John Doyel — who runs the county’s drug and alcohol programs for the Department of Behavioral Wellness — estimates 1,400 overdoses have been reversed by naloxone kits administered by his department and through Pacific Pride. | Credit: Paul Wellman (file)

As the United States quietly exceeded 500,000 fatal opioid overdoses in the past 20 years — with more than 100,000 last year alone — the Santa Barbara County Board of Supervisors even more quietly approved a settlement with fentanyl manufacturer Johnson & Johnson and three major opioid distribution companies that will “reimburse” the county for the pain and suffering inflicted by the opioid epidemic to the tune of $9.5 million-$22.6 million.

This trickle-down is the county’s share of a $26 billion nationwide settlement with the four companies alleged to have turned a blind eye to destructive and addictive nature of the drugs they so aggressively marketed. Of that $26 billion, $2.2 billion will be distributed to California cities and counties that participated in the litigation. The county’s share — minus 17 percent in attorneys’ fees — will be doled out over an 18-year period and used for drug detox, rehabilitation, and prevention programs. It will also be used to underwrite the cost of programs designed to divert habitual drug users out of the criminal justice system and into rehab.

Although this settlement involved far more money, it garnered far less national — and local — attention than did last week’s legal meltdown of the proposed $4.5 billion settlement with Purdue Pharma, the company widely credited for masterminding the explosion of opioid addiction over the past 20 years. Last week, a federal appeals judge overturned a “painstakingly negotiated” bankruptcy settlement worked out between about 4,000 state and county governments and Purdue Pharma and their owners — members of the now-notorious Sackler family.

The county supervisors had joined that litigation as well. Most of the county’s ire was focused on the Sackler family and Purdue Pharma in the body of its 139-page complaint filed in 2018. Attorneys for the county — the law firm of Keller Rohrback — termed the opioid crisis “the worst man-made epidemic in modern medical history.” They accused Purdue and the Sacklers — marketing geniuses who patented and sold OxyContin — of masterminding a diabolical campaign to persuade and “bribe” medical professionals throughout the country over the past 20 years to prescribe their highly addictive drugs. In 1995, the county’s lawsuit alleged, Purdue was selling $1 billion worth of OxyContin a year; by 2020, it projected, the number would be $18 billion.

By 2007, federal authorities brought criminal charges against Purdue — bought in 1952 by three Sackler brothers who were each psychiatrists — fining them $600 million. Over the next 10 years, the Sacklers would then withdraw more than $10 billion out of the company, squirrelling the money away into offshore bank accounts. Thus drained of its assets, the company was forced to declare bankruptcy in the face of widespread litigation involving no fewer than 800 lawsuits. 

The bankruptcy settlement, first announced in September 2019, would personally shield the Sacklers from litigation while doling out $4.5 billion of what was left of their company. It would later be approved by a judge in White Plains, New York.

A few handfuls of attorneys general throughout the nation — including California’s — appealed the settlement deal, arguing that the money was too small, the Sacklers were getting away with murder, and it wasn’t even legal. 

Last Thursday, an appeals court judge — Colleen McMahon — ruled that these states were correct as to the fundamental illegality of the deal. If the Sacklers themselves were not personally declaring bankruptcy, she concluded, they could not avail themselves of the protection from civil litigation that only bankruptcy offers.

With that deal now unraveled, it becomes pending litigation, something county counsel Rachel Van Mullem says she will not discuss. 

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But legal commentary aside, the county’s own death statistics are stark enough. Since 2014, 639 county residents have died of opioid-related overdoses. When the final stats are tabulated for 2021, the number will be even higher. Of those, at least 140 died from overdoses related to fentanyl — a synthetically made opioid said to be 80-100 times stronger than morphine. Those numbers, likewise, will get higher as the final tabulations roll in. 

Most striking is the acceleration of opioid-related overdoses. In 2005, the county reported 27 overdose deaths. By 2015, it was 59; in 2018, it was 85; and last year, it was 114. This year, by November, the number was 95. 

The good news — however perversely so — is that these numbers could have been so much worse. Since 2015, John Doyel — who runs the county’s drug and alcohol programs for the Department of Behavioral Wellness — estimates 1,400 overdoses have been reversed by Narcan kits administered by his department and through Pacific Pride, which contracts with the county to get such kits into the hands of likely drug users.

“Most assuredly, the vast majority of those who were administered Narcan would have died,” Doyel stated. Narcan is the product name for naloxone — a chemical developed in 1961 to counter the effects of an overdose — which is administered in the form of a nasal spray. Naloxone can also be administered intramuscularly via a syringe-like apparatus. 

Nationally, it appears COVID has helped propel an increase in overdose deaths. Locally, Doyel said, “the jury is still out” as to what effect COVID has had on overdose stats. “We’re still tracking it,” he said. 

One thing’s for certain: Fentanyl is having a much bigger impact. In the first six months of the year, Doyel said, fentanyl was involved with 28 of the first 36 overdose deaths. Last year, fentanyl was implicated in 33 of the county’s 114 fatal overdoses. By contrast, in 2015, it was involved in just nine out of 75 deaths.

According to Kristin Flickinger of Pacific Pride, fentanyl is now added not just to heroin but also to cocaine and methamphetamine. Two years ago, she said, it was added only to heroin. Unsuspecting users, she said, could find themselves taking speedballs. “That can be very deadly,” she said, noting as well that fentanyl is so much more potent that morphine and heroin. 

In response, she said Pacific Pride is now distributing fentanyl test strips so that users have a better idea of what they’re putting in their bodies. “Some people use fentanyl very intentionally. Some are not,” she said. The test strips cost about a buck apiece. “Some users might say, ‘Gosh, I don’t want to use this,’” Flickinger said. “Others might say, ‘I’ll use less, slower, and make sure I have some Narcan on hand.” To date, she said, Pacific Pride has passed out thousands of test strips.

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