Heating Up

Doctors Reb Close and Casey Grover say the goal of the heat mapping is to find out in real time where overdoses are taking place, so agencies can distribute naloxone in the neighborhoods that need it most.

”Fentanyl Weekend” is what Reb Close, an emergency room physician at Community Hospital of the Monterey Peninsula, calls Oct. 18-20, the same weekend she and her husband Casey Grover, another CHOMP emergency room doctor, were enjoying a getaway in Lake Tahoe. The two woke up to text messages about a crisis back home. Perla Velasco, 16, of Seaside overdosed and died after taking an illegal pill laced with fentanyl. At least four other people overdosed that same weekend. (Those four people survived.) Law enforcement suspected a flood of fentanyl on the streets was to blame.

An emergency meeting of medical personnel and law enforcement took place within days. As founding members of Montage’s Prescribe Safe program, which is credited with drastically reducing the number of opioid-related deaths, Close and Grover were there. Someone asked why they weren’t using ODMAP, a free overdose mapping application program that has mostly been used on the East Coast. “I had never heard of it,” Close says. She signed up and dove in, adding as much data as she could get.

The result is an interactive heat map showing down to the street address where overdoses, both fatals and non-fatals, have taken place in Monterey County in recent months. The color-coded diamonds or circles tell a story based on which drugs were taken.

“Each of these diamonds is a fatal overdose,” she says pointing to clusters. (Circles represent those who survived.) “It’s heartbreaking, to be honest.”

There’s encouraging news in the data, as well. They discovered 150 overdose rescues in Salinas’ Chinatown neighborhood between October 2018 and October 2019, reported by the nonprofit Access Support Network which distributed the antidote naloxone to homeless residents.

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Scouring past records is time-consuming – it’s taken Close dozens of hours to review data from CHOMP and the Monterey County Coroner extracting information on which overdoses are linked to specific drugs. She’s enlisted the help of a doctor at Salinas Valley Memorial Healthcare System and another at Natividad, but she’s still short on non-fatal overdose data from South County. She’s about two-thirds of the way through 2019 fatals – she’s found 80 total representing all drugs so far. (By contrast, there were only nine opioid-related deaths in all of 2018.)

She’s reviewed 20 non-fatal cases so far for the month of December at CHOMP: Two-thirds were age 25 or younger and more than half were suspected fentanyl overdoses.

Both doctors have given talks at schools and agencies around the county warning people about the presence of fentanyl either as counterfeit pills purporting to be painkillers or mixed into cannabis or other drugs. On Jan. 8, they asked the county’s Emergency Medical Services Agency, populated by numerous first responders, to join the effort to track overdoses. Approved users can download an app to their smartphone and input data on scene. The phone’s GPS pinpoints the exact location. (ODMAP is not available to the general public.)

On Jan. 15, Close was scheduled to travel to San Francisco to meet with officials from Santa Cruz, San Francisco and other Bay Area counties to brainstorm what else they can do to prevent people dying from overdoses. “We’ve just got to figure it out,” she says.

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