What happens to your brain on opioids
In what could be the first sign of a rising threat, public health officials estimated more than 5,000 Californians died from fatal drug overdoses last year. The number of reported deaths to the Centers for Disease Control and Prevention leaped by 5.3 percent, and officials say heroin and the powerful narcotic fentanyl is partly to blame.
The CDC’s figures outstripped previously reported numbers by the California Department of Public Health, which said there were 4,200 confirmed deaths at the end of the year. The CDC did not break down the cause by substance but the state’s data show that two out of every 10 cases involved fentanyl — a 50 percent jump from the year before.
The growth in drug overdose deaths alarmed some leaders in the state where many efforts to combat the opioid crisis are already underway. California, they say, hasn’t seen an overdose death problem like some places in the Midwest because programs like Medi-Cal and Covered California make it easier to get treatment.
Nationally, the number of reported cases grew by 6.3 percent and surged by double digits in some states like Nebraska, New Jersey and North Carolina. Nevertheless, advocates say the new figures present a challenge even if the scourge of opioid overdose deaths remains small in some pockets of the state.
Dr. Kelly Pfeifer, who leads the effort to combat opioids for the California Health Care Foundation, said fentanyl’s rapid arrival is like a warning shot that a deepening crisis could be on the horizon.
“Maybe we haven’t hit it yet but we’re getting there,” Pfeifer said. “The steepness of that fentanyl curve is terrifying because going up by 50 percent just in the last 12 months despite all our efforts is really a wake-up call for all of us.”
Public health department officials said the state and federal numbers vary because the agencies used different cutoff dates and the CDC counts everyone who died in the state and not just residents. Officials said the gap between the two figures should close once the state’s website is updated with new data.
There were 258 overdose deaths in the four-county Sacramento region last year and more than a quarter were attributed to opioids, according to the state’s figures. That is still a low point compared to 2014, when the tally reached 350 overdose deaths.
Some local health leaders were not as worried by the upward state trend. They said the death rates at the county and ZIP code levels could be misleading and often are not a sign of crisis.
Dr. Nancy Williams, the health officer in El Dorado County, said her department pays close attention to trends over time unless the number of overdose deaths is unexpectedly high. The ZIP code 95619 had an opioid overdose death rate more than three times that of the state but just a few deaths can skew the rate.
“For small populations like we generally have at the zip-code level, we determine significance by looking at trends over time rather than for a single year,” Williams said in an email. “Because that ZIP code population is small, even a single death results in a high rate for that year.”
The overdose death rate in the rural county has ticked up slowly in recent years, but in 2017 there were only 29 deaths and three where opioids were the cause. Placer County had 41 overdose deaths last year, but the number involving opioids — 17 — nearly doubled compared to the previous year.
“I would say Placer County has not been as impacted, certainly not by overdose deaths, as some other counties in the rural north have been. But we recognize that could change — and change pretty quickly,” said Rob Oldham, Placer County’s public health officer.
The state has moved in recent years to reduce opioid prescribing and increase the availability of the nasal spray Narcan that is used to revive someone experiencing an overdose. Increasing access to medication-assisted treatment in the form of methadone, buprenorphine and naltrexone has also been a key part of the strategy.
Pfeifer said the state is off to a good start but is still short of where it needs to be.
“There’s still huge gaps where there’s more demand for addiction treatment than there is available treatment, and we need to get to a place where it’s easier to get treatment than it is street drugs and we’re far from that,” she said.
This summer, the California Department of Health Care Services announced that 22 counties, including Placer County, were selected for a pilot program that would increase access to drug treatment in jails.
Research has shown that treating drug abuse in jail can reduce the risk of overdose. A study published earlier this year found overdose deaths of released inmates from could decline by as much as 85 percent if they are treated for abuse in jail.
Without such programs, inmates would have to experience sudden, painful withdrawals without the benefit of at least slowly tapering down.
Donna Strugar-Fritsch, a principal with the consultancy Health Management Associates in San Francisco, who is also leading the state’s initiative, said the state intended to attract 12 counties but received 23 applications.
“Treatment in a jail has a lot to offer. It’s a good time for people to reckon,” Strugar-Fritsch said. “It’s an opportunity to treat people in groups and the risk of death from overdose right after leaving jail or prison is extraordinarily high, and so providing treatment that will mitigate that risk from death is very important.”
Not many counties have established policies on in-custody drug treatment and often handle it on a case-by-case basis, Strugar-Fritsch said. But all the participating counties said they want more treatment.
“There’s a lot of interest but there are many barriers,” she said. “It’s very challenging to move from a desire to a practice.”