The Opioid Epidemic

by Laura Welter

Opioid Fast Facts

• An opioid is any pain-relieving medication or drug that resembles morphine in its physiological or pharmacological effects.
• In 2015, opioid deaths in the U.S. reached 33,092, nearly 5,000 more than the year before.
• Each day, nearly 44 people die in the U.S. from an overdose of prescription pain killers.
• In 2013, more people age 25 – 64 died from drug overdoses than auto accidents.
• Workers Comp reported that with long-term opioid use, it was likely the injured person would never return to work.
• Chronic pain affects 100 million Americans annually. That is more than those with cancer, heart disease, and diabetes combined.
• After only two months, opioids usually stop working.
• Evidence is accumulating that addiction is a chronic disease like diabetes or hypertension.
• In July 2016, doctors in CA were required by the State to register for CURES – a prescription drug monitoring database that shows when, to whom, and how much narcotics are prescribed.
• In Mendocino County, all emergency departments have enacted safe prescribing guidelines for pain medications.

     In many rural counties across America, an opioid epidemic is quietly raging through communities. What begins as a prescription for pain relief after an injury can end in dependence or addiction. Mendocino County averages two deaths from unintentional prescription opioid overdose each month. That is, per capita, twice the state average.

     This month, the Safe Rx Mendocino Opioid Safety Coalition is providing information about opioid addiction in the context of other health problems that have been identified in the Mendocino County Community Health Improvement Project, or CHIP.  Priority areas include poverty, housing, mental health, and childhood trauma.

Opioid Addiction and Mental Health

     Addiction can result from a person’s attempt to self-treat a mental health problem. Perhaps their depression, anxiety, or bi-polar disorder has never been properly diagnosed. Or the stigma about seeking mental health counseling has prevented effective treatment from being prescribed. Turning to alcohol or other drugs is seen as a way to lessen distressing symptoms. It isn’t always clear which came first – the addiction or related psychiatric condition. They often evolve simultaneously, and reinforce each other. The result is a person with a “dual diagnosis.”

Opioid Addiction and Homelessness

     The National Alliance to End Homelessness released a fact sheet in 2016 that cited several studies that investigated opioid addiction in the homeless population. “While the opioid epidemic is notable for affecting people from any race, gender, socioeconomic status, or other identifier, its effects are felt in unique and notably harmful ways by people who are experiencing homelessness.” A survey by the U.S. Conference of Mayors found that 68 percent of cities reported that substance abuse was the largest cause of homelessness for single adults. Another study that looked at veterans found that the prevalence of homelessness in veterans with opioid use disorder is 10 times more than the general veteran population. Yet another study showed that homeless adults, age 25-44, were nine times more likely to die from an overdose than their counterparts who were stably housed. In addition, treatment barriers are more significant and complex when a homeless person is socially isolated, and lacking transportation and medical care.

Opioid Addiction and Poverty

     In her book, Unbroken Brain, author Maia Szalavitz states, “Addiction disproportionately kicks people who are already down.” She asserts that opioid addiction hits hardest for lower middle class, poor, and working class whites, who have “fallen prey to stagnating incomes, debt, job loss, foreclosure, and financial insecurity.”  Rural areas are especially hard hit. Research released in 2015 from Princeton economist Angus Deaton showed an unexpected jump in mortality rates among white Americans. This trend is blamed on the “diseases of despair” – alcoholism, suicide, and overdoses. That year, opioid deaths in the U.S. reached 33,092. 

Opioid Addiction and the Family

     Family members and close friends are deeply affected when a loved one is addicted to opioids.  Consequences that impact the non-users include added stress (the addict’s illness is heartbreaking to witness), an inability to control the family’s finances (bills go unpaid and job loss looms), relationship problems (many conversations revolve around the addict’s problems), and co-dependency (a loved one incorrectly believes they are helping the addicted person).

      An addicted parent is one of the adverse childhood experiences (ACES) that can affect a child for a lifetime. An article posted on the Narconon (drug treatment center) website, “How Children are Affected by Drug Addicted Parents” states, “While even just exposing children to dangerous and illegal drugs could easily be considered maltreatment, additional abuse or neglect may manifest in any of the following ways:

* Violence or verbal abuse resulting from being drunk or high
* Sexual abuse or behavior which makes a child feel uncomfortable
* Forcing a child to hide an adult’s drug abuse or alcoholism
* Consistently leaving a child alone at home
* Consistently ignoring a child or their needs; lack of attention”

When these additional ACES are present, the childhood trauma that results can lead to a lifetime of poor mental and physical health.

Local Efforts – Safe Rx Mendocino Opioid Safety Coalition

     Each year, more than 4,500 Californians die as a result of prescription opioid overdose. No wonder that diverse groups are forming all over the state in 31 counties to bring together the medical community, law enforcement, pharmacists, counselors, public health advocates, and health insurers to reverse this trend. The Safe Rx Mendocino Opioid Safety Coalition meets monthly, on the coast at the Fort Bragg Police Department, and inland at Public Health on South Dora Street in Ukiah.

     Complicated problems tend to require complicated solutions. Opioid addiction is one of those complicated problems that need to be addressed using a variety of approaches and resources. The Safe Rx Mendocino Opioid Safety Coalition is learning how its members can offer meaningful assistance to reverse the trend of ever increasing overdose deaths in our county. 

     The Safe Rx Mendocino Opioid Safety Coalition has several projects in the works, which can be seen on their website, www.saferxmendocino.com. The Coalition is making lock bags available to high risk populations to provide them with a safe place to store their prescription drugs. Medications that are left in plain sight are vulnerable to theft.  Storing medications in lock bags will deter this, and also prevent young children from accessing pills that to them might look like candy. On the coast, lock bags are available at the Fort Bragg Police Department, the Sherriff’s office, and by calling Jean at Public Health at 961-2453. Inland, they are available at the Arbor on Main Youth Resource Center in Ukiah, and at the Laytonville Heathy Start Family Resource Center.

     The Opioid Safety Coalition is also promoting increased availability of Naloxone, an opioid overdose reversal medication, in the form of a nasal inhaler, that has saved many lives. Law enforcement and other first responders in our county will soon be learning the protocol for Naloxone use. The Coalition is encouraging others as well, such as family members of those who use high doses of opioid medications, to ask their doctor about getting a prescription for Naloxone. Having it in the home may save a life.

     Drug Take-Back events to be held twice a year are being promoted by the Opioid Safety Coalition, providing people a chance to remove medications from their cabinets that they no longer use, and dispose of them at a safe location. This prevents the pills from ending up at a “Skittles party” in which teens raid their parents’ and grandparents’ medicine cabinets and dump the prescription and over-the-counter drugs they’ve gathered into a communal bowl. The teens then take handfuls of a random assortment of pills, often with alcohol, to get high. Currently there are several places in the county where pills can be safely disposed of at any time, including most police departments and sheriffs’ offices.

     In Humboldt County, the opioid safety coalition produced a booklet listing the many options available for alternative pain management therapies. Practitioner names, contact information, and payment method accepted are all included. This resource guide is useful for those wishing to reduce their dependence on opioids, and instead try acupuncture, massage, meditation, hypnotherapy, nutritional counseling, tai chi, yoga, or behavioral therapy/counseling. The coastal chapter of Safe Rx Mendocino is interested in creating a resource guide like this for Mendocino County.

     Finally, education is a key component of the efforts made by the Safe Rx Mendocino Opioid Safety Coalition. Last August, a panel discussion and community forum called Opioid Use and Abuse was presented at Fort Bragg’s Mendocino Coast Clinics. It can be viewed at  http://mendocinotv.com/2016/07/14/the-opioid-epidemic-what-does-our-community-need-to-know/ on the Mendocino TV website. Reaching young people with accurate information about the use and abuse of opioids is another ongoing goal of the coalition, to reverse the trend of increased overdose deaths.

     Another exciting development is that the County has received a grant for 4.5 years to do opioid prevention work focusing first on youth 12-25 years old and with underserved communities as well as the general population.

Sources of information for this article include the National Institute on Drug Abuse, the CA Health Care Foundation, the Journal of American Medical Association on Psychiatry, the State of CA Dept. of Justice, the UCLA Dual Diagnosis Program, Narconon.org website: How Children are Affected by Drug Addicted Parents, Opiate.com website: Effects of Opiate Addiction on the Family, Unbroken Brain – A Revolutionary New Way of Understanding Addiction by Maia Szalavitz.

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Laura Welter is the Executive Director of Safe Passage Family Resource Center in Fort Bragg, a Member of the Coalition for Gang Awareness and Prevention and Coast Opioid Coalition.