A panel of local medical and law enforcement experts fighting the opioid epidemic in Sonoma County met in Healdsburg last week to discuss what they felt the region needed to do to protect residents from the full brunt of the epidemic.
Their message was clear: the wave of opioid addiction, which has devastated states like West Virginia, New Hampshire and Ohio, is rolling westward, and Sonoma County had better get ready, because as Dr. Walt Maack, a Healdsburg physician who lost his son to opioid addiction last year, said, “This is going to get worse before it gets better.”
The group had gathered for an event called “Confronting the Opioid Epidemic,” sponsored by the American Association of University Women. The evening included the screening of a PBS documentary, “Understanding the Opioid Epidemic,” as well as demonstrations of fentanyl detection strips and Narcan, a drug that can revive people who have overdosed on opioids. But the real meat of the evening was a panel discussion, featuring health policy expert Terry Leach; Dr. Maack and his wife Bretta Rambo; Healdsburg Chief of Police Kevin Burke; Dr. Gary Pace, a Sebastopol resident who is now the county health officer for Mendocino County; and Sarah Katz, chief epidemiologist for Sonoma County.
Sonoma County’s opioid epidemic by the numbers
Katz gave a presentation on the impact of opioids in Sonoma County that elecited gasps from the audience.
According to Katz, emergency department visits due to opioid overdoses (excluding heroin) in Sonoma County went up 50 percent between 2010 and 2017. There were 12 emergency room visits per 100,000 in 2010 versus 18 visits per 100,000 in 2017. She noted that Sonoma County’s rate of emergency room visits for opioids is 80 percent higher than the rate for California as a whole (10 per 100,000).
More troubling still, she said, was the rise in emergency room visits for drug overdoses among the young, which for the 20-24 year old group more than doubled between 2005-2014, going from 54 visits a year to 119 visits, an increase of 120 percent.
The number of emergency room visits for opioids was up 64 percent for 25-29 year olds and up 40 percent for teenagers aged 15-19.
The number of deaths from opioid overdoses has both increased and shifted younger, Katz said, with the death rate from opioids doubling for the 25-34 age group between 2005 to 2016. It also continued to rise for the 45-54 and 55-64-year-old age groups, though not as steeply. Deaths from opioids actually declined in the 35-44 year-old group over this time.
There were 62 unintentional drug overdose deaths per year from 2014-2016, Katz said. Thirty of these were due to opioids, according to the California Department of Public Health statistics.
That may not seem like much in a county with more than 500,000 people, but according to Katz, “It’s more than the number of people who die in automobile crashes in the county each year, and it is the leading cause of death among people, 20 to 50 years of age.”
She also gave the audience a peek at preliminary statistics for 2018. As of October 1, there were 50 drug overdose deaths in Sonoma County. Opioids have been implicated in 50 percent of those, with fentanyl specifically mentioned in most of them. (Methamphetamine was the runner-up, responsible for 25 fentanyl of overdose deaths).
The rise of fentanyl and the changing shape of the epidemic
The increasing involvement of fentanyl is a worrisome shift, according to Katz. Fentanyl is a powerful synthetic opioid that, according to the National Institute on Drug Abuse, is 50-100 times more powerful than morphine. Katz said the number of deaths involving fentanyl has been rising every year.
According to a public health advisory sent out in early August by the Sonoma County Office of Public Health, suspected accidental fentanyl-related deaths have more than quadrupled in Sonoma County since 2016. There were 12 fentanyl-related deaths in Sonoma County as of July 31; compared to just five in 2017 and three in 2016.
Fentanyl started appearing in illegal opioid drugs over the last few years, but according to several of the panelists, it’s now being added to other kinds of drugs as well.
“Right now, this is one of our biggest worries,” said Leach, one of the organizers of the event and a founding member of the Northern Sonoma County Harm Reduction Taskforce, a group working to stem the opioid epidemic.
“Yesterday we learned that two teenagers in Livermore died after taking Xanax, which was most likely laced with fentanyl. Livermore is not that far away from us. We need all of the Healdsburg community to understand that fentanyl is now appearing in otherwise somewhat ‘innocuous’ drugs.”
“You can lace a lot of different drugs with fentanyl, which is extremely dangerous, highly addictive, and so potent that it’s been feeding this exponential increase in overdoses in our community,” Police Chief Burke told event attendees.
In response, the Healdsburg Police Department and Healdsburg District Hospital have recently made fentanyl detection strips available for free, no questions asked. The strips are available in the lobby of the police department and in the emergency department of the hospital. (No other police department in Sonoma County currently offers fentanyl detection strips.)
Tackling over-prescription and the problem of unused medications
Leach, a health policy expert who works for Sonoma County, said the opioid epidemic needs to be fought on several fronts. The Northern Sonoma County Harm Reduction Taskforce, a volunteer organization of health professionals, is taking a four-pronged approach that includes talking to physicians, schools, law enforcement and the community.
“The first thing we’re doing is working with area clinicians to teach them about prescribing guidelines for opioids, because one of the ways this epidemic got started was through overprescribing opioids for pain,” Leach said.
How serious is the over-prescription problem in Sonoma County? In a county with 502,146 people, there were 399,240 legal prescriptions for opioid medications filled in 2017, according to the California Opioid Overdose Surveillance Dashboard, a website of the California Department of Public Health. That’s enough for one prescription for four out of every five people in the county.
In addition to tackling the issue of over-prescription of opioid pain-relievers by doctors, several panelists asked audience members to take a look at their own medicine cabinets, urging audience members to gather up old, unused or unfinished prescriptions and dispose of them at one of several drug disposal sites in Sonoma County (see sidebar). Doing so, they suggested, may save the life of someone you love.
“1 in 4 teenagers get started on the road to addiction by taking drugs from their parent’s medicine cabinet,” said Dr. Dave Anderson, a member of the taskforce who was in the audience.
Spreading the word about Suboxone and Narcan
Taskforce volunteers are also spreading the word to their fellow doctors about prescribing Suboxone, a medication that blunts the effects of opioid withdrawal, allowing people to start their recovery. “We are trying to get clinicians to prescribe Suboxone to individuals who want to end their addiction,” Leach said.
Dr. Pace said Suboxone doesn’t work for everyone: “It’s effective in about 50 percent of cases,” he said, “but for those for whom it does work, it gives them a real chance to reclaim their lives.”
Several panelists also talked about the importance of Narcan, a medication that can revive someone who has overdosed. Healdsburg Police Department recently became the fourth department in the county to train all of their officers in the use of Narcan.
(See our article “Police departments looking into opioid overdose remedy,” https://bit.ly/2y5Qxzg.)
Pace, who ran the Narcan training at the beginning of the evening, re-emphasized the importance of spreading the knowledge of how to use Narcan. “All first responders should carry it,” he said. “It should also be in schools and libraries and in home medicine cabinets, especially if someone in the family is struggling with opioid addiction.”
Narcan is available without prescription, and a box of two nasal sprayers costs roughly $75.
“I’d like to see as many residents trained in administering Narcan, as possible,” Leach said, noting that it’s a good public health measure, similar to mass civilian training in CPR.
Lessons for schools and the broader community
Besides working with doctors and law enforcement, Leach says the taskforce is also working to bring information about the opioid epidemic to schools and the broader community.
“We’ve identified an evidence-based curriculum called ‘Being Adept,’ that was developed in Marin County, which we would like to see adopted by junior highs and high schools throughout Sonoma County,” she said. This is the taskforce’s newest initiative, and they are just beginning to reach out to local schools in an attempt to interest them in the curriculum.
“The fourth element is raising community awareness, which includes reducing the stigma, and letting people know that this epidemic is with us, and we need to put programs in place now to get ahead of it. ” Leach said. “That’s what evenings like this are all about.”