Matthew Ary was a typical 19-year-old college student who just started college at the University of Arizona when he suddenly died of a fentanyl overdose in 2018.

A graduate of San Marino High School, Ary was an avid athlete who had a promising life ahead of him.

As fentanyl deaths were not as common at that time, Ary’s parents had no idea it would soon become a full-blown crisis in cities big and small, including San Marino.

“Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in California and the United States,” states the California Department of Public Health website.

Locally, the growth of fentanyl-related deaths is following national trends as overdoses double each year in the region and are not expected to slow anytime soon, according to the CDPH. In the San Gabriel Valley, L.A. County reported that 64% of fentanyl deaths were people between the ages of 18 and 39.

In the San Gabriel Valley, there were 315 total deaths in the period between 2016 and 2021, and 204 of those were people between the ages of 18 and 39. More than half of those 315 deaths took place in 2020 and 2021, indicating a significant increase in overdose cases.

The CDPH reported about five fentanyl overdose deaths in San Marino in the period between 2017 and 2021.

According to San Marino Police Records Manager Angelica Gonzalez, there were no fentanyl related deaths in the city within the last year, though police data only accounts for a fraction of recorded overdoses, as emergency department data and County Coroner reports are the key indicators for overdose death.

Overdose is more common in young people like Ary as they fall into a demographic that is more likely to experiment with drugs or purchase pills over the internet.

The issue touches every corner of the country. Deaths by drug overdose in the United States surpassed 100,000 annually in 2021 and death by synthetic opioids — which includes fentanyl — increased 97-fold in a 10-year span.

Fentanyl is manufactured in a variety of bright colors, shapes and sizes, and has been made to look like prescription pills such as oxycodone, hydrocodone, Adderall and Xanax in the illegal drug trade, according to police.

Fake pills are often pressed with markings that imitate real prescription medication. Other street opioids such as heroin are also commonly laced with fentanyl because they have similar effects, while fentanyl is cheap, easy to manufacture and is extremely potent in small sizes, making it convenient for drug traffickers to transport.

But even a tiny dose of fentanyl, no larger than a grain of sand, is often lethal. When illicit drug makers who have no pharmaceutical training combine fentanyl with other drugs and fillers, the results can be deadly.

That’s what happened to Ary, who went on social media to find pills. He was looking for Xanax to take in his dorm to relax his brain before finals.

He was set to go back home for the December break, when his mother, Cynthia Ary and her husband, Vincent Ary, noticed that Matthew Ary was not getting back to them. One thing led to another, and a roommate went to check on him to find Matthew Ary dead.

“Because fentanyl was really not as prevalent as it is these days, we didn’t really know what had happened to him,” Cynthia Ary told the Tribune. “It wasn’t really until we got the autopsy on him.”

Since then, Matthew Ary’s case has been considered a homicide and still, after four years, there is an open investigation in Arizona.

Cynthia Ary emphasized that her son was not a drug addict and that his death was not a fentanyl overdose, but a fentanyl poisoning.

“He was a normal college kid, drinking and doing things like that, but he was not a drug addict,” Cynthia Ary said. “It’s very difficult and devastating on his dad and I but the fallout and tsunami of my other two kids has just been heartbreaking.”

Cynthia and Vincent Ary have two children who were 15 and 18 at the time of Matthew Ary’s death and have since longed for their older brother.

“My mom’s still alive, and all of it was just a blur, to be honest with you,” said Cynthia Ary. “It’s just so hard to believe, and it was right before Christmas.”

Since then, Cynthia Ary has taught her kids about the dangers of purchasing illicit pills. They all carry Narcan now, in case of emergency.

Over and over, Cynthia Ary repeated that her son simply made a mistake and didn’t know what he was doing.

“He just made a mistake, and it cost him his life,” said Cynthia Ary. “He was such a great kid and had so much to offer. It’s just such a hole in our world that he’s not around anymore.”

Cynthia Ary described her son as a “gentle giant,” someone who was loved by everyone and always had friends surrounding him. He was an accomplished Eagle Scout in the city of San Marino and had passions of studying business and real estate.

“We kind of called him the gentle giant, because he was a pretty big kid, but he had just such a soft heart and soft soul,” said Cynthia Ary. “He was a big foodie and sandwich guy. He was really a standout kid.”

Since his death, the family held a service for Matthew Ary at the San Marino Community Church where about 800 people showed up to honor him. The family really felt the love and support coming from the community.

“We had an overwhelming amount of donations when he passed away that we set up a fund for San Marino High through the Foundation of San Marino,” said Cynthia Ary who added that with the donations, they were able to do a complete revamp of the weight room on behalf of her son.

DOCTORS SPEAK OUT

Dr. Edwin Peck is an emergency medicine physician and fentanyl expert at Huntington Hospital in Pasadena. Peck treats addiction and overdose cases daily and is developing several programs in Huntington’s emergency department around the treatment of opioid use disorders with opioid overdose as a focus.

According to Peck, fentanyl deaths are usually sudden, and the resulting trauma of the families of the deceased can be different than that of a lifelong user.

“The issue with fentanyl now is that you can have a teenager experimenting, or just using Adderall that they did not get from a physician, for productivity reasons. These things can now be laced with fentanyl, and these people will die suddenly with nobody around,” Peck told the Tribune.

Peck said that the grieving process is markedly different with fentanyl overdoses.

“There’s no difference in the tragedy between a family losing a loved one to a drug addiction problem over decades versus a sudden one. But there is a difference in the trauma that occurs to the four-person family when one of the teenagers makes a single mistake and is very abruptly taken away,” he said.

“That’s similar to losing somebody to gun violence or to a car accident where that abrupt trauma really brings the whole family to its knees and many families do not make it through,” he added.

To Peck, there is no better immediate solution to the opioid crisis than getting Narcan into every home, business and public organization. Still, for the long term, better education and policy is needed to combat the crisis, Peck said.

THE
NARCAN/NALOXONE
EFFECT

Naloxone, also referred to by the brand name Narcan, is an opioid antagonist that rapidly reverses the effects of an opioid. Touted as a “miracle drug,” Narcan has proven to be incredibly powerful against opioid overdose. With a fentanyl overdose specifically, public health experts recommend two or more doses of Narcan may be needed.

“If it were a perfect world, I’d have everybody with [Narcan] in their backpack, in their pocket, because it’s such an easy, safe solution when someone is overdosing,” Peck said. “But, long term, that solution can be seen as a Band Aid for a gunshot wound, because when you’re alone, it doesn’t matter how much Narcan there is. The education, the understanding and the greater approach to how we go about drug use has to improve because fentanyl will not be the last thing that comes up.”

Dr. Angelique Campen, an emergency physician and fentanyl expert, said that fentanyl-related overdoses are a daily occurrence in the emergency room at Providence St. Joseph Medical Center in Burbank.

“In my eight-hour shift yesterday, there were two patients that needed Narcan to reverse the effects of fentanyl. It happens daily,” Campen told the Tribune.

Narcan, which can be bought over the counter or picked up for free at most hospitals, including PSJMC and Huntington Hospital, comes as a nasal spray, and is incredibly safe and easy to administer, Campen said.

“When I train police officers or community members about the use of Narcan, I stand in front of them and spray one up my nose just to show that it will not hurt you. If you think of using it, use it. You cannot hurt someone by giving them Narcan,” said Campen, who engages in training and public education when she is not busy saving lives at PSJMC.

Though Narcan can be purchased without a prescription for about $100 at some local pharmacies, others do not yet sell it. That’s because the drug just got FDA approval for over-the-counter sale. The manufacturer states that Narcan will be widely available for purchase in stores by “late summer 2023.”

SCHOOL, POLICE,
STATE EFFORTS

As Narcan becomes more commonly adopted as a lifesaving remedy against fentanyl overdoses, school districts and police departments are taking advantage of the tool.

The San Marino Unified School District purchased Narcan kits and have them placed at both Huntington Middle School and San Marino High School, according to Superintendent Linda de la Torre. The district nurse, Rosyln Nott, also provides annual comprehensive training for all employees at both schools. During past training sessions, representatives from both San Marino Police and Fire departments were present.

“These life-saving kits may be found in the health office and are also strategically placed alongside every AED on each of the aforementioned campuses,” de la Torre told the Tribune. “Each kit contains two doses of Narcan, gloves and one face shield (in the event that rescue breaths need to be provided), along with simple step-by-step directions.”

“San Marino Unified School District has taken an active role in addressing the alarming rise of fentanyl-related incidents, which have become a nationwide crisis,” said de la Torre.
Understanding that this is a serious topic at hand, the district implemented comprehensive measures to combat the fentanyl crisis directly.

“By prioritizing education, prevention and collaboration with local law enforcement and first responders, mental health providers, and health care providers, the district’s goal is to safeguard its students and ensure a safer learning environment for all,” said de la Torre.

“The district has educated parents through the distribution of important and timely facts regarding the dangers of fentanyl and other potentially lethal drugs. Recognizing that prevention is the key to mitigating the fentanyl crisis, the district is working with principals, counselors, and psychologists to provide age-appropriate presentations to students to deter drug use.”

The San Marino Police Department were unsure of how many fentanyl overdose cases there have been in the city for the last year or recent years. Local police and fire departments are not mandated to report on overdose death data. However, they have partnered with the district to bring resources to students.

“The police and fire departments gave a presentation to educate San Marino High School staff about fentanyl toward the end of this school year,” said Sgt. Naved Qureshi. “The presentation included consequences from exposure and how to use Narcan in [overdose] situations.

He also added that one of their police officers has also talked with students about the dangers of fentanyl and drug abuse. Each police vehicle includes Narcan as standard equipment.

About 83% of all opioid-related deaths in the state can be attributed to fentanyl, and it is a leading killer nationally, taking the lives of more young Americans than COVID-19, car accidents or gun fatalities.

Despite the widespread availability of Narcan, fentanyl cases and deaths in California are increasing at “an unpredictable pace,” according to the California Department of Public Health. The most recent statistics from the CDPH show that there were 5,961 deaths due to fentanyl overdose in 2021, and 7,175 opioid deaths statewide.

In the upcoming year’s state budget, Gov. Gavin Newsom planned investments of more than $1 billion to crack down on opioid trafficking and enforce the law, combat overdoses, support those with opioid use disorder and raise awareness about the dangers of opioids.

Under the CalRx Naloxone Access Initiative, the state will allocate $30 million to support a partner in developing, manufacturing, procuring and distributing a naloxone nasal product under the CalRx label.

“One more fatal overdose is one too many. California is tackling the opioid epidemic from all sides,” said Newsom. “Naloxone is, quite literally, a lifesaver — so we are making it more accessible and affordable for anyone who needs it.”

The Department of Health Care Services created the Naloxone Distribution Project in 2018 to combat opioid overdose-related deaths in California through the provision of free naloxone. As of June 25, the NDP has distributed more than 2.6 million naloxone kits, resulting in more than 181,665 reported overdose reversals.

As federal and state government attempt to treat the drug crisis, public health experts say that municipalities are still a far cry away from closing the gap on the local level. According to the California Department of Public Health, cities that want to fight fentanyl locally can:

• Increase the distribution of naloxone.
• Promote overdose prevention education.
• Expand equitable access to treatment for substance use disorders.
• Intervene early with individuals at the highest risk for overdose.
• Improve detection of drug-related overdose outbreaks and facilitate a timely and effective response.
  Community members can also order Narcan and learn how to recognize the signs of an overdose. For more information, visit cdph.ca.gov and search “NaloxoneStandingOrder,” or visit a hospital.