The story comes from KCLU’s podcast The One Oh One. You can listen to the full episode here.
If you, or someone you know, is suffering from opioid addiction you can find help by calling the Ventura County Behavioral Health Department’s helpline on 844-385-9200 or visit www.VenturaCountyResponds.org.
When I meet Dr. Tipu Khan, he’s wearing bright blue scrubs, a wide brimmed straw hat and he has a backpack filled with medical supplies.
“I wear my scrubs and I wear my pocket pen and my little notebook and my water bottle,” said Khan. “The only thing different is I have sunglasses and a hat on because it's sunny outside. But other than that, I try to really wear the same outfit they’d see in clinic.”
The they Khan is referring to is the homeless community he’s about to visit that’s living along the Santa Clara River basin on the border between the cities of Oxnard and Ventura. He’s joined by law enforcement, nurses and housing advocates. They’re out doing what they call backpack medicine.
“We essentially provide these basic essential services to patients in the field where they're at -- our homeless patients,” Khan said.
Khan is the chief of addiction medicine at Ventura County Medical Center and the director of backpack medicine. Over the years he’s found that people experiencing homelessness often don’t feel safe seeking out services and that’s why he’s bringing services to them.
We leave the parking lot of a local shopping center and make our way towards the encampment. This river bottom doesn’t have water in it most of the year and so it’s very sandy and there are shrubs and reeds extending above my head. Make-shift tents come into view among the dry brush.
Dr. Khan meets a woman he’s known for a little while. She’s asking for Narcan today, a nasal spray that’s used to reverse opioid overdoses.
“Not for anybody in my house, but for the people around my home, you know,” she said. “And I think it's terrible for that... for me to have to feel like I need that. But honestly, I do at this point… yeah.”
The people I met experiencing homelessness asked that I not use their names in order to protect their privacy.
“And so when somebody gets hurt or sick or something, I generally will go and check on them and make sure that they're OK,” she continues. “That's why I got the Narcan, because they've had overdoses down here. I myself I'm not... I don't... Yuck. But there are quite a few people down here that have that addiction, which is... it's frightening.”
While we’re speaking her brother joins us. He’s struggled with addiction before and just a week ago he says he helped someone who had overdosed. He’s pleased to have the Narcan.
“I mean, that's why we try to keep this stuff on hand. It’s actually been saving people's lives,” he said. “I mean, they're averaging, I think, one a day out here. I had my own overdose last year on that stuff. And, you know, that was it. That was enough for me.”
Backpack medicine up close: treating patients using fentanyl in a homeless encampment
I follow Dr. Khan further along the river basin. The addiction medicine doctor encounters a young woman. She agrees to let me record her full medical consultation with Dr. Khan. She hopes her story will help those suffering from addiction.
Tipu Khan [TK]: How old are you?
Patient [P]: I'm twenty-five.
[TK]: Twenty-five. How long have you been down here, the Santa Clara River bottom?
[P]: On and off. I'd say a good three and a half years.
[TK]: Three and a half years. Okay. Well, thank you for talking to us today. As I was mentioning... is our group comes in and provides some basic services. And I wanted to ask you if you're using any substances that I can help you with... You said you were using...
[P]: Yeah, I am a little bit I'm... but I'm not doing as much as I used to…
[TK]: Good for you.
[P]: But I'm doing fentanyl. I do want to get off of it. I don't see a lot of people down here doing, you know, on their own will or free time going into programs I think. I haven't met anybody else who's done that except me.
[TK]: And how long ago was that?
[P]: Ahh, like maybe two months ago.
[TK]: Good. Congratulations.
[P]: Yeah.
[TK]: That's awesome.
[P]: I've... I've had clean time before, so it's like...
[TK]: You are so amazing. Good for you.
[P]: Because I've done it before. I know I can do it again.
[TK]: Well, tell me, how much fentanyl are you using right now?
[P]: I probably take like four hits a day.
[TK]: And are you smoking it?
[P]: Yeah.
[TK]: Do you inject?
[P]: No.
[TK]: Have you ever overdosed?
[P]: No.
[TK]: OK. All right. And have you ever heard of the medication Suboxone?
[P]: Yes. It helped me get off of it. So that's why I was kind of interested in...
[TK]: Yeah, definitely. Well, let's talk more about Suboxone. What dose were you on before, do you remember?
The consultation continued. Dr. Khan prescribed Suboxone, a medicine to treat opioid addiction. It works by blocking cravings and physical withdrawal symptoms. He told her she needed to be in moderate withdrawal before she could start taking it. He arranged for the prescription to be picked up at a nearby pharmacy that afternoon.
Dr. Khan also asked her to visit him at the county clinic for a follow up visit. A nurse then stepped in to do some blood tests.
A visit to the morgue: where more and more people suffering from opioid addiction are ending up
Dr. Khan doesn’t want any of his patients to end up at the Ventura County Medical Examiner’s Office. That is where those who have died from a suspected opioid overdose end up. But sadly that’s been happening more and more.
“We've seen a steady increase in overdose deaths. And unfortunately, this is something that's affecting all parts of our country,” said Dr. Christopher Young. He’s the chief medical examiner for Ventura County.
He’s been in the job since 2017.
"Currently because of the opiate crisis, we're doing more autopsies on accidental deaths than natural deaths like in the past,” Young said.
He compiles the data on all overdose deaths in the county.
“You know, if you look as far back as 2016, there were only 116 overdoses. So we could be looking at as many as 270 in 2021,” said Young.
That’s a 132 percent increase over five years. Young calls this a staggering increase. and the reason for the increase -- fentanyl.
“I think really what’s happening is that there's a drug in our community that wasn't here before. Fentanyl really was not a big... it wasn't a drug that we were seeing in deaths that often prior to the COVID-19 pandemic,” said Young.
Fentanyl is a drug that is typically prescribed in a hospital setting for surgeries to treat chronic pain. It’s commonly prescribed as a patch so the drug releases through the skin over a long period of time. It’s 50 times more potent than morphine, can be up to 100 times stronger than heroin and a very small amount can kill you.
And it’s been flooding the black market. People purchasing illicit drugs don’t necessarily know that what they’re buying could contain fentanyl.
“People will mix it up with pill filler and they'll add color and they'll press pills that look just like a Xanax pill, just like an OxyContin pill and sell them on the streets,” said Young. “One pill might have very little fentanyl in it. The next pill might have a lot. So the user really never knows what they're getting.”
On the day I visit Young at the Medical Examiner’s Office he’s about to start work on a case that has just come in -- a potential overdose. He sits at his computer to go over the case file.
“So in this particular case, this is a woman in her 30s. She's found down in her residence,” said Young “At the scene, there was a small baggie with white powder found in it, which is, you know, typically fentanyl.”
He pauses to read more about this person. The photographs are difficult to look at. The details are difficult to hear.
“The stories can be quite sad because this is somebody who's struggled with opioid addiction and had actually gone through rehabilitation,” Young said.
Young pauses at one particular photograph. It’s of an opened Narcan packet -- someone attempted to use this medication to reverse the overdose and save her life.
“This actually makes me happy because it shows me that Narcan is getting out in the community,” Young said. “That our county’s response to the opioid addiction problem is at least... it's permeating the community.”
With the case file studied it’s time to conduct the autopsy. Young takes me back to the morgue area.
And a warning to listeners: the descriptions can be difficult to read.
“The bodies come into the loading area here and they're brought into the office, they're given a unique case number at the scene to identify them by,” Young said as he gave me a tour. “And then the bodies are weighed on our scale. They're placed in the cooler.”
We then head into the autopsy suite. There are stainless steel counters, sinks, scalpels, rulers for measurements and many more tools. The light is streaming in from the windows and music plays softly in the background.
“Most people, I think, in their mind think of pathologists working in the basement with poor lighting and... and silence,” said Young. “And really, we enjoy working with one another. And fortunately, we tolerate each other's taste in music.”
A separate autopsy is already in process. The sound of a bone saw drowns out the music for a moment.
“So when we perform an autopsy, we wear protective gear,” said Young. “So we wear a plastic apron, foot coverings, a mask, eye protection for splashes -- those type of things. Would you like shoe coverings?”
I accept his offer and put on some protective covers that go over my shoes and all the way up to my knees and we head over to one of the autopsy tables.
The young woman we saw in the photographs has been brought in. It was very hard to see her in the photographs. It is much harder to see her now in person.
She lies naked on the steel table. Her eyes are slightly open so I can see their color. Her mid-length hair drapes over the edge of the table. I am struck by how bright her skin looks, not gray as I had anticipated.
A forensic pathology technician has started collecting fluids and taking photographs of the body.
Young starts a recording of his own. He begins with the external examination by describing the outer surface of the body.
When he comes to examining her nose he shares an important discovery.
“You can see right there, there's some... there's some foam in the... in the nose that is typical of an opiate overdose,” Young said.
Opiates slow breathing down and so fluid begins to leak into the lungs. More and more evidence in this case is pointing to an opioid overdose.
The rest of the autopsy involved looking at internal organs and sending specimens to toxicology. The whole process takes about an hour to an hour and half.
At the end of the autopsy Young did conclude this woman died of an opioid overdose. She was positive for methamphetamine and fentanyl. He said she was otherwise a healthy young woman.
As I left the medical examiner’s office that day Young wanted to share this message about how fentanyl and opiates are affecting so many parts of this community.
“I really think that historically people have looked at drug overdoses as them. And it really is us. This is an epidemic and it's affecting our entire country. And I think you'd be hard pressed to find someone who hasn't been affected by an overdose or someone who's died. In the similar way that the COVID-19 pandemic has rocked our entire country. Simultaneously so has the opiate epidemic.
Opioid addiction isn’t hopeless. “It's so worth just being sober.”
So what do you do if you’re worried about the risk of fentanyl. Maybe someone you know is taking drugs, engaging in risky behavior. Maybe you’re offered a mystery pill at a party, or you bought something from a dealer. Remember, this isn’t about them, it's about us.
Dr. Loretta Denering is the chief of substance use services for Ventura County’s Behavioral Health Department.
“We have a very robust naloxone program in Ventura County and have for many years.” said Denering.
Residents can get a ‘Overdose Rescue Kit’ from over 30 sites in the county. The county offers free training for anyone on how to use naloxone or Narcan, the nasal spray that can reverse the effects of a suspected opioid overdose.
“We have a really awesome training team that have personal experience as family members,” said Denering. “As health care professionals that can help be empathetic to that because we recognize, you know, it's scary.”
With how potent fentanyl is, the county now includes three doses of naloxone in the kit instead of two -- what the kit previously had.
She also wants people to know there are options for before you even take these drugs.
“Making sure that people have knowledge that there are drug check strips that you can use to test substances to see if there's fentanyl present,” said Denering.
There’s also a 24/7 access line you can call to get help for yourself or a family member. That’s 844-385-9200.
I wanted to end this piece with someone who did find help. Erik is 22 years old. We’re only using his first name to protect his privacy. He’s about six months sober. This is his story of hope.
I was first introduced to opioids when I was 16. And at that point I had been like… kind of partying a little bit harder. I had started going to home school, which was probably a big part of it, a lot of isolation. And I just was trying to find something.
I naturally starting seeking more. And I was definitely being more risky. And I met this guy who introduced me to heroin. And that is kind of when things went pretty downhill for me. I had just turned 17 and I was working two jobs and doing home school. And I was starting to shoot up dope.
And within like two months, I got fired from my first job for leaving a bag of syringes and then ended up OD'ing and getting sent to a hospital and to a mental hospital.
My whole family has addiction. My mom's twenty-two years sober, but the rest of my family are alcoholics or... my uncle just died a few years ago from a heroin overdose.
What ultimately led me to recovery was I went to this clinic. I was using and I basically ran out of dope and I was just really sad and just back to the same cycle. And I went to this clinic. And so I really had a bias against any medicated assisted treatment at all. I thought it was the same as getting high, which now that I'm on medication, I think is probably the stupidest thing in the world. Because it's not at all. It has really saved my life. I have the best job I've ever had. I have my own apartment, I haven't asked my family, my mom, for money. And I can't remember how long… that's never, ever been the case.
What I want people to know about opioid addiction, is that it's not hopeless. A big one for this is that medication assisted treatment is OK. You know, if you don't want to do it, if you really are, you know, can't... don't want to do it. But if you can't stay sober, maybe you should do it like it's so worth just being sober.
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