are about to take effect. Supervisors recently approved tripling spending for substance abuse treatment. The county’s investment in substance abuse treatment will leap from $54.6 million to $179.6 million over the next three years.

The county currently funds 85 beds that provide withdrawal, or detox management services. When the county makes those changes starting on July 1, officials expect to have up to 115 detox beds and many other expanded services, said a county spokeswoman.

“Frankly, naloxone is just one thing, and it’s a wonderful thing and as a county overall we’re doing pretty well – the Sheriff’s Department is at the forefront of it,” Thihalolipavan said. “But that by itself is not the solution, so we are talking about long-term treatment, and the county is making a huge systems change that will make it easier for people to get and stay on treatment.”

The Sheriff’s Department is indeed ahead of the curve when it comes to naloxone. All deputies in field service and specialized investigations carry naloxone. Last year, the drug was administered 26 times with 22 lives saved, said a Sheriff’s Department spokeswoman.

Many of the smaller law enforcement agencies in the county told me they’re currently working on implementing new naloxone policies and arming their officers with it. The San Diego Police Department and Carlsbad Police Department also have naloxone programs up and running.

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