Todd was 29 years old when he died alone, a needle in his arm, in an abandoned house 5 miles from where he grew up. His family lost hope about two years prior, after attempts to treat his heroin addiction failed due to a lack of programs that were able to provide medication to assist with withdrawal from the opioid.
Todd’s addiction began with his recreational use of his mother’s Vicodin as a teenager. When prescription pain medications became inaccessible, he turned to heroin.
Elizabeth had 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 pain medication she was taking and her caregiver did not have access to Narcan, which could have reversed the respiratory depression effects of those opioid medications.
Carrie was a mother of four when she died. The medical providers caring for her, and her various health conditions, failed to check her prescription history and discover a dangerous combination and duplication of controlled medications that cut her life short.
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Scenarios such as this play out daily across our nation and regularly in our Valley.
Prescription painkiller abuse is now one of the fastest-growing public health concerns in the United States, and the personal toll that opioid abuse takes on individuals, their friends and their families is alarming. Our Valley is no exception.
Deaths due to prescription painkiller overdoses currently outnumber deaths from motor vehicle accidents in this country, claiming an average of 46 lives every day. Between 2009 and 2013, there were 280 deaths related to opioid pharmaceuticals in Fresno County.
Misinformation with regard to treatment of chronic non-cancer pain, and aggressive marketing of newer, longer-acting opioids in the management of this pain, led to a quadrupling of sales of prescription painkillers from 1999 to 2013.
More frequent use of these substances (including Vicodin, OxyContin, Percocet, codeine, and morphine) over longer periods of time has resulted in a dramatic increase in rates of addiction and death due to overdose.
Because past use of prescription opioids is the strongest risk factor for heroin initiation and use, overuse of these prescription opioids has driven an only slightly less dramatic increase in deaths due to heroin overdose. Still, there is no evidence that chronic pain is better managed in this country today.
Locally, the strongest effort to date at curtailing this epidemic has been the Lock It Up program, offering outreach education to students and their parents regarding drugs and alcohol, and the Lock It Up, Clean It Out, Drop It Off program, which encourages, and provides information on, appropriate disposal of prescription medications.
To further address this growing problem in our region, a number of public health partners have come together to form the Central Valley Opioid Safety Coalition. This coalition will ultimately be composed 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 envisions adopting the three federally sponsored approaches to the opioid overdose epidemic:
▪ encouraging safe prescribing by providers
▪ increasing access to medication-assisted treatment of addiction
▪ increasing use and distribution of Narcan in the immediate treatment of overdose
The initial emphasis of the coalition will be on the safe prescribing of these medications, and will be predicated upon recent guidelines such as those issued by the Medical Board of California in November of 2014 and those issued by the Centers for Disease Control and Prevention in March of this year.
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.
The coalition is assisting local health care providers in adopting these new pain management guidelines, and utilizing these tools in their practice, by orchestrating an educational series, in three parts, given by recognized subject matter experts.
The first of these is Understanding Pain (scheduled for Sept. 21), followed by Management of Chronic Pain on Nov. 9, then Safe Prescribing on Jan. 18.
You can assist this effort to bring a halt to premature death from opioids in our community. Learn what you can about the dangers these medications pose. Carefully guard against their misuse, and effectively limit their access to others.
Ken Bird, M.D., is the public health officer for the Fresno County Department of Public Health.