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• How to spot and prevent a fentanyl overdose
• Where to find help for addiction in the Bay Area

Howard’s son loved everything about the natural world, but especially the Earth’s soil.

“He grew vegetables in our backyard, experimented with different soils. That's what he was super passionate about,” said Howard, describing his 18-year-old son, who had been accepted to a California state university to study soil science.

Looking out on the lush garden from the living room of his Silicon Valley home, Howard recounted why that never happened.

Last fall, because of the COVID-19 pandemic, the teenager chose to defer for a semester, with the hope that in-person instruction would resume. During the wait, he went to stay with a friend in another state. Then, the day before Thanksgiving, Howard got a call from that friend’s family.

“They were to go snowboarding,” Howard said. “They went to wake him and he had passed.”

Howard’s son died Nov. 25, 2020 from a single pill of what he thought was Percocet — a commonly prescribed painkiller that contains acetaminophen and the opioid medication oxycodone. A friend in Santa Clara County sent it to him.

A toxicology report later showed that the pill actually contained fentanyl, a synthetic opioid so strong that just 2 milligrams can kill a person in a matter of minutes.

Howard, a technology company executive, spoke to KQED on the condition that we not use his full name or identify his son, in order to preserve the privacy of his younger child. He said he’s also concerned about protecting an ongoing criminal investigation into his son’s death, but agreed to an interview because he wants to warn other parents and teenagers.

“We didn't know,” Howard said. “You read about fentanyl as if it's in some far-off place. ... It's not.”

The teenager’s death was part of a dramatic rise in deadly, fentanyl-related overdoses in Santa Clara County during the pandemic, particularly among school-aged children and young adults. In 2020, the number of fentanyl deaths in the county more than doubled, and the victims were younger, on average, than in the previous two years, according to an analysis by KQED and the Documenting COVID-19 project at Columbia University’s Brown Institute for Media Innovation.

The Documenting COVID-19 project and KQED obtained data from the county medical examiner that showed 11 people died from a fentanyl overdose in 2018. That number grew to 27 people in 2019 and then shot up to 73 people in 2020.

The increase mirrors a surge in drug overdoses in California and around the country during the pandemic. What’s notable about the victims in Santa Clara County is their youth. One was a 12-year-old girl.

According to county data available so far, the median age of those that died from fentanyl overdoses last year is just 26 years old, though authorities have not yet completed investigations of every case.

Overall, more than 20% more people died last year in Santa Clara County than in 2018 or 2019, according to the California Department of Public Health. The pandemic played a role but, strikingly, most of those deaths were not due to COVID-19. Of the 2,109 so-called excess deaths in the county, 932 have been attributed to the coronavirus, while more than half — 1,177 people — died from other causes, including drug overdoses.

Though they died from too much fentanyl, many people, including Howard’s son, thought that they were taking far less potent drugs, according to county officials.

That has led some families of the victims to say that “overdose” is the wrong word for what happened. Instead, they say their loved ones suffered poisoning, and their deaths should be prosecuted as such.

Fentanyl Deaths Increased During Shelter in Place

Fentanyl fatalities in Santa Clara County had already started to increase in 2019, but county officials believe the pandemic accelerated that trend.

Mira Parwiz Shamel, who directs addiction medical services for Santa Clara County, said the pandemic has increased younger people’s exposure to the drug.

“Because the schools were closed, kids at home had more access to the internet,” Shamel said. “A lot of these drug deals are happening through social media sites.”

Illicitly manufactured pills have been purchased on Snapchat, Instagram and WhatsApp, according to law enforcement.

The drugs cost as little as $20, roughly the price of a pizza — and just like a pizza are delivered to the home. “A cheap drug that gets you high very quickly is popular, however, unfortunately it's also very deadly in a small amount,” said Shamel.

Tragedy can happen fast: Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine, according to the Centers for Disease Control and Prevention.

Pandemic Thwarted Access to Addiction Treatment

The loss of access to treatment programs and other support for people addicted to opioids and other substances was another contributor to the increase in deaths. In Santa Clara County, and around the country, most of the patient therapy for people struggling with mental illness or addiction moved online last year.

“The pandemic has been hard for all of us,” Shamel said. “But those who also experienced more loneliness and depression and job losses — all of that has played a role to bring this to a higher level than usual.”

Another Silicon Valley tech professional who lost a teenage son to drugs last year sees a direct line from the pandemic to his 17-year-old’s death.

“COVID happened and it affected this whole globe,” said the father, who asked to be identified only by his middle name, Otto, and not to name his son, in order to protect the privacy of younger siblings and the ongoing criminal investigation. “It affected everyone on this planet, including him. I think it compounded his situation and I think that partially is to blame.”

Otto described his son as a charismatic and gifted high school athlete who made friends easily. But he said that during the pandemic he felt the teenager had too much time on his hands. He changed.

“I think there were pills that these kids got introduced to in parties and things like that. And I think he did start to develop issues in the last year,” Otto said, adding that by last June his son had become dependent on opioids.

Otto said he and his wife got their son into a 30-day inpatient treatment program for addiction, but he relapsed a few days after completing the program. The parents tried to send their son back, but the treatment center lacked the space to take him right away, and due to COVID-19, local outpatient treatment options had an admission backlog of several weeks. As the family struggled to find another facility, their boy started disappearing for days at a time. When he returned home on July 22, he appeared stable to Otto.

“I talked to him a couple of hours before, and he seemed to be sober,” the father said.

But when Otto went to check on his son a couple of hours later, he found him dead in his bedroom. Otto said the memory of that moment haunts him.

“He took a pill that he assumed was a prescription pill or opioid,” Otto said. “It's very unlikely that he knew it contained fentanyl.”

Otto said that had he and his wife known about fentanyl poisoning they might have checked sooner or more often, or learned how to use naloxone, a drug that temporarily reverses an overdose.

Two days after his son’s death, staff from the drug treatment facility called to say they had a space available, he said.

Otto told KQED that he was reluctant to discuss his son’s struggles with addiction because that’s not how the family wants to remember him.

“That's such a small part of his life and we think of all these other things and all the richness and the greatness that he had in his life,” Otto said. “That last year is not what defines him at all.”

Fentanyl Killing Across Bay Area Counties

While the 170% increase in fentanyl deaths in Santa Clara County in 2020 was the most dramatic increase, fentanyl deaths were also rising in other Bay Area counties.

In San Francisco, at least 396 people died from the opioid in 2020, which is nearly 68% more than in 2019.

The actual number of deaths is likely much higher, per county officials.

In Alameda County, deaths rose 29% in 2020 to 62 people, according to data that the Documenting COVID-19 project and KQED obtained from county officials.

But the victims in each of those counties were older. Based on available data, the median age of people who died from fentanyl overdose in Alameda was 33.5 and in San Francisco was 43, compared to Santa Clara County where the median age was 26.

Initial data from the three counties suggest that fentanyl deaths did not affect any one race or ethnicity disproportionately, but those county authorities are still completing death investigations for 2020, so the conclusions are preliminary.

Law enforcement officials say that fentanyl illegally manufactured in China and Mexico has flooded into the U.S. in recent years because it’s cheaper to produce and cannot be detected by sight or smell. Drug trafficking organizations initially used fentanyl to augment more expensive drugs, but now they are manufacturing pills that only contain fentanyl and disguising them as common prescription drugs like Percocet and Xanax, the brand name for the anti-anxiety drug alprazolam, which is also popular with teens.

Hard to Prosecute

The Santa Clara County District Attorney’s Office has created a special unit to combat the sale of illicitly manufactured opioids.

Brian Buckelew, a supervising deputy district attorney in the narcotics unit, said that the profile of fentanyl dealers in his county differs from dealers of methamphetamine, who are frequently users as well.

“Here, what we're seeing is young people aged 15 to 25, largely, they are the dealers,” Buckelew said. “They are not addicts. They are profiteering. They're selling small amounts to a lot of people and making money off of it.”

In April, the Santa Clara County District Attorney’s Office filed murder charges against one of those alleged dealers for selling fake pills that killed an 18-year-old woman.

Grace Bhardwaj and her 17-year-old boyfriend had purchased what they thought were Percocet pills on Snapchat on April 5, according to the county's District Attorney’s Office..

What the couple got instead, officials said, are known on the street as M-30s, little blue pills with an M inside a box on one side and the number 30 printed on the other side, fake oxycodone tablets that were actually laced with fentanyl.

After taking the drug that evening the boyfriend overdosed, paramedics were called to the scene and revived him using naloxone.

Bhardwaj, though, was found dead later that night in an upper bedroom of the house.

The alleged dealer, Anthony Minjares, 22, is in custody awaiting trial. If convicted, he faces 15 years to life imprisonment.

Murder charges against fentanyl dealers are rarely filed, though, according to Buckelew.

It’s difficult to prove that the dealer knowingly or intentionally poisoned a buyer, Buckelew said, referring to the legal threshold for charging murder. “This case is different because the defendant knew of the deadly properties of fentanyl. He knew that his drugs contained fentanyl and he did not share that information with the purchaser.”

The U.S. Attorney's Office for the Northern District of California recently filed indictments against alleged members of drug trafficking organizations selling fentanyl out of San Mateo County to dealers all over the Bay Area. Similar indictments were filed against dealers in the East Bay and Monterey County.

Warning the Public

While the families interviewed for this story want changes in the law to strengthen prosecutors’ ability to put dealers in prison, they say the best way to prevent more deaths in the short term is to raise public awareness about the substances dealers are actually selling.

“They're very good at pushing their products out in ways that make them look safe, with colorful menus and price lists,” said Ed Ternan, a financial adviser who worked in sales and marketing for most of his life.

Ternan said his son, Charlie, fell prey to that ruse, just three weeks before he was to graduate from Santa Clara University last spring.

In the early months of the pandemic, the campus shut down, so Charlie sheltered at home with his parents in Pasadena, Ternan said, but the 22-year-old returned to Santa Clara in early May because he wanted to spend time with his friends before graduating.

A week later, on May 14, Ternan said, he learned that Charlie had died in his room at his fraternity house from fentanyl poisoning.

At the time the family was baffled.

“Charlie was happy, he was not suicidal, he was not depressed. He didn't have a substance-use disorder,” Ternan said.

But as Ternan and his wife met other families whose children had died after trying drugs for the first time or using them occasionally, they saw a pattern.

“These are kids who are experimenting. They're not addicted yet,” said Ternan. “In the old days, you would experiment and you drink too much tequila and you'd say, ‘I'll never drink that much tequila again because I got really sick and hung over. I learned my lesson.’ These days, if you experiment with what you think are prescription pills, you don't get to learn a lesson. You die.”

Ternan and his wife, Mary, formed a nonprofit organization, Song for Charlie, to get the word out to parents like themselves who had no idea that poison is being marketed and sold in the guise of prescription medication.

Ternan said parents need to recognize that their children’s generation grew up experimenting with prescription medications and that it’s common for friends to share them. They say parents should tell their kids: "All these pills are likely fake. They're made with a deadly, powerful synthetic, and you need to tell all your friends.”

Seek Treatment Early

The fact that fentanyl is so widespread and so lethal makes it more urgent to intervene swiftly when someone is struggling with addiction, family members say.

Robin Dosskey told the story of her son Kyle, 38, who had recently lost his job at a law firm and was struggling to find treatment for his heroin addiction.

Dosskey said she had finally found Kyle a spot in a medication-assisted recovery program, but on Nov. 18, 2019 — the night before they were going to sign him up — he took heroin he did not know was laced with fentanyl in her Mountain View home.

Kyle’s death was one of a cluster of fentanyl deaths Santa Clara County officials warned about in late 2019.

Dosskey said the toxicity of fentanyl means people like Kyle are dying before they can conquer addiction.

“He struggled with this addiction problem for a long time, whether it was alcohol or opioids. It is not something he was lazy about,” Dosskey said. “I want people to know it can happen to anyone's child — I don't care about their race, their gender, their economic status. It happens and it begins in high school.”

Dosskey, who is a retired teacher, wishes she had done more, early on, to help her son. And she wishes she had known more about where to get help.

“One of the things that happens is that you try to hide it and cover it up so that you take care of it yourself. Well, that doesn't work,” said Dosskey. “It's going to take a whole team of people to help a child that needs treatment.”

She’s part of a new support group in Santa Clara County called Moms Alliance that will help defendants referred from the drug courts and their families get connected with therapy and other services.

Post-Pandemic Hopes

The opioid crisis began well before the COVID-19 pandemic, and it’s not going away.

Howard and Otto, who met in a support group for bereaved families, say they hope that as COVID-19 vaccination rates rise and coronavirus deaths decrease more resources can be focused on the fentanyl crisis.

“A lot of the attention, of course, globally has been on the COVID pandemic,” said Otto, “while at the same time there is this silent killer that people haven't really necessarily known about.”

“It's hard to get resources and attention when there's clearly another, you know, raging epidemic globally,” Howard said. “I do hope with this (Biden) administration that we see a renewed focus on this.”

FAQs About Fentanyl Addiction

How Can Overdoses Be Prevented?

You can prevent a fatal opioid overdose using a drug called naloxone (also known by the brand name Narcan), which temporarily “attaches to opioid receptors and reverses and blocks the effects of other opioids.” According to the National Institutes of Health, naloxone does not cause any serious side effects.

You can get free naloxone/Narcan training and kits from Santa Clara County clinics, and staff will train you how to use it.

In San Francisco, the Drug Overdose Prevention and Education Project trains people how to recognize signs of an overdose, and refers people to the CVS pharmacy in downtown San Francisco for free naloxone kits.

Pharmacists are permitted to prescribe naloxone to you without a doctor’s prescription. Contact your local pharmacy to confirm if they have naloxone available.

What Are Common Signs of an Overdose?

Someone may be overdosing if they are groggy, lethargic or barely able to stand. The pupils in the person’s eyes may be constricted to the smallest point. These “pinpoint pupils” will not expand when exposed to light. The person’s breathing may become slow, become irregular or even stop.

Where Can a Person Get Help With Addiction in the Bay Area?

Santa Clara County Behavioral Health Services treats people struggling with stress and substance use issues, including fentanyl use, through a program called Gateway. 1-800-488-9919

Youth Substance Use Treatment Services within Santa Clara County Behavioral Health Services provides medication-assisted treatment, case management, confidential counseling and mentoring. 408-272-6518 (Monday-Friday, 9 a.m. to 9 p.m.)

The Santa Clara County Suicide and Crisis Hotline at 1-855-278-4204 is open 24 hours a day/seven days a week. You can also text the word "renew" to 741741 (24 hours per day/seven days per week).

Mental Health Services can be accessed by calling 1-800-704-0900.

Elsewhere in the Bay Area, San Francisco County offers behavioral health care and services for addiction and substance abuse treatment. Alameda County offers similar services to people struggling with addiction.

You don't have to have an overdose to get medication-assisted treatment for opioid addiction. Emergency medicine doctors can prescribe FDA-approved drugs that treat opioid dependence and arrange for the patient to follow up with an outpatient center. Santa Clara County clinics and hospitals also have these medical treatments available and coordinate outpatient care. You or your loved ones can begin treatment while in county jail and receive outpatient care upon release.

How We Did It

For more than a year, reporters from KQED and the Documenting COVID-19 project at Columbia University's Brown Institute for Media Innovation have been requesting and analyzing mortality data from Bay Area counties to better understand who has died, and why.

Our analysis revealed a 2020 spike in deaths across these counties that could not be explained by COVID-19 alone. We found an increase in deaths from natural causes, such as Alzheimer’s disease, diabetes and hypertension. But we also found an increase in drug overdoses.

For this report, we requested death records through the state’s Public Records Act and analyzed the local mortality data from the Santa Clara County Office of the Medical Examiner-Coroner, the San Francisco Office of the Chief Medical Examiner and the Alameda County Sheriff's Office Coroner’s Bureau for 2018, 2019 and 2020. These records include only deaths that were deemed “unnatural” — sudden, unexpected, violent or from contagious diseases, including COVID-19.

We compared the counties’ death records and data with statewide data collected and released by the California Department of Public Health, and cross referenced our data with an analysis of California Health and Human Services’ death statistics for 2018, 2019 and 2020.

We focused our analysis on Santa Clara County because the data revealed a striking rise in deaths from fentanyl poisoning both in 2019 and, even more sharply, in 2020, and the age of the victims trended notably younger — the youngest among them a 12-year-old girl — indicating that the trend was not necessarily born of the pandemic, but might have been exacerbated by it.

Under California law, county medical examiner and coroner’s offices are responsible for investigating all sudden, violent and unnatural deaths, such as accidents including overdose, suicides and homicides. Thousands more deaths that occurred at home are not part of this data set, but those deaths are represented in state data.

While reporting on infectious disease deaths is normally considered the purview of the medical examiner or coroner, most counties in California assigned the tracking and reporting of COVID-19-related deaths to local health departments.

You can learn more about our analysis.

Kyra Senese and Eric Fan of the Documenting COVID-19 project contributed to this report.