In the summer of 2021, San Carlos resident Elizabeth Walker confronted the most devastating news that any parent could face: the death of her 17-year-old son, Colin, from a fentanyl overdose.
Colin had been experiencing depression and anxiety as a teenager; the condition worsened by pandemic-induced isolation. He saw a therapist and received treatment. His parents had him drug tested after he began using marijuana. They had him regularly tested to monitor his drug use. He made it through a year of passing all the tests, so in April 2021, they stopped testing him, assuming he had learned not to self-medicate.
Four months later, Walker's husband found Colin dead in his bedroom, she said.
A toxicology report found there was actually a very small amount of cocaine, which, apparently, Colin thought he was using.
"It was almost completely fentanyl," Walker, head of speaker engagement at the Stanford Graduate School of Business, said.
Walker, who leads the Colin Walker Memorial Foundation, told Colin's story during an online town hall meeting regarding opioids, hosted by California Sen. Josh Becker on Thursday, Aug. 31. At the event, some of the top local administrators, educators and researchers discussed fentanyl toxicity, treatment, antidotes and resources for parents and the community.
It was a sobering meeting. Of the five panelists who joined Becker, four had family members with drug addictions. Three had family members who died from opioid toxicity. Among them: Santa Clara County Supervisor Otto Lee, who lost a first cousin; Walker, and Ed Ternan, who started Song for Charlie, a resource website, with his wife, Mary. Their 22-year-old son, Charlie, died in 2020 of a fentanyl overdose after taking fake Percocet.
The fourth panelist, San Mateo County Office of Education Superintendent Nancy Magee, said one of her sons was exposed to oxycodone, another potent opioid, when he was a senior in high school.
"And it took impact on him very quickly. Before we knew it, we were dealing with a very serious addiction," she said. Her son is now in his sixth year of sobriety. If fentanyl had been on the streets when her son was addicted, he most likely would have succumbed, she said.
"I can't count the number of people in my sons' lives that have passed due to overdose," she added.
The numbers are stark: nationwide, 14 to 18 year-olds accounted for 94% of overdose deaths in 2019-2020. In San Mateo County, there were 134 overdoses in 2021, and in Santa Clara County, 373 in 2022. Fatal overdoses from fentanyl codeine and morphine have recently doubled in Santa Clara County, Becker said.
Dr. Windy McNerney, a research health specialist at VA Palo Alto, and a clinical assistant professor at Psychiatry and Behavioral Sciences at Stanford School of Medicine, said people should first understand the causes of addiction.
She explained, "I think a big thing that I want to push is that there's biology behind this, that there's a biological reason why people are seeking out this medication recreationally, maybe to alleviate symptoms of depression, anxiety. And then what happens is that your brain adapts to the fact that you're taking this substance and now you have to worry about maintaining homeostasis, and about not having withdrawal symptoms because your brain has changed. Your physiology has changed.”
"And one thing that a lot of people think is that addiction or substance use is like a failing of willpower. Like why can't these people care about themselves and stop? It's not that simple. They're fighting against some really, really strong biology to the point of taking substances just to feel normal or okay, rather than to go out and party or to do whatever it is that they want to do. So there's a big distinction there," she said.
As families fight to save their loved ones, the California legislature and Gov. Gavin Newsom have dedicated more than $1 billion to fighting the opioid crisis in the state. Efforts to remove opioids from the streets, provide resources to communities and increase awareness, are underway.
"As both a father of two teenagers and a public servant, the urgency of this matter strikes me very deeply," Becker said.
A drug in disguise and an antidote
Fentanyl, which is 50 times more potent than heroin and 100 times stronger than morphine, is used in hospitals to control pain during and after surgeries. But it has made its way into adulterated pills and other street drugs, often killing unsuspecting users. Many of its victims are teens and students who are experimenting with drugs. A fake Percocet taken at a party can quickly result in a fatality, the panelists said.
There is an antidote, but it must be used quickly: Naloxone, or Narcan. Spraying the drug in an overdosing person's nose can counteract its effects. Naloxone works by targeting certain receptors in the brain rather than stimulating the heart, Supervisor Lee, who brought spray kits to the panel discussion, said.
"I firmly believe that everybody should have Narcan. Narcan is a reversal for overdoses. It rips fentanyl or other opioids off the receptor that has been occupied (by the drug) and it'll save people's lives," Supervisor Lee said.
Both Santa Clara and San Mateo counties are making the life-saving drug available to the public. Many emergency departments, including Kaiser Permanente, will make the drug available to anyone who asks. The Santa Clara County Board of Supervisors has pushed and funded Narcan kits in jails and schools this past year and some libraries have the drug on hand, the panelists said.
In San Mateo County, Magee said, the drug has been dispensed at all county schools. "We've been able to train all our schools," she said. Teachers, principals and adults supporting those schools have the capacity and knowledge to save lives. Libraries and other community partners are also administering or distributing these kits directly to young people, she added.
There's no harm that can be done by administering Narcan if it is done accidentally, she added. "People shouldn't be scared of it. You can't hurt anybody," she said.
Narcan will soon be available over the counter without a prescription – within the next one to two weeks. Becker said when that occurs, it will be a gamechanger. The kits could be kept in bars, hotels, sports stadiums and at parties and other venues where an overdose might occur. And in purses and cars.
"I think everyone should have a box or two of Narcan in their car and their purse because you never know where you'll be in the community where it may save a life," Magee added. "I think the movement is coming where young people will have ready access to Narcan for themselves."
McNerney said it's important to note that one dose of Narcan might not be enough. The effects might last for 15 minutes – enough time, hopefully, for paramedics to arrive. But the kits come as a two-pack, so a second dose can be given quickly if needed.
Regarding treatment of addiction, the Food and Drug Administration has also approved medications that work extremely well, but that not many people know about, McNerney said. Medications for opioid use disorder include buprenorphine, methadone and naltrexone, which reduce cravings and the compulsive behavior that comes from addiction. They are also harder to overdose on, even though they are also opioids, she said.
"They're extremely important but also highly stigmatized, and I wish they were more readily available," she said.
Education and a cultural overhaul
The panelists said that education is key to managing the crisis – and a change of culture.
Walker recalled talking with a Stanford student who was open about his drug use.
"You don't get another chance," she said, if the drug one takes is laced with a deadly opioid.
"He said, 'You know, my friends are probably not gonna stop taking party drugs, but we are going to create a culture where all drugs are tested.' And they're gonna use fentanyl testing strips and test their drugs and look out for their friends," she said.
Much like in the ‘80s when AIDS was an epidemic, people thought it would never happen to them. But then they started handing out condoms, she noted.
"Places like Stanford are making fentanyl testing strips available," she said.
Testing strips aren't ideal when it comes to checking a pill, however, Ternan said. If one scrapes a little off or breaks a pill in half, one might test a spot where there's no fentanyl, or might find no fentanyl in one pill in a lot or in a baggy.
He said, "But in the baggy of 10, the other nine are loaded with fentanyl. So it's called the chocolate chip cookie effect, where you can imagine a cookie has chocolate chips in some places,” but not in others.
People also don't want to destroy the pill they plan to take, which is what occurs when using the test strips, he said.
Even so, there’s merit in testing. “Fentanyl tests work. They should be widely available in my opinion. Whether you're 21 or 41, no one who doesn't also bring the test strips should bring any cocaine to a party. These are cultural changes that need to happen in the age of the chemical drug landscape," he said.
You can watch the entire panel discussion here.
Both counties also have call centers for substance use where people can obtain information about resources and drug treatment. In San Mateo County, it's 1-800-686-0101, and in Santa Clara County, it’s 800-704-0907.