As the most populated state in America, California has not been immune to the effects of the opioid epidemic that has swept across the country. From the rich suburbs to the desert towns, Californian doctors are struggling to control a wave of overdoses that have been fueled by a black market of prescription medication and heroin. Statistics on opioid use in California reveal a troubling trend, but the medical community is rallying to turn a dire situation around.
Reaching California’s Shores
The New York Times calls it a “ripple” of drug overdose deaths that has spread across the country. It had its beginnings on the East Coast, in places like New Jersey (where many pharmaceutical companies have set up shop) and Appalachia, where blue collar workers are pressured to work through their on-the-job injuries in declining industries. But due to drug smuggling, the dark web, and massive pharmaceutical lobbies, the abuse and diversion of powerful prescription painkillers have made their way to California, bringing (and reviving) the heroin trade as well.
Bakersfield.com writes of how the opioid problem “is one of the worst healthcare crisis California has ever seen.” Even as the epidemic wreaks havoc on a national scale, California is being hit hard; hospitals in the state treat one heroin or prescription opioid overdose every 45 minutes. In 2014, California lost 4,521 of its residents to overdoses, the largest number of any state in America. In Bakersfield’s Kern County, 131 people lost their lives to opioids between 2011 and 201, and a further 1,112 were hospitalized.
In 2013, hospitals in the Golden State saw more than 11,500 patients who were admitted for heroin or other opioid overdoses, an increase of more than 50 percent since 2006. The Sacramento Bee equates that to one overdose every 45 minutes.
The problem is worse in the state’s rural regions. Hospitals in Shasta County (the 31st most populous of California’s 58 counties) saw more than 1,100 people overdose between 2006 and 2013, which is roughly eight overdoses per 10,000 people. That amount is three times that of the state’s average.
Similarly, other counties, like Sacramento, Placer, and El Dorado, have opioid overdose rates that are higher than the overall Californian average; only Yolo County came in with overdose rates that were lower.
Overdoses that resulted in emergency room visits and hospitalizations were also up, the Office of Statewide Health Planning and Development reported, between 2006 and 2013.
The Los Angeles Times writes of some efforts to turn back the tide. In the face of rising deaths from opioid overdoses (which have risen steadily in the last decade), the Controlled Substance Utilization Review and Evaluation System, or CURES, was created by Californian lawmakers to impose some controls over the rampant overprescription of narcotic painkillers. Pharmacists are required to enter into the database any customers who receive potentially addictive drugs; doctors, however, are not required to check the CURES database before they write a prescription.
A 2013 survey by the Substance Abuse and Mental Health Services Administration found that 66 percent of the people who abuse prescription medication hadn’t even received the drugs from their doctor; they either “borrowed” the pills from a friend or family member, stole them, or bought them online. Such people would not be in the CURES database, but doctors and pharmacists could nonetheless use the program to identify so-called “doctor shoppers”: people who go from doctor to doctor to procure prescriptions, and thus cut off one way controlled medication is diverted from its intended use.
Pill Mills in Los Angeles
California has a very good reason to be skeptical of a law that lightens restrictions on pharmaceutical companies. In a single week in September 2008, a pill mill in MacArthur Park in Los Angeles placed orders for 1,500 oxycodone painkillers, sold as OxyContin by Purdue Pharma – two of the most infamous names in the opioid crisis, and largely blamed for the start of the overprescription trend. That order – 1,5000 in a week – is more than legitimate pharmacies sold in a month. The next month, the doctor prescribed 11,000 pills; by December, she gave out more than 73,000, at a street value of almost $6 million.
In Connecticut, Purdue Pharma tracked the prescriptions, with a sales manager discovering that the MacArthur Park pharmacy was in cahoots with another pill mill out of Huntington Park. She asked her supervisors if Purdue should inform the DEA of what she called “an organized drug ring,” but Purdue quashed the inquiry and kept silent about the issue for several years, until the clinic was shut down and its leaders charged. When that finally happened, over 1 million OxyContin pills had found their way into the hands of organized crime rings and gangs.
The Los Angeles Times found that Purdue Pharma had “extensive evidence” that showed OxyContin was being illegally distributed in the two sites in California, but opted not to share the information with law enforcement. A former executive for the company told the Times that even when the company knew that pharmacists were selling pills to drug dealers, Purdue “did not stop supplying distributors selling to those stores.”
One of the rings that was on Purdue’s silent radar was in Monterey Park, represented by Judy Chu. The Center for Responsive Politics reports that Chu was a co-sponsor of the Ensuring Patient Access and Effective Drug Enforcement Act, and
has received contributions of over $31,000 from the pharmaceutical industry.
In a statement, Chu said she was “deeply concerned” about Purdue’s decision to not report diversionary practices to the government, but stood by her support for the new law, claiming that it would lead to “the guidance needed to end the prescription drug epidemic.”
Not all of California’s politicians are so amenable to the overtures of the pharmaceutical industry in their state. Two of the state’s congressmen, both members of the House Oversight and Government Reform Committee, called for a formal investigation of opioid manufacturers.
One of them, Mark DeSaulnier of Concord, is well aware of the prescription medication problem in California. As a senator in 2013, he was part of a law that improved the prescription monitoring program, which helped authorities identify and go after patients who shopped for doctors and physicians who prescribed beyond safety regulations. DaSaulnier told the Los Angeles Times that the reason behind his support for a congressional investigation was because Purdue Pharma seemed to be getting away with how it withheld information about pharmacists in collusion with criminals in California.
Only a Matter of Time
Complicating the problem is the fact that fentanyl is easy to produce, giving organized crime rings and Central and South American drug cartels an easy substitute for oxycodone or even heroin itself. At only $5 a pill, fentanyl is the newest wave of the opioid epidemic that has reached California. Like the victims of the crisis in towns and neighborhoods across America, the Californians who overdosed on fentanyl represented a crisscross of demographics: They were between the ages of 18 and 59, and evenly split by gender.
Los Angeles County saw fentanyl overdoses rise from 42 in 2011 to 62 in 2014. The spike is not as severe as that found on the East Coast, but the medical director of the LA County Department of Public Health’s Office of Substance Abuse Prevention and Control is nonetheless pessimistic. Speaking to the Los Angeles Times, Dr. Gary Tsai worries that “it’s only a matter of time” until Los Angeles County – at more than 10 million residents, the most populous county in the United States – will fall under the sway of the prescription opioid epidemic.
The director of a Sacramento-area needle exchange program says that her organization has been readying itself for the problems associated with fentanyl abuse. Users are at risk for lowered blood pressure, breathing, and heart rate, to the point of the body shutting down entirely, much quicker and more completely than with other opioids.
Stopping the Opioid Epidemic
Opioid trafficking in California is a big operation, whether conducted by drug cartels or individual criminals. But whoever is behind it, the victims are always the same: innocent people, some of whom have become desperate for opioids for their pain; others who misguidedly think that by getting high off legal substances, they can’t be doing themselves too much damage. Writing in the San Francisco Chronicle, a doctor says that it will require a concentrated effort to stop the trend of rampant opioid consumption.
Part of the problem comes from the medical community itself. In the mid-1990s, pharmaceutical manufacturers (like Purdue Pharma) embarked on a massive campaign to “liberalize the approach to pain management,” and certain doctors in the California Blue Shield network have showed “a casual approach to opioid prescribing.”
Blue Shield California has launched a program that has targeted the end of 2018 as the time by which the number of opioids prescribed to patients should drop by 50 percent. The plan is to help patients who are on high dosages to shift to reduced, safer dosages, and to provide patients who haven’t been prescribed opioids with alternatives. One example of an alternative might be medicinal marijuana, which was a suggestion put forward by a study out of the University of Georgia. In the 17 states (and the District of Columbia) that allow cannabis to be prescribed and dispensed for legitimate medical purposes, more than $165 million were saved on prescription drugs in 2013. The study found that there was a significantly reduced demand for opiates and other painkillers, all of which are potentially habit-forming.
The California Health Care Foundation is taking similar steps to curb the trend of opioid use (and abuse), such as investigating other treatment options, partnering with competing healthcare providers, and working closely with the Justice Department on improving the prescription medication database and getting more doctors to use it.
Paying the Price
For now, opioids remain the most prescribed medication in California, writes Business Insurance. Even as trends show that such drugs are being prescribed less, they remain the dominant painkillers in workers’ compensation programs, both in California and across the country.
In August 2016, to coincide with International Overdose Awareness Day (August 31st), the Obama administration announced the allocation of $53 million in grants, to help states implement policies to fight the opioid epidemic. The announcement came with a warning that even $53 million is a “fraction of the funding needed” to fully combat the crisis. California stands to receive $78 million over a two-year period.
Some of that money will be sent to drug court programs, like one in Sacramento County, where parents who complete mandated addiction treatment will be reunited with their children. A social worker told NPR that what the county is doing is a radical difference to how the judicial system used to handle cases of drug abuse: sending people to court and blaming them for their problems.
Now, by giving people the tools they need to recover – “support, medication-assisted treatment, and tough love” – there is the growing hope that treating opioid abuse (which has been blamed in some of the 80 percent of cases where Child Protective Services remove dependents from homes due to substance abuse) can reunite families.
There is cause for cautious optimism: The director of Sacramento’s Health and Human Services Department praised the drug court program, saying that this line of rehabilitation provides “the most effective motivation” she has ever seen, to help people overcome their addiction.
But, as with the state overall, much work remains to be done. The social worker told NPR that only 33 percent of parents (either single or still with their partner) complete Sacramento County’s drug court program. For many people, the physical rush of a drug hit is too difficult to overcome. “If these parents aren’t successful [in graduating from the program],” he says, “it’s the kids who pay the price.”