Understanding the Fentanyl Challenge in Greenville County

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This episode of Simple Civics: Greenville County was made possible by support from First5SC.org. Parents of young children in Greenville can find free resources and services for child care, health screenings, and community support at First5SC.org. By answering a few questions on the website, you can quickly determine your eligibility for over 40 programs, apply online, and potentially access immediate assistance at no cost.

Today we talk about an important public health issue affecting Greenville County: fentanyl use and prevention. Senior Deputy Coroner Shelton England shares insights on local trends, interagency cooperation, and community education initiatives. Tune in to understand how our local government and health services are working together to address this challenge and how you can stay informed.

Transcript

Katy Smith:
I suspect every single one of you listening has heard of fentanyl and know that is a national crisis. It is a crisis here in Greenville County as well. And today we’re here to talk with Shelton England, who is Senior Deputy Coroner with the Greenville County Coroner’s Office, about fentanyl, its impact on Greenville County, and what it means for you as a resident. Shelton has been with the Greenville County Coroner’s Office since 2019. And prior to that he served as an EMS supervisor with the Greenville County EMS and as a deputy coroner and paramedic in Lawrence County. So Shelton has seen the impacts of fentanyl on victims and their families. We want to make sure that you or someone you love is not a victim of fentanyl so we hope you’ll take a listen and share this with family and friends.

Katy Smith:
Well, we’re here today to talk about a really serious topic, but one that is so important, and I’m so glad to have a great person to address it with us, and that is Shelton England. Thanks so much for being with us today, Shelton.

Shelton England:
Thank you for having me.

Katy Smith:
In our recent candidate interviews, we had several candidates for coroner and sheriff talk about the fentanyl crisis as just one of their biggest concerns in Greenville County. And I believe anyone who’s heard the news, of course, has heard of fentanyl, knows a little bit about it, at least knows that it’s a serious problem. But I do think it would be helpful to start with the most basic of basics. What is fentanyl and what’s the history of its arrival here in Greenville County?

Shelton England:
One thing to know about fentanyl is, first and foremost, it’s also a prescription drug. That’s not where we’re seeing the problem at. We’re seeing the problem in the illicit use of fentanyl. It’s an opioid. Some of the side effects are, you know, it slows down respirations. Slowing down respirations is going to slow down heart rates. Ultimately, in most cases, resulting in death, unfortunately. As far as first seeing it in Greenville County, we started seeing it late 90s, early 2000s, by a very small number. I think the first year we’ve seen it, we’ve seen four cases. That number, unfortunately, has grown tragically. In 2022, we’ve seen 205 deaths that involve fentanyl.

Katy Smith:
This is a really basic question, but it’s one I don’t know the answer to. What does fentanyl look like? How does it present itself when someone consumes it intentionally or unintentionally?

Shelton England:
So great question. It’s tasteless. It’s odorless. So there’s not necessarily a way to know outside of using something like fentanyl test strips or something of that nature that a substance even contains fentanyl. And we’re seeing it mixed in everything. We’ve seen cases where from our side of it, the death investigation side, we’re seeing in toxicology, maybe they only have THC or marijuana and fentanyl. I can’t say that they smoked laced marijuana with fentanyl, but that’s what the toxicology suggests. So we’re seeing something as simple as marijuana laced with fentanyl. So in most of the cases, fentanyl is always mixed in and there’s not really a way for the user to know that it’s in there outside of using something like a fentanyl test strip.

Katy Smith:
Wow. So it could be someone who’s intending to smoke marijuana, to use cocaine, to use what looks to be a prescription tablet that they have purchased on the black market in some way, and it may be laced with fentanyl, and they would have no idea other than, as you say, using a test kit.

Shelton England:
That’s correct. I mean, it could be a first-time user of something, just trying something out, and it has enough fentanyl in there that unfortunately they lose their life from it.

Katy Smith:
Can you share some statistics about how big of a problem it is here?

Shelton England:
So in 2022, our total accidental overdoses was 274 deaths. Out of that 274 accidental overdoses, 205 of those cases involved fentanyl. That’s roughly 75% of those 274. I’m happy to report that in 2023, we actually had a decrease in that overall number. That overall number went from 274 in 2022 to 227 total accidental overdose deaths in 2023. Out of that 227, 143 of those cases involved fentanyl. So from 2022 to 2023, we cut down on the total number of accidental overdoses, but we also It also cut down drastically on the number of cases that involve fentanyl.

Katy Smith:
That’s fantastic. That’s a trend in the right direction. But of course, any of those deaths are too many.

Shelton England:
Absolutely.

Katy Smith:
So what you’re saying is when we think of drug overdose, by and large, it is fentanyl. That is how people are overdosing in Greenville County. That’s correct. Oh, my gosh. Well, what are you and your colleagues seeing when you’re out on an investigation or when a body comes to you, not just in the coroner’s office, but from law enforcement, too? What are you seeing and hearing?

Shelton England:
So I think the trends that we’ve seen over the years, Katy, is constantly changing. When we first started seeing the greatest impact of fentanyl-related cases, we were more so seeing someone who has a substance use problem. They had went to purchase some other type of substance, and when they went to purchase that substance, they end up passing away. We did toxicology, and we found that the substance also had fentanyl involved. Now, as we’re doing our victimology and our death investigations, we’re finding out from family members that there are people that are going and looking for straight fentanyl. They’re not looking for heroin and getting fentanyl anymore. I think some other trends that we’ve seen, you know, initially when we started seeing such a big impact of overdose related deaths, you had the stories of someone who was prescribed pain medication at an early age in their life. And then that pain medication stopped. And then they started seeking other ways to fix that addiction. And now we’re seeing more cases that the stories don’t start like that. It starts with hanging out with the wrong group, hanging out with the wrong crowd, trying something for one time.

Katy Smith:
So someone could seek fentanyl and have a dosing of it that does not kill them.

Shelton England:
All the publications that you see is something as small as a grain of sand, of fentanyl is enough to take out, you know, a room full of people. But what you have to keep in mind is some of your users out here also have a tolerance built up. Your drug dealers, they’re not pharmacists. They’re not going and laying things out and making sure it’s the right concentration and stuff of that nature. So we’re even seeing cases where there may be a group of people that are all using out of the same bag of drugs that one dies, the other two don’t. And it’s a concentration-based type deal. So this person, the side that they got from was just heavier laced in fentanyl than the other two people.

Katy Smith:
That makes sense, but also terrifying.

Shelton England:
It’s very scary.

Katy Smith:
So as you and your colleagues are thinking about fentanyl and battling it successfully, thankfully, what else is on your mind? What else has you worried or keeps you up?

Shelton England:
I think the biggest thing that we need to get out there now is the Xylazine and stuff. So as laws are increasing on fentanyl, now there’s this new drug coming in. It’s been out west, it’s been up north, and it’s Xylazine, and it’s an animal tranquilizer. But it extends the effects of fentanyl. So laws are increasing on fentanyl, so the number of fentanyl is coming down. Xylazine is an uncontrolled veterinarian medication that people are now mixing with fentanyl. So you still have to be careful about that and be mindful of it as well. And that particular drug, not only does it do the same effects of opioids, but people using it to inject can result in sepsis and large wounds that become severely infected and in some cases even lose limbs.

Katy Smith:
Oh my gosh. People keep getting creative.

Shelton England:
They do. Every day this world changes in the drug industry.

Katy Smith:
If listeners are hearing this and are terrified now, as they should be, how does this relate to them and what can they do to avoid its dangers? What do you have in mind that the public needs to be thinking about?

Shelton England:
Biggest thing, education. If you know someone that has a substance abuse problem, be supportive. You can get Narcan just about anywhere. If you have a loved one that you know has a substance use problem, maybe they have Narcan, but you don’t know how to use it. Educate yourself on that. That way you can be supportive of them. There’s education programs out there for the community. Our office currently has number two in the nation mobile substance abuse education unit where we partnered with our local drug and alcohol commission, the Phoenix Center, to go out in the community and educate. Don’t hesitate to call our office. We’re happy to bring it out or reach out to the Phoenix Center. Be mindful of what’s going on in your community. Have those tough conversations with your children at home. Unfortunately, they’re going to be exposed to things in school and they need to be aware of the risk out there. That’s one of the big things that we try to do with the education unit when we go out into the schools is educate these children. We’re not going to stop them from being exposed to it, but we want to at least make them aware of it.

Katy Smith:
So speaking of Narcan and its use then, how would a family member or friend or bystander know when Narcan is needed and how to administer it?

Shelton England:
Someone being unresponsive, administer it. You’re not going to hurt them. Decrease respiratory rate. They start having the blue lips, the pinpoint pupils. You can administer it and you’re not going to hurt them. And getting that product is as simple is you can go to the health department and walk in the door and say, hey, I know someone that has a substance use disorder. I’d like to get Narcan. They’ll get you to a sign a little form, give you a little education, five-minute thing, and they send you out your way, as well as the Phoenix Center does the same thing.

Katy Smith:
Great. And it can be purchased at any drugstore, too, correct?

Shelton England:
That’s correct.

Katy Smith:
Someone told me once that if you are in doubt or you aren’t sure if it could be overdose, but you’re seeing some health situations that are concerning. Administering Narcan– whatever impact there may be that you were inaccurate about is so much worse than what could happen if you don’t administer it.

Shelton England:
That’s absolutely correct. As I said, just a minute ago, you’re not going to cause harm by administering it.

Katy Smith:
Yeah. I will say to listeners that I was given a free Narcan kit and test strips kit. I hadn’t really thought about it, but when I got it, I thought, okay, well, I have college-age kids. I put it in our guest room bathroom. I let them know it is there. I hope you never need it. There should be no reason you need it. But if you do, that’s where it is. Use it.

Shelton England:
I think that’s great.

Katy Smith:
It does seem like given the environment that we’re in, it’s worth most anyone running out to CVS, Walgreens, the health department, Phoenix Center and doing that as well.

Shelton England:
Absolutely. These substances are not prejudiced at all. I mean, they’re in your high-income neighborhoods, your low-income neighborhoods, your school-age kids, your non-school-age kids, and your professionals. It’s everywhere. So I think that’s great that you kind of knocked that stigma off by just saying, hey, it’s here.

Katy Smith:
I was lucky to have it handed to me for free, but it forced me to think, gosh, yeah, this could be anywhere.

Shelton England:
Absolutely. I think the biggest thing that I’d like to say is I think that Greenville County, in all aspects, law enforcement, coroner’s office, EMS, the hospitals, health care, have all partnered up together. And the result of everybody working together to try to combat this problem has resulted in the first time in greater than five years we can show a decrease. Can’t tell you which of those avenues are working, but I think it’s huge that we all came together at the same table and tried to work together, and we’re seeing results.

Katy Smith:
That is fantastic. Well, I’m grateful to you and to your colleagues for the partnership and the expertise and really the care. I mean, you have an extremely difficult job, but doing it with such care for all of us community members who hope to never encounter your office and actually making sure that we don’t because of this work on fentanyl. I’m very grateful to you and your colleagues for it. Shelton, thanks so much for joining us and for informing us, and for all that you do in our community.

Shelton England:
Katy, thank you for having me. 

Catherine Puckett: Simple Civics: Greenville County is a project of Greater Good Greenville. Greater Good Greenville was catalyzed by the merger of the Nonprofit Alliance and the Greenville Partnership for Philanthropy. You can learn more on our website at greatergoodgreenville.org. This is a production of Podcast Studio X.

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