SANTA CRUZ — After reaching a troubling peak in 2023, drug overdose deaths have declined for the second year in row in Santa Cruz County.
Public health officials across Santa Cruz County convened online earlier this month for the fifth annual presentation on local drug trends organized by SafeRx Santa Cruz County and the Health Improvement Partnership of Santa Cruz County.
According to figures shared by Dr. Joneé Taylor, a forensic pathologist with the county Sheriff Coroner’s Office, the county had experienced 57 accidental drug-related overdose deaths from January through November of this year. That’s 20 fewer than the 2024 total of 77 and 76 fewer than the 133 people who died from accidental overdoses in 2023.
“The numbers have come down significantly,” said Taylor at the Dec. 4 meeting.
The deaths skewed largely toward men, who accounted for 47 of total accidental decedents so far in 2025, while 10 were women. When broken down by race, 34 of the individuals who died were white, 16 were Hispanic, four were Black and three were listed as “other.” Most accidental overdoses occurred in the 40 to 49 age bracket and 17 of the year’s total were among those who were housed, while nine were unhoused.
The pockets across the county where most of the overdoses occurred remained mostly unchanged from 2024 to 2025, Taylor reported. Santa Cruz was an especially high frequency overdose location, but other hotspots included Watsonville, Aptos, Capitola and Boulder Creek. The density of overdoses slightly worsened in Watsonville, and Capitola was listed as a higher frequency location compared to last year.
Fentanyl drop
Taylor said opioid drugs, including fentanyl, continue to make up the majority of overdose cases. Deadly fentanyl overdoses peaked in 2023 at 106 before dropping to 60 in 2024 and again to 38 through November of this year. That’s a 64% decrease in about two years.
County Deputy Health Officer and Emergency Medical Services Director Dr. Eli Carrillo shared that nonfatal overdoses have, encouragingly, followed a similar downward trajectory. Nonfatal overdoses went from 317 in 2023 to 176 in 2024 and were at 120 through November of this year.
One factor that has helped prevent many of these overdoses from becoming fatal was the opioid overdose reversal drug naloxone, known by its brand name Narcan. Carrillo said the average dose of Narcan per patient has risen every year since 2020 and increased 9.5% within the past year, going from 3.38 mg in 2024 to 3.7 mg 2025.
“What this tells us is that No. 1, we may be seeing stronger drugs; drugs that have additives mixed into them,” said Carrillo. “It could also mean that (emergency medical services) is only being called when the stronger drugs are taken and (victims) are not responding to bystander Narcan.”
Lt. Nick Baldrige with the county Sheriff’s Office was also present at the virtual meeting to detail how the approach from law enforcement has evolved in response to the rise in overdoses in recent years, especially as fentanyl emerged as a critical issue.
“For so long, law enforcement was focused on ‘Arrest your way out of the problem,’” said Baldrige. “We’ve learned very quickly that we cannot do that. It really takes a partnership.”
Baldrige credited the continued drop in overdose cases to more targeted law enforcement work that has been combined with medication-assisted treatment services by local health care providers, education efforts and the increased availability of Narcan.
When fentanyl overdoses spiked during the COVID-19 pandemic, the Sheriff’s Office formed an investigative unit known as the Fentanyl Crisis Response Team that was tasked with spearheading overdose-related investigations in unincorporated territory, but it primarily targeted dealers and traffickers. During the first 10 months of this year, the unit seized 1,237 grams of fentanyl, 693 grams of methamphetamine, 145 grams of heroin and 103 grams of cocaine.
The Sheriff’s Office also participates in at least two fentanyl overdose review groups that analyze each overdose from enforcement and treatment perspectives. This work includes collaborations with health and substance use disorder providers, outreach professionals and others to discuss current trends and identify any potential gaps in services.
“There’s a lot of factors and I think it takes a total team effort; (that’s) why we’ve seen that success.” said Baldrige.
Cause for concern
But not all trends are moving in the right direction. Ashlee Deherrera, a substance use navigator with Watsonville Community Hospital, said the hospital has experienced an increase in adolescents arriving at the emergency room with symptoms of Cannabinoid Hyperemesis Syndrome. The condition involves cyclical nausea, vomiting and abdominal pain typically after years of chronic cannabis use.
“I think that trend has been peaking and (we continue) to receive more presentations as time progresses,” said Deherrera.
Deherrera added that the hospital is working with local community partners to develop a streamlined treatment referral process and to potentially launch a pilot program meant to educate and engage directly with at-risk youth.
Several attendees online also asked about the use of kratom, an alkaloid derived from the Southeast Asian plant mitragyna. Kratom has opioid properties and has been used to treat opioid withdrawal, said Taylor. However, its active compound, 7-hydroxyitragynine, is 13 times more potent than morphine and, if abused, it can cause a fatal overdose.
Taylor said during the first 11 months of this year, there were two cases of deadly overdoses involving kratom that had been combined with at least one other illicit drug. In 2023, there were three fatal overdoses involving kratom alone and two more in 2024. Two health care providers at the meeting said they were actively treating patients that were addicted to kratom.
Because local retailers can sell kratom over the counter and the product faces little regulation at the federal, state or local level, county Supervisor Kim De Serpa proposed a ban on the sale of kratom throughout the county in October. However, the proposal was met by kratom advocates locally and across the country who praised it for its medicinal uses.
The ordinance, which sought to ban the sale of kratom entirely, was rejected by a majority of the board. But Baldrige, who helped De Serpa craft the proposal, said county staff received direction to revise the ordinance in such a way that it targets only concentrated forms of kratom. The ordinance has not yet returned to the board for review.
Accidental drug overdose deaths
2022: 98
2023: 133 (highest since at least 2014)
2024: 77
2025: 57 (through November)
*Data from Santa Cruz County Sheriff Coroner’s Office.