A community coalition in the fight against fentanyl

Good grades. Good geography. Even good parents can’t necessarily save you.

The tendrils of drug use wrap themselves around even the most unsuspecting, the most seemingly shielded. Here in Monterey County, teen drug overdoses and deaths — particularly from fentanyl — continue to rise sharply. And when it comes to the victims, there is no sorting.

“No child is immune from substance use,” says Dr. Casey Grover, an addiction medicine and emergency medicine specialist with Community Hospital of the Monterey Peninsula and Montage Health’s Prescribe Safe program. “We know of cases from multiple school districts. We know of cases from different cultural backgrounds. We know of cases of those who have struggled with mental health, and others who were experimenting and got a dose of fentanyl unexpectedly.”

Gaining a foothold in the battle against this powerful threat — particularly considering escalating mental health challenges during and post COVID-19 — can be extraordinarily complex.

Do you focus on overdoses? Schools? Mental health? Education? Advertising? The F-word (fentanyl)? Narcan®? Grieving parents and families?

The answer? All of it.

If you’re Montage Health Foundation and Ohana, you fight the fight piece by piece, resolute in the goal of a comprehensive community transformation toward healing and health. Allies of this goal are found in accurate information, connection to trusted adults, and opportunities in school, after school, and at home to build healthy relationships and develop mental health skills.

“We are working hard to prevent teen deaths from overdose,” says Krista Reuther, Assistant Director of Community Health and Prevention at Ohana, Montage Health’s child and adolescent mental health program.

It helps when you receive a five-year, $625,000 grant (that could turn into 10 years of funding) from the White House Drug-Free Communities Support Program.

But it also takes an enormous passion to fight this sometimes-intractable fight. And you get the idea that the people involved in this grant-supported coalition just might do it even if the money were missing.

“I’m humbled by the challenge,” says PK Diffenbaugh, Superintendent, Monterey Peninsula Unified School District (MPUSD). “But I’m going to fight it until I have no more strength.”

Diffenbaugh is part of an impressive lineup.

There’s also Dr. Reb Close, an addiction medicine and emergency medicine specialist at Community Hospital. When she cared for a 19-month-old child 11 years ago who ultimately died from an opioid overdose, she became fierce. One year later, in 2014, she co-founded Prescribe Safe to address the opioid problem, along with former Community Hospital Vice President Anthony Chavis and Monterey County Deputy District Attorney Amy Patterson.

“I have become friends with moms who have lost some of their kids,” Close says. “They support each other beautifully. I’m the only person in the mom group who has not lost a child.” Some might argue she has lost far too many.

There’s Grover. His addiction-fighting roots run deep. He has been exposed to and learning about addiction since his first year in medical school in 2006 when he volunteered at syringe exchanges at homeless clinics. Fast forward almost a decade, and he joined Prescribe Safe. He and Close are now its medical directors, and they both became certified in addiction medicine in 2023.

“My mom once asked me, ‘If you had unlimited money, what would you do to stop what’s happening here with fentanyl?’” Grover says. “I told her I would end intergenerational trauma, abuse, and substance use. I can’t tell you how many times I hear someone battling addiction say, ‘I saw my parent using, so I used.’ Or, ‘My parent was the first one who showed me how to shoot up.’”

There’s Diffenbaugh. As the head of MPUSD — the grant’s target group of students — he has endured overdose deaths of multiple students in his district.

“The way it is now,” he says, “if you take the wrong pill, life is over. There’s no second chance. And the family is torn apart forever. That’s what I’m probably most worried about.”

There are the teams at Ohana and Montage Health Foundation. They received the grant in 2021 and have spent the ensuing time building their community coalition and augmenting those funds with resources, time, passion, and additional grants.

“The members of the coalition meet monthly for training about anything related to youth drug and alcohol use, treatment, and prevention,” Reuther says.

With almost 27 organizations represented — from the Monterey County District Attorney’s Office to RockStar Dance Studio — there are so many in this group trying to change the course of youth substance use.

In the first two years, the coalition established a foundation (think: policies, strategic plans, etc.), including the critical formation of youth drug and alcohol awareness clubs at every high school in MPUSD. The entire coalition is adamant that youth input is essential.

“We ask them, ‘What matters to you? What do you care about?’” Close says. “It’s the concept of, ‘not about us without us.’” One example — fentanyl posters are being plastered in every middle and high school bathroom in the county. The Ohana Youth Advisory, a group of local high school students who meet monthly with Ohana to provide a youth perspective on Ohana’s work, was instrumental in reviewing the posters to ensure the message was on-point for their peers.

“I don’t think we can assume that our own personal experience as adolescents was similar to what our kids are dealing with now — the pandemic, social media, access to drugs,” Diffenbaugh says. “As adults, we have to say ‘Hey, let’s shut up and listen.’”

Learn more about Montage Health’s substance use prevention efforts.