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0000017c-41c3-d5e7-a57d-69ef67430000From a national perspective, California may appear to have missed the worst of the opioid crisis. Californians are dying of overdoses at a slower rate than the national average, and at just a tenth the rate of drug-ravaged West Virginia.But don’t be fooled: Opioids are still killing Californians by the thousands each year, and Kern County in particular is faring worse than the state as a whole. From 2016 to 2017, the county reported a nearly 40 percent rise in deaths from overdoses.Fatal overdoses are not the only indicator of the opioid problem. According to data from the state Department of Public Health and the non-profit Urban Institute, per population, the whole southern San Joaquin Valley reports higher-than-average rates of opioid prescribing and abuse. Two of the three zip codes with the highest prescription rates in the state are located in the Valley. Overdoses are sending Kern County residents to hospitals and emergency departments at a faster rate than almost anywhere else in the San Joaquin Valley.This rural, majority-Medi-Cal-eligible region of the state also suffers a disproportionate lack of access to critical treatment. Fresno contains the only needle exchange program in the Central Valley between Sacramento and Los Angeles, leaving Bakersfield as California’s biggest city not served by a needle exchange somewhere within its surrounding county. Simultaneously, the San Joaquin Valley contains far fewer prescribers than the state average who are waivered to provide medically assisted treatment to opioid users.Who is using opioids in this area? Why? And how can they be better served? We'll address those questions and more with this series throughout 2019.This project was supported by a 2018 California Data Fellowship from the University of Southern California’s Center For Health Journalism.

Four Years Sober, Recovering Heroin User Shifts Focus To Saving Other Lives

Kerry Klein
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Valley Public Radio
Heather Menzel, who gave up heroin four years ago, is now distributing free Naloxone around her Kern River Valley community and advocating for better substance abuse care.

Earlier this spring, a few dozen people sat in a Bakersfield conference room in front of a table piled high with nondescript white boxes, each a little wider than a shoebox. Among those was Heather Menzel, who, along with three colleagues, couldn’t wait to grab as many as possible. When the man behind the table asked how many she wanted, Menzel answered simply, “as many as we can all collectively get together.”

They looked almost like cake boxes, but inside were certainly not pastries. Each contained a dozen kits of Naloxone, the drug that can stop an opioid overdose cold, and this was one of six county-sponsored events that have provided Naloxone training and free 2-dose kits to community members throughout Kern County.

Credit Christina Lopez / Valley Public Radio
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Valley Public Radio
Kern County has obtained nearly 2,300 of the 214,000 kits of an opioid overdose recovery drug dispersed through the Naloxone Distribution Project.

Between this and another training a few weeks later, Menzel nabbed over 100 kits, all of which went back to the Kern River Valley, an isolated region roughly 40 miles outside Bakersfield where she lives in the small community of Lake Isabella. “For, I would say, regular everyday problems, there's not a lot of services,” she says, “let alone a lot of services for people that have substance use disorders or alcoholism or mental health disorders.”

These trainings are part of the state’s Naloxone Distribution Project, which so far has dispersed more than 214,000 kits of the drug—more than $16 million worth—throughout California. Critics say Naloxone enables drug use, but the medical and recovery communities agree it saves lives. In the Kern River Valley, Menzel and her colleagues estimate the drug has been used at least three times. After spreading word of the kits through social media, Menzel says they’ve handed them out to both users and providers, but also to locals simply looking out for the people they care about. “I want to cry just thinking about a couple of the people I've given one to,” she says. “They just feel like they're doing something when they feel so helpless in saving the life of their loved one.”

Four years ago, Menzel was one of those people in need of help, but today, the petite 36-year-old with bright eyes and a Hello Kitty tattoo is a full-time student, full-time waitress, and full-time mom to a 4-year-old named Isabella Sunshine, or “Bella”.

Credit Christina Lopez / Valley Public Radio
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Valley Public Radio
In March 2019, Heather Menzel and three colleagues collected 60 Naloxone kits to hand out within the Kern River Valley, where fatal opioid overdose rates are high and few substance abuse treatment services are available.

It’s a Friday night a few months after that training, and Menzel is hustling around the valley in her heavy duty Ford Excursion, first driving Bella to and from day care and dance class, then rushing to a recovery meeting.

While Bella’s in class, Menzel says pregnancy was a turning point in her struggle with drugs. Menzel, who was 32 at the time, estimates she first used meth around 12 or 13. Then, “before you know it you wake up and you’re 18 and you haven’t graduated from high school,” she says. “All of a sudden you’re not just a partier, you realize you’re a drug addict.”

In her 20s, she says she switched from meth to heroin. “I did heroin up until I got pregnant with my first child at the age of 32, and that’s when I got sober,” she says.

But she didn’t just flip a switch. After having attempted other recovery methods, she enrolled in a medication-assisted treatment program, where she received methadone every day. She could feel it working, but the clinic was an hour away in Bakersfield. “I was still homeless, in an abusive relationship, living in a garage,” she says. She didn’t always have the money for bus fare, and eventually the administration told her she could no longer participate. “Even though I was pregnant, they told me I was too much of a liability and that they couldn’t help me anymore.”

It was late one night that she realized what a bad spot she was in. “I just remember crying out to God, I hadn’t prayed in years, the most earnest prayer I’ve ever prayed in my whole entire life,” she says.

Credit Heather Menzel
Menzel and 4-year-old Isabella Sunshine during Easter 2019.

Around 4 a.m., Menzel remembers, the phone rang and wouldn’t stop. Finally, she picked it up, only to hear her mother’s voice. They’d been estranged for years, ever since Menzel had pawned her mother’s wedding rings to buy more heroin, and during the many years Menzel had lived out of town. “She said, ‘they’re going to let you back on treatment and I’m going to drive you down there myself every day and you’re not going to lose this baby’,” Menzel says tearily. “And she did.”

Those first few weeks were hard, but eventually, Menzel moved back in with her mom and step-dad, she had Bella, and, after nearly four years, she weaned herself off of methadone just a few months ago. And now, she’s helping take care of her niece, 27-year-old Jordan Mendoza, who’s in recovery from meth addiction. She says Menzel was there for her when Mendoza got out of prison in May, after serving nearly a year on felony burglary charges. “She’s the best positive influence that I have,” Mendoza says of her aunt. “She’s my best friend.”

Through Menzel, Mendoza also joined their local chapter of the 12-step program Celebrate Recovery, where Menzel heads next after Bella’s dance class. Menzel helped establish the program in 2018 at Faith Community Church in Wofford Heights, where she shuttles other locals each week who can’t make it there on their own.

Credit Kerry Klein / Valley Public Radio
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Valley Public Radio
Every Friday, Faith Community Church in Wofford Heights hosts Celebrate Recovery, one of a small handful of support groups like Alcoholic and Narcotics Anonymous that meet regularly in the Kern River Valley.

This week is the group’s monthly community dinner, warm and lively with home-made turkey chili and Flamin’ Hot Cheetos for the kids of the 40 or so attendees. “I love you” is a normal part of conversation. Before separating into support groups, the pastor delivers a sermon about finding strength in God and moving beyond selfishness, then finishes with the serenity prayer. Two attendees say this is the best recovery group they’ve ever joined.

One of the organizers is Ron Haigler, who’s recovering from meth and alcohol abuse. He went to high school with Menzel, and he attributes a lot of the community’s positive momentum to her. “She makes time to help the next person, she engages, and she recruits, and she brings people to the table,” he says. “She’s got a heart of gold and it’s purely out of wanting to see the next person have help and hope.”

Help and hope are critical in the Kern River Valley. This region of roughly 10,000 people consistently reports one of the highest rates of fatal opioid overdoses in Kern County. The biggest culprit is heroin, which also sends dozens of people to hospitals and emergency rooms each year.

Credit Kerry Klein / Valley Public Radio
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Valley Public Radio
Ron Haigler, left, and Pastor Jeremiah Maxwell helped establish the Wofford Heights chapter of Celebrate Recovery along with Heather Menzel.

Of the county’s 47 prescribers waivered to offer treatment medication, zero work in the Kern River Valley. Only one clinic and one independent therapist offer outpatient substance abuse counseling, and Celebrate Recovery is one of only a handful of community-driven support groups. “As a community, we do lack resources and we do lack educated people that are providing the services that are needed,” says Lisa Wyly, a program manager at Kern Valley Healthcare District in Mountain Mesa, the only hospital in the area.

But attention to substance abuse in the region appears to be growing. As part of Wyly’s work at the hospital, she oversees a state grant to better connect patients to substance abuse care. And around a year ago, a county representative approached her to help establish the Kern River Valley Community Action Network, a grassroots coalition with the goal of bringing together law enforcement, residents, and other groups to address prevention at the local level. It’s an organization Wyly gladly manages outside her day job. “We’ve been so disconnected, everyone having their own voice and doing their own thing,” she says. “I just think there’s a huge benefit when we all come to the table.”

Thanks in part to locals raising their voices, Wyly says the county’s mental health department has also become more active in substance abuse prevention in the area. However, Ana Olvera, head of the substance use disorder division of Kern Behavioral Health and Recovery Services, says the county’s priority is not to establish a clinic offering medication-assisted treatment, a proven method of treating opioid addiction using methadone or buprenorphine.

Instead, Olvera says her department is pushing for expanded access to substance abuse treatment in primary care settings, as well as encouraging local providers to obtain waivers that would allow them to prescribe treatment medication from their own practices, without needing to work at specialized clinics. “That’s really one of our goals is to bring in medical providers to expand these services,” Olvera says. “It’s not efficient to have just one type of service to treat a large problem like this.”

Kelly Pfeifer, a director overseeing behavioral health with the California Health Care Foundation, agrees Kern County is taking substance abuse seriously, not just in hospitals and primary care settings, but also within the criminal justice system. But she says programs that engage community members—particularly the Naloxone Distribution Project, which appears to already be saving lives—are just as important. “I think the state of California has been very deliberate in trying to support interventions in the community,” she says. “We can’t turn this opioid epidemic around without the community members.”

In her community, Heather Menzel thinks she’s finally beginning to feel a shift away from the stigma and stereotypes about people struggling with substance use disorder. When she put up a Facebook post about distributing Naloxone earlier this year, she braced for anger and trolling comments—but there were none. She says she’s having more meaningful conversations with other community members. “Little by little, through all the things we do through the community, you can just see that start to change, even just one person at a time,” she says. “You can just see it in their face when that shift happens. So it's really cool to witness.”

When Menzel isn’t directly advocating for her community, she’s studying online to get a bachelor’s degree in addiction counseling. Her hope, despite what health officials say now, is that a medication-assisted treatment will someday arrive in the Kern River Valley. “This is my home and this is my community,” she says. “Now that I see all the beautiful things here, I want to be a part of that, and I want to use my degree locally to help our community.”

Kerry Klein is an award-winning reporter whose coverage of public health, air pollution, drinking water access and wildfires in the San Joaquin Valley has been featured on NPR, KQED, Science Friday and Kaiser Health News. Her work has earned numerous regional Edward R. Murrow and Golden Mike Awards and has been recognized by the Association of Health Care Journalists and Society of Environmental Journalists. Her podcast Escape From Mammoth Pool was named a podcast “listeners couldn’t get enough of in 2021” by the radio aggregator NPR One.
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