The isolation of the coronavirus pandemic had seriously begun to take its toll on Alexander Joubert by the time his 21st birthday came around in May.
The skate parks were closed. He missed his friends. And the in-person family counseling he’d started just months earlier now consisted of conversations through a computer screen.
So, to lift his spirits, his parents allowed him to celebrate his landmark birthday with a few friends in the backyard of their Encinitas home.
But someone must have brought Alexander several doses of cocaine as a gift, sparking cycles of relapse and self-detoxing that revealed a hidden struggle with drug use. It was excruciating for his parents to witness over the next couple of months.
“Clearly he was in some deep pain and the whole situation with the pandemic and the political climate created in his mind a sense of doom for his future,” said his mother, Yolande Snaith. “He was frustrated with not being able to achieve what he wanted, and the pandemic made it worse.”
On July 26, Snaith found her son dead on the floor of his bedroom. There was evidence he’d used alcohol and cocaine the night before, but what killed Alexander were two little blue pills laced with a deadly dose of fentanyl.
Overdose deaths have spiked in San Diego County this year, as an already worsening drug epidemic collides with the coronavirus pandemic. Over the summer, that amounted to an average of three deaths a day.
Part of the increase is attributed to the illicit drug supply getting deadlier as traffickers increasingly rely on fentanyl, a powerful synthetic opioid. It is either laced into traditional street drugs or sold as counterfeit prescription pills similar to the ones that ended Alexander’s life.
But experts say the bleakness of 2020 has played no small part.
“I don’t know of anyone who is not impacted by what’s going on,” said Scott Silverman, a crisis coach and founder and CEO of Confidential Recovery, “and someone who suffers from the dependence of self-medication has really found themselves in a precarious position.”
Rising threat
The scourge of fentanyl has been a growing focus of public safety and health campaigns for a few years now.
Fentanyl, a prescription pain reliever mostly used for surgery or to treat cancer pain, is up to 100 times more potent than morphine and up to 50 times stronger than heroin. Even small amounts can be deadly.
Mexican drug cartels widely introduced fentanyl into the illicit street market about five years ago, won over by how cheap and easy the opioid is to manufacture compared to cultivating poppies for heroin.
The cartels also seized upon another trend — Americans’ growing appetite for prescription pills. Little blue pills that began showing up on the streets and sold as oxycodone — with the signature “M” and “30” stamps — were actually filled with fentanyl.
Fentanyl has also been regularly found in methamphetamine, cocaine, heroin and counterfeit Xanax, making the illicit drug supply deadlier overall.
Users are oftentimes unable to identify what they are consuming, much less its strength. Batches not mixed thoroughly can contain fatal hotspots of fentanyl.
“One pill can kill,” said San Diego County District Attorney Summer Stephan, “and it has killed many.”
The demographics of the fentanyl crisis in particular are wide-ranging, from a teen at a pill party to a parent self-treating anxiety to a long-time drug user.
“It should not just be a concern of people we would think of as ‘hardcore drug users’ who we associate with the risk of overdose,” said Luke Bergmann, county director of Behavioral Health. “People who are succumbing to fentanyl can be very recreational drug users.”
Last year, 152 people died from fentanyl overdose in the county, a 65 percent jump from the previous year.
Nationally, the United States was on track to hit a new record for fatal drug overdoses, particularly fentanyl, in the first few months of 2020, according to the Centers for Disease Control and Prevention.
The situation went from bad to worse with COVID-19.
New heights
The pandemic, along with a rise in political and social unrest, has profoundly exacerbated the normal stressors of everyday life.
Suddenly people were forced to cope with a toxic mix of isolation, fear, anxiety, loneliness, depression, divisiveness, financial fragility, boredom and stress.
“Factor all those things in, and it’s a perfect storm,” said Silverman.
A survey in late June by the CDC found that 40 percent of adults had experienced a mental or behavioral condition related to the pandemic.
The same survey found 13 percent of respondents had started or increased substance use to cope with the stress or emotions related to COVID-19. The behavior was more prevalent among essential workers and unpaid adult caregivers.
Accordingly, more than 40 states have reported increases in opioid-related overdose deaths during the pandemic, according to the American Medical Association.
In San Diego County, the death toll from all drug-related overdoses, including fentanyl, has already surpassed last year’s total of 645 — with 675 confirmed through October, another 80 still under investigation, and two more months to go.
Drug traffickers were briefly stymied by the shutdowns brought on by the pandemic — in Wuhan, China, the world’s biggest producer and exporter of fentanyl and precursor chemicals needed to make the drug, as well as at the U.S.-Mexico border.
But cartels are experts at adapting on the fly and have found workarounds to continue business, said John Callery, special agent in charge of the U.S. Drug Enforcement Administration in San Diego.
Seizures plummeted along ports of entry at the beginning of the pandemic, federal data show. But the pace has picked up since June.
Despite the pandemic, Customs and Border Protection officers have seized more fentanyl at ports of entry during fiscal 2020 than any other year — nearly 4,000 pounds compared to fiscal 2019’s 2,500-plus pounds.
Similarly, fentanyl deaths locally are now on pace to more than double in 2020 when compared to last year. There were 69 deaths blamed on the drug in August — “the worst month so far,” noted Dr. Steven Campman, deputy chief medical examiner.
The spike has prompted the county to launch its own public awareness campaign — “Fentanyl: San Diego’s hidden killer” — earlier this month.
“Combining the pandemic’s mounting stressors with the misuse of prescription and illicit street drugs will have severe consequences,” warned Nick Macchione, director of the county’s Health and Human Services Agency, “and in fact we are already seeing it in our county.”
Treatment
Drug treatment providers have seen an uptick in demand for services, but only recently, as fear of contracting the virus has overshadowed the urgency for getting help.
It’s a conflict that Silverman has found himself discussing often with desperate families this year.
“I know any excuse not to go to treatment is a good excuse, and COVID has been one of the best,” Silverman said. “But if it’s a choice of saving your life from overdosing versus getting COVID, then go save your life from overdosing.”
Recovery has also looked a lot different during the pandemic.
Residential programs have had to reduce capacity to account for social distancing, and in-person counseling and 12-step meetings have suffered by going online. The eye contact, body language affirmation and repetitive act of physically sharing a space with like-minded people just aren’t as powerful through a screen, treatment providers acknowledge.
“There are a lot of relapses happening,” Silverman said.
Since the pandemic began, demand for in-patient beds at Casa Palmera, a drug and alcohol treatment center in Del Mar, has gone up by 20 percent to 30 percent, said Curt Moothart, a social worker and treatment counselor.
In recent years, he has seen a rise in patients 19 to 23 years old, young users who are fooled by a sense of invincibility and drawn to the easy-to-consume pills. Many of them return for treatment two or three times, as it can take a full year to kick opioid addiction.
“The sad thing is that people … aren’t getting the opportunity to have multiple treatments,” Moothart said, “because they’re dying upon their next use.”
Alexander Joubert never went to rehab. He’d successfully hidden his addiction from his family for years, and he had flat out refused during what would be the last few months of his life.
“It was like this long, drawn-out build-up,” his mother recalled. “I would find myself thinking this isn’t going to end well. It was a path to self-destruction. We did everything we could to help him, but he didn’t want help.”
The night before he died was the first time he had ever bought the fentanyl-laced pills, his friends later told his parents. He had been broke, and the $30 tablets were all that he could afford.
Healing through action
Just over a month after Alexander’s death, on Aug. 30, Snaith and her husband, Pierre Joubert, found themselves in an Encinitas park with other families who’d also lost loved ones to overdose, in commemoration of International Overdose Awareness Day.
They arranged flower petals on the grass in a mandala design in honor of their son. Other families did the same.
It was the first meeting of the Addiction Awareness Initiative, formed by a group of North County women who are channeling their own grief into action as the situation grows more dire within their community.
“Parents who’ve lost their children to overdose is a club you don’t want to belong to,” said Lisa Nava, who lost her 24-year-old son Alex in April 2019 to a fentanyl overdose. “But when you see the same heartbreak in others, you want to help hold them up and find a way to survive.”
The initiative grew out of a social justice organization, North County Justice Allies, that Nava founded four years earlier.
She’s joined by Jennifer Potter, who lost her son Cory Williams, 27, to an opioid overdose in May 2019.
Because Cory survived a few overdoses before his death, Potter is a strong advocate for making widely available naloxone, a nasal spray medication that reverses the effects of opioid overdose. She hopes that by raising awareness, the public will have more empathy for drug users who are desperate to quit, but often defenseless to their addictions.
“I felt shame my son was an addict,” Potter said. “One of the hardest things for me was watching the kids he grew up with doing great things, going to college, having babies … I would’ve just been happy if my son stayed clean.
“I’ve gotten to the point now where I don’t feel ashamed about it, but I still have guilt. That will never go away but when I talk to others about it as a means of raising awareness, I feel better,” said Potter, who now works for a local company that’s developing a non-opioid pain medication, Heron Therapeutics.
Also on the Initiative team is Samantha Terauds, 26, who has lost 12 of her middle- and high-school classmates to drug overdoses, including Alex Nava, since 2011. The overdoses used to be primarily from heroin and other drugs. Lately it’s been fentanyl.
“I think the pandemic has absolutely made it worse,” Terauds, a Carlsbad resident, said. “Everything is so shut down. People are isolated and they’re falling back on using drugs.”
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