On a Thursday spring morning in Paso Robles, Aurora William drives into a dirt lot by a hotel to a familiar sight: four other volunteers equipped with bags of supplies, from breakfast burritos to Fentanyl test strips. For the past four years, William and other community members from local churches have met here each week to serve an estimated 150 people living in encampments at a nearby riverbed.
But this time, the group’s mission felt particularly close to home. Hours before, William lost another unhoused friend to an overdose of Fentanyl, a synthetic opioid.
William got out of her car and formed a prayer circle with the rest of the group—something they always did before starting their 15-minute descent to the riverbed.
“I ask that you let her life and her death not be in vain,” William prayed.
William, 63, is one community member on the frontlines of San Luis Obispo County’s opioid epidemic as part of Hope & Faith Street Outreach. The issue hits close to home for her; in 2017, a friend of her sons, who are now 29 and 31, died from an opioid overdose — just like many other children she knows in the community.
“This is so prevalent,” William said. “I don’t know if it’s the street outreach work, I don’t know. But I know that I have too many friends who’ve lost kids to overdoses.”
San Luis Obispo County’s opioid-related deaths have skyrocketed to a rate of 33.92 — the ninth highest in the state. What used to be isolated to misuse of prescription opioids in older adults is now an epidemic among virtually all age groups, fueled primarily by an illegal drug supply.
But there’s one silver lining in the county’s persisting fight against opioids: New funding, paired with a destigmatized approach to drug use inspired by harm reduction activists like William.
How we got here
The county’s annual count of people who died by an overdose of prescription or illegal opioids rose 5% since 2018, according to the California Public Health Department’s Overdose Surveillance Dashboard.
The opioid addiction crisis spanned across the U.S. due in large part to pharmaceutical companies overprescribing opioid medications. SLO County Public Health created the Opioid Safety Coalition in response. Its coordinator, Jennifer Rhoads, said the nationwide crackdown on overprescribing opioids wasn’t coupled with a safety net for individuals already addicted. As a result, illegal opioids became more prevalent.
“A lot of people were experiencing addiction and starting to use other drugs like heroin from their prescription drug use,” Rhoads said. “Those policies really didn't take into account, what are we going to do with all of these people that now have an opioid dependence?”
The issue was so prevalent in San Luis Obispo that the county and its cities were plaintiffs in a nationwide lawsuit suing pharmaceutical companies for their role in the opioid epidemic, garnering more than $3 million projected to be disbursed annually for 18 years according to County Board of Supervisors meeting documents.
At the end of 2023, the county approved a two-year plan for disbursing the funds, which will go toward the county’s SLO Opioid Safety Coalition, police departments’ community action teams that allow them to partner with behavioral health services, a public awareness campaign called “Fentanyl is Forever” and a sobering center currently under construction, according to Rhoads.
During the COVID-19 pandemic, Fentanyl began replacing heroin. According to Rhoads, counterfeit pills have increasingly become the center of the issue. A few years ago, four out of 10 counterfeit pills had a lethal dose of Fentanyl — now, it’s seven out of 10.
Fentanyl is cheaper to produce and comes in multiple colors, allowing dealers to mix it into other, more expensive drugs like Xanax and Ecstasy. Rhoads says younger people who overdose from Fentanyl tend to do so inadvertently through counterfeit pills, thinking they were another drug.
“It's hard for me because I'm always looking at the data and we haven't seen like a huge decline in our death rate,” Rhoads said. “But [the funding is] really preparing us to kind of continue on, not just with harm reduction but also continue on in just being more accepting of people who are kind of entrenched in substance use. Hopefully, people are understanding that it's not just moral failing, that these are bad people. These are regular people like you and I, that have gotten to a place in their lives where they need additional support.”
Behind opioid addiction
Angel, an unhoused resident in her 20s who preferred to use only her first name for privacy, picked up food in May at a monthly popup clinic put on by Paso Cares. Here, locals including Angel’s uncle, provide food, clothing and other supplies. Narcan, a brand of naloxone, is increasingly popular among the unhoused community; the medicine helps temporarily reverse an opioid overdose.
On paper, the county has fewer services to provide due to its small population, Rhoads said. As such, opioid response efforts rely heavily on direct outreach, including from community groups like this one that help leverage the little resources the county has available.
As an opioid user, Angel said she wishes there were more resources available, such as more methadone clinics available for recovery.
“I see people OD all the time, and that's super scary,” Angel said. “I was just thinking about it the other day, about how little it takes for people that don't have a tolerance at all to overdose and how we're addicts — like we're out here doing so much of it, like every day.”
Oliver is a 29-year-old who has been unhoused in Paso for the past five and a half years, experiencing his struggles with mental health, alcohol and drug use. He has not personally used opioids but has witnessed its effects on others in the unhoused community,
“I was too blind by the fact that I had mental health issues, and I wasn't able to identify it and really step up for myself,” Oliver said.
Jenn Bartenetti first encountered SLO Bangers to pick up Narcan and get trained on how to use it. She was living in a homeless encampment in Morro Bay at the time. Bartenetti experienced firsthand the physical inaccessibility and transportation issues — a key barrier for people seeking resources. Prior to the pandemic, SLO Bangers only had one location in San Luis Obispo, but Bartenetti still tried to take the bus every week to pick up Narcan.
When the pandemic started, Bartenetti said the Fentanyl crisis “hit the camps hard,” amounting to over 60 overdoses in three years. Her Narcan supply was able to save them.
Bartenetti’s opioid journey began when she survived a surfing accident and needed back surgery. It took her two years to get off the medication. But when Fentanyl gained popularity during the pandemic, Bartenetti began using it to help reduce her pain.
“I said, 'I want my life back. I want to be me again,'” Bartenetti said.
Bartenetti, who now volunteers with SLO Bangers, said that with an overdose, brain damage occurs within a few minutes, and as a respiratory depressant, opioid overdose prevents people from breathing. Even without naloxone, rescue breathing may help bring them back.
Bartenetti began going to the county’s methadone clinic, and two months ago, she got into housing after being on a waitlist for three years. Bartenetti believes harm reduction for opioid use must be coupled with more support for basic needs like housing and mental health services.
Harm reduction: ‘The path to the future’
Local nonprofits have criticized the county’s several treatment facilities for long wait times and high barriers to entry, such as requiring a patient to test negative for all substances before entering a facility for substance treatment and services. Some facilities take only private healthcare and not MediCal or CenCal — a barrier to unhoused people.
William, who works directly providing Narcan and other supplies to the unhoused community, said the county doesn’t “rule people in” for treatment — but rather, looks for reasons to rule people out.
“When somebody decides that they want to get out, there's no easy door to get through,” William said. “There's no phone for people to pick up and say, ‘I need help. Can you help me?’”
With the additional financial support for the county has come an emphasis on harm reduction — public health practices that lessen the consequences associated with illegal drug use and prioritize the user’s safety and well-being.
“A lot of our treatment providers are moving towards lower barrier services to better meet folks where they're at,” Rhoads said. “That is the path to the future.”
The Opioid Safety Coalition has joined one main group in the county that is at the center of harm reduction: SLO Bangers.
SLO Bangers is a syringe exchange nonprofit that regularly schedules clinics around the county to provide drug testing, overdose reversal, and other supplies. It heavily relies on Cal Poly student volunteers to do so.
“It definitely opened my eyes to how bad it is, and how apparent it was — but it also showed me how preventable a lot of the outcomes are,” SLO Bangers volunteer and biological sciences junior Zane Sieger said. “I wish people understood how easy it was and how little money it really takes to just prevent someone from losing their life by giving this Narcan out. It instantly makes an impact.”
As a result of the SLO Opioid Settlement Fund, SLO Bangers was provided with $162,000 per fiscal year for three years. According to SLO Bangers director Lois Petty, the group reversed more than 800 overdoses in 2022. With a budget of about $430,000 total for this fiscal year, Petty said the settlement funds help the group continue its work while expanding its staff.
To Petty, the success of SLO Bangers speaks to the need to stop thinking about drug recovery as just strict abstinence and criminalization.
“[We are] able to empower our participants and give them the supplies to save lives,” Petty said. “Those people might not have made it. You know, people would have lost friends, they would have lost family.”
Since the county’s recent emphasis on harm reduction services, Rhoads said that overdose deaths remained stagnant with no meaningful decline, reaching 80 deaths in 2023 alone. However, they’ve had a “significant increase” in overdose reversals.
“The number of overdoses that have successfully been reversed and the number of lives being saved — I think that speaks a lot to the work community groups have done in getting Narcan out and accepted,” Rhoads said.