Nevada County Grapples With Deadly Fentanyl Epidemic

Last January, Nevada City resident Joni Vincelette lived her worst nightmare. 

Her son Micah Price, a 32-year-old high school teacher in San Francisco, didn’t show up to work. The principal of Price’s school was shocked—Price never missed a day. Vincelette called her son, but there was no answer. After arriving in the city, she checked his apartment. It was locked and Price’s husband was out of town. 

“I remember running all over the city looking for him,” said Vincelette. “I went to the police department and asked them if they’d seen my son. I looked everywhere, but I knew he was in that apartment. And that was where he was eventually found, dead in his bedroom.”

The previous day, Price had bought a bag of cocaine off the streets in San Francisco’s Tenderloin district. He’d struggled with addiction for years, going in and out of rehab and Narcotics Anonymous meetings. Still, addiction hadn’t stopped him from having long term relationships, and a rewarding professional career. 

“He was a real expert in his field,” said Vincelette. “He taught all over the world. Nobody would have guessed he had this problem. He told me that addiction was his dharma, his curse, something that he was destined to overcome.”

But the cocaine he bought that night had been cut with fentanyl, and Price became another tragic statistic. 

Vincelette said that her son had been aware of the risks of fentanyl. “He would cry to me and say, ‘I don’t want to die,’” she said.

Vincelette with her two sons. Price, on the left.

Between January and April of this year, 252 people died in San Francisco of drug overdoses, and in 182 of them, fentanyl was to blame. Similar to San Francisco County, fentanyl has been the primary driver of a deluge of Nevada County overdose deaths. In 2020, 37 people died here from a drug overdose, 19 of which were fentanyl-related, a drastic increase from 49 total overdose deaths between 2017 and 2019, according to data from the National Center of Health Statistics. 

In an effort to reduce the risk of fatal overdoses and promote substance abuse awareness, Nevada County shifted in 2017 towards a harm reduction strategy, like that used by San Francisco County. The idea is: keep people from overdosing, not from doing drugs. It’s an approach centered on the idea of self determination, seeking to understand rather than judge, to provide tools to users rather than locking them away. 

But despite its benevolent intention, the county’s strategy may not be strong enough to keep an increasing number of people from dying due to fentanyl overdose. 

Scope and Scale

Fentanyl, which has been prescribed by doctors for years to treat chronic pain, is a cost-effective and powerful synthetic opiate. Just a few micrograms produce sedative and analgesic effect. Fentanyl, which is 50 to 100 times more potent than heroin, can be taken by itself, but is increasingly being added to heroin and other drugs, such as cocaine, MDMA and meth, to cheaply increase potency and addictiveness. Previously, adulterants like caffeine, procaine, or lidocaine were used for this purpose, but they decreased the potency of the drug. Fentanyl has the opposite effect.

Casey Davey, a behavioral health nurse for Nevada County, works as a member of the Homeless Outreach Medical Engagement Team (HOME), which visits homeless camps to assist residents with medical service needs. “About 75 percent of the individuals I deal with have a serious substance abuse problem,” said Davey. “In Nevada County, meth is the biggest problem, and now it’s cut with fentanyl. Adding the fentanyl creates a much stronger dependency than methamphetamine alone.”

Lethal dose of fentanyl. US Attorney Generals Office

This year, the Grass Valley Police Department has seized enough fentanyl to kill almost the entire county’s population twice over.

“In 2019, we had .21 grams of Fentanyl powder booked into evidence,” said Grass Valley Police Chief Alex Gammelgard. “Last year, 7.03 grams. This year 366.79 grams.”

The DEA has reported that since 2019, most fentanyl entering the US market has been produced in Mexico. For law enforcement, stopping its distribution is like playing a game of whack-a-mole.  “Some think it’s coming from Sacramento. Others, from Yuba City or Marysville,” said Nevada City Police Sergeant Sean Mason. The forms it takes are even becoming hard to predict. “Lately, we’ve been finding a lot of pre-loaded syringes—something a user can buy and get one good high with as a one-time use.” 

Doing Heroin Shouldn’t Be a Death Sentence

Unable to stem the deluge of drugs entering from the south, Nevada county officials are presented with few options. Criminalizing drug users has shown to be historically unsuccessful in crushing drug markets. Stepping up treatment services such as building new rehab facilities, is difficult and expensive. The county, in cooperation with local activist groups and treatment centers, has instead adopted the harm reduction model of San Francisco.

In the nineties, harm reduction principles were widely seen as crucial in lowering the rates of teenage pregnancy. Teens were provided with contraceptives and resources in public schools to navigate sex safely, a departure from previous abstinence only approaches. 

According to the National Center for Harm Reduction—on whose principles the Nevada County Department of Public Health’s policy is based—harm reduction for drug use is defined as, “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It’s also viewed as a movement for social justice, based on the “belief in, and respect for, the rights of people who use drugs.”

“People have been using substances to alter their states of mind forever,” said Phil Summers, an emergency room and addiction physician at Sierra Nevada Memorial Hospital . “When you take a substance and criminalize it, you force it into the shadows and it becomes more dangerous. Doing heroin shouldn’t be a death sentence.”

Summers is a member of the Nevada County Harm Reduction Coalition, a nonprofit group working in conjunction with city officials to keep drug users safe. The organization formed in the fall of 2020 when members began distributing Narcan at the Condon Skatepark in Grass Valley in response to a spate of local overdose deaths. Narcan is a medication that can reverse an opioid overdose in minutes, either through injection or a nasal spray. 

Founding member Bethany Wilkins says the Coalition now distributes about 100 Narcan doses a month, mostly through on-the-ground outreach with the homeless. “Every week, I hear from someone that a life has been saved because of Narcan,” said Wilkins. “We tell people that if you are going to use, make sure you or the person with you has Narcan.”

The Nevada County Harm Reduction booth at a recent event. Photo by Bethany Wilkins

As overdoses have risen across the county, so has the widespread use of Narcan. Local law enforcement and emergency service workers now carry and administer it. So far this year, EMS personnel have distributed 31 life-saving doses of Narcan in Nevada County.

Besides Narcan, proponents of harm reduction are also handing out fentanyl test strips, which are supposed to measure whether you have fentanyl in your drugs. The Nevada County Public Health and Behavioral Health Offices, as well as Granite Wellness—the primary addiction treatment center in Nevada County—provide them to the public for free. 

If you are of a certain age you may remember the advent of drug-test testing booths at raves and festivals. Amy Morrill, a Nevada City harm reduction advocate and self-described “lover of drugs, partying, and dancing,” was one of the first to set up these booths in California. Her organization, Safer Raving, began in Los Angeles in 2013 and eventually expanded to San Francisco. 

“A kid might show up to a booth with a ‘blue dolphin’[MDMA] pill—and we’d shave a little bit off, get it wet and apply a chemical reagent,” said Morrill. “If it turns a certain color, we could say, ‘These have Methylone in them, not MDMA. Stay away from the ‘blue dolphins’ and spread the word.’”

Now, living a quieter life on a ranch near the Yuba River, Morrill is a vocal advocate for fentanyl test strips, and gives them out to friends and party goers. However,  fentanyl test strips are not as effective at identifying fentanyl as the old rave tests were for finding impurities in MDMA and other pressed pills. Evan Morill acknowledged that when you have a drug in powder form, you need to test the entire bag to be sure there is no fentanyl in it. A fatal amount of fentanyl is about 2 milligrams, and it may not be evenly distributed throughout.

“If you have a bag of coke, the grains may be on one side [of the bag] or the other,” said Morill. “You really need to test the entire bag to know it is safe.”

To test the entire bag, you have to get the contents wet, mixing the powder with the water into a slurry before dipping the test strip in. If two lines appear, fentanyl is present. 

Clearly testing a bag of cocaine, heroin, or methamphetamine requires patience. In order to know for certain that your bag is safe, you’d have to wait for it to dry after testing all of the product. Opioid and methamphetamine withdrawals are intense, with common symptoms including shaking, muscle spasms, heart palpitations, insomnia, cramping, cold sweats and vomiting. These symptoms set in within six hours, and grow continually worse.

It would be naive to assume that a user experiencing serious withdrawal or cravings will test their product thoroughly, if at all.

A deserted encampment near Sugarloaf Mountain in Nevada City where fentanyl paraphernalia had been previously found. Photo by Joseph Hudson.

The Nevada County Department of Public Health did not provide any data or point to any research on the use of fentanyl test strips among users. The department  also declined to answer what steps would be taken if local overdose deaths continued to rise in spite of increased distribution of Narcan and test-strips. It offered this statement:

Nevada County Public Health has been working to reduce overdose deaths in Nevada County through harm-reduction practices, including distribution of Naloxone [Narcan] and fentanyl test strips, training community members and partners on how to use these life-saving interventions, bringing together community organizations to discuss response and resources, and supporting local businesses and organizations in becoming Naloxone distributors themselves.

A 2017-2018 survey on fentanyl test strip utilization from The DOPE Project in San Francisco, found that half of responding users tested prior to using. But their use hasn’t been effective in curbing overdoses. Since the survey was conducted, the accidental overdose death rate in San Francisco has quadrupled

Nico*, a homeless man in Grass Valley, said that a fentanyl-spiked shot of heroin almost cost him his life last year. “I was staying at [a local motel] and I did the shot of dope and I was sitting there feeling real funny,” said Nico. “I thought I needed my insulin, so I reached down to grab my insulin, and that’s all I remember. I woke up in jail. I couldn’t remember anything. They’d given me Narcan and said it was fentanyl that put me there.”

Despite this near-death experience, Nico still uses heroin. 

Does he have any test strips?

“Yep.”

Has he used one yet? 

He looked away.

 “I don’t know why I don’t.”

*Not his actual name

Featured image from Grass Valley Police Department

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