And these days, fentanyl is front and center.
As COVID cases dwindle, Fresno County health director Dr. Rais Vohra has his eyes on a growing problem, possibly made worse by the pandemic.
"The biggest threat to health in Fresno County is no longer COVID," he said. "It's substance use."
Dr. Vohra says the new pandemic is drugs and the problem deserves the same level of community response.
DA Lisa Smittcamp says fentanyl is highly addictive and deadly.— Corin Hoggard (@corinhoggard) June 4, 2021
We know Fresno County recorded fentanyl-related 35 overdose deaths last year after 15 in 2019 and two in 2018.
In 2021, the county is on pace for 38.
(Meth contributed to 148 overdose deaths in 2020, up from 91.)
10-15 possible fentanyl cases still pending toxicology, according to @fresnosheriff Assistant Sheriff John Zanoni.— Corin Hoggard (@corinhoggard) June 4, 2021
Fresno County District attorney Lisa Smittcamp says everyone needs to pay attention.
"Stop saying 'It's not going to happen to me. It's not going to happen to my family. It's not going to happen to my kids'," she said.
Drug overdoses have increased drastically over the last few years - from 123 in 2018 to 146 in 2019 and 240 in 2020.
Methamphetamine is the number one overdose drug, involved in more than half of deaths.
But fentanyl is moving up the list fast - from contributing to two deaths in 2018 to 15 in 2019 and 35 last year.
And as assistant sheriff John Zanoni says, those numbers aren't just statistics.
"They're someone's daughter, someone's son, someone's dad, someone's uncle, someone's grandparent," Zanoni said. "They are a person."
The aim of a press conference Friday was to raise awareness and discourage kids from taking the types of pills some of them can access pretty easily now.
Smittcamp says the pills they might think are opioids from a pharmacist are often made in Chinese pill mills.
The DEA says fentanyl is cheap for drug cartels to move, so they can sell a laced pill for $5 now when purer pills might've cost $20 a few years ago.
And even though very few of the overdose deaths have killed teens, county behavioral health director Dawan Utecht says it's important to focus on them.
She says teenagers and young adults are at an age when they haven't developed the tools and resilience to deal with the impact on their brains and bodies.
"If we can impact these early years, we have our best chance to stave off lifelong addiction," Utecht said.
So leaders in law enforcement, education, and public health say they're desperate to stop opioid use before it starts and to give kids already using drugs a chance to stop.
Fresno County superintendent of schools Jim Yovino spoke at length about getting people on board with the effort and shared his talking points on a small notecard.
It included just a single exclamation: "HELP!"
Yovino's county office of education is establishing a couple of websites - All4Youth, which isn't ready yet, and Help Me Grow - with resources so parents and fellow students can intervene.