By Ken Bird, M.D., M.P.H

Todd was 29 years old when he died alone, with a needle in his arm, in an abandoned house five miles from where he grew up.

His family deserted him about two years prior, after several attempts to treat his heroin addiction failed due to a lack of programs that included medication to assist with withdrawal from the opioid. His addiction began with recreational use of his mother’s Vicodin as a teenager. When prescription medications became inaccessible he turned to heroin.

Elizabeth had early dementia and a variety of other chronic illnesses causing her a great deal of persistent pain.

She died when she lost track of the amount of prescription pain medication she was taking. Her caregiver did not have access to the naloxone that could have reversed the respiratory depression effects of those opioid medications.

Geri was a mother of four when she died because the medical providers caring for her for different conditions failed to check her prescription history and discover the opioid/benzodiazepine combination that cut her life short.

Fresno County Death Rate Twice State Average

Prescription painkiller abuse is now one of the fastest growing public health concerns in the U.S. Annual deaths due to prescription painkiller overdoses outnumber deaths from motor vehicle accidents. The personal toll that opioid abuse takes on individuals, their friends, and their families is alarming.

Misinformation with regard to treatment of chronic non-cancer pain and the addiction potential of these medications, along with aggressive marketing of newer, longer-acting opioids in the management of this pain, led to a quadrupling of sales of these prescription painkillers from 1999 to 2013.

While Fresno County is somewhat less impacted by this epidemic than are many areas in the nation and the state, we ranked 14th among California counties in deaths related to opioid pharmaceuticals, at double the state average, in 2014.

To address the epidemic, public health partners have formed the Central Valley Opioid Safety Coalition. This coalition is comprised of representatives from hospitals, clinics, health plans, the medical society, pharmacies, law enforcement, addiction treatment centers, Fresno County Department of Public Health, Fresno County Department of Behavioral Health, and other community groups.

The coalition is involved in critical approaches to the opioid epidemic. They are:

  1. Encouraging safe prescribing by providers.
  2. Increasing use and distribution of naloxone in the immediate treatment of overdose.
  3. Educational outreach to all segments of the public on the dangers, proper use, proper storage, and proper disposal of opioid medications.

Tools to Reduce Opioid Abuse

Safe prescribing of these medications is predicated upon recent guidelines, especially those issued by the Medical Board of California in November of 2014 and those issued by the CDC in March 2016.

Key elements of these guidelines are the consideration of other pharmaceutical and non-pharmaceutical options in the treatment of chronic pain, careful assessment of the risk, versus the benefit of treatment with opioid medication if it is used, and close monitoring of patient dosage and usage, especially through the California Prescription Drug Monitoring Program’s Controlled Substance Utilization Review and Evaluation System.

This tool allows a healthcare provider to acquire a Patient Activity Report detailing all of a patient’s opioid (or other scheduled) drug prescription activity over the prior year.

Naloxone is an easy-to-administer medication that rapidly reverses the respiratory depression that occurs with the overdose of any opioid drug or medication.

It is essential that loved ones or caregivers that are in regular contact with individuals addicted to opioids or that that take high doses of opioid medications for long periods of time have naloxone readily available and know how, and when, to administer it to prevent overdose death. The medication should be available from a pharmacist by prescription and is covered by Medi-Cal.

Our entire population should be familiar with all the information presented here and a campaign to effect that is in the making.

Lastly, no effort to end this epidemic would be complete without work toward making medication-assisted treatment of opioid addiction readily accessible, and CVOSC will be working to help assure this in our community.

Dr. Ken Bird is Fresno County Health Officer, Fresno County Department of Health

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