Doctors prescribed fewer opioids to local patients last year as legislators passed laws designed to fight rising overdose rates.
Doctors wrote about 1.5 million opioid prescriptions to Sacramento-area patients in 2018, down by about 180,000, or 11 percent, from the previous year, the latest figures from the California Department of Public Health show.
Age-adjusted prescription rates fell in all four of the region’s counties. They ranged from about 487 prescriptions per 1,000 residents in Yolo County to about 602 prescriptions per 1,000 residents in El Dorado County.
There were about 587 prescriptions per 1,000 Sacramento County residents last year. Rates peaked in 2010 when doctors wrote about 862 opioid prescriptions per 1,000 Sacramento County residents. Prescription rates have also fallen statewide.
The decrease in prescriptions is no surprise to most doctors, said Dr. Loni Jay, who oversees Marshall CARES, an opioid addiction clinic in El Dorado County.
Guidelines published by the Medical Board of California and the Centers for Disease Control and Prevention within the last five years have encouraged doctors to shift away from using opioids as a first- or even second-line treatment for chronic pain, or in postoperative care or emergency room settings.
“We’re recognizing the risk with opioid medication — how they’re useful tools, but also imperfect tools,” Jay said.
Despite the decline in opioid prescriptions, the number of opioid-related overdose deaths statewide rose from 2,194 in 2017 to 2,311 in 2018, preliminary data show, indicating that a large number of Californians remain addicted to opioids. The number of opioid overdose deaths in the Sacramento region fell from 91 in 2017 to 82 in 2018.
Risky and unnecessary opioid prescriptions were a major factor in opioid-related deaths nationwide, said UC Davis Health’s Dr. Stephen Henry. In 2016, 20 percent of deaths among adults aged 24-35 were associated with opioids, according to a study published last year.
The California state legislature passed a host of laws last year designed to prevent opioid over-prescriptions and overdoses. The laws focused on physician education, standardizing prescriptions, increasing access to an overdose antidote called Naloxone and bolstering the database that doctors use to record opioid prescriptions. The U.S. Congress also passed a detailed law meant to curb opioid addiction.
But Henry said “there has to be a balance” — reducing opioid over-prescription while also ensuring the relatively small number of patients who do need longterm or high-dose opioids can still get medication.
Moreover, treatment for opioid misuse or addiction is a “critical and complimentary” part of reducing overall opioid overdoses, Henry said.
Pain management techniques
At Marshall CARES, Jay frequently sees patients come in after arriving the previous day to the hospital’s emergency room suffering severe withdrawal symptoms. The clinic is able to quickly get patients stable on buprenorphine, a effective medication that treats opioid addiction
As clinicians try to reduce excessive opioid prescriptions, some patients experiencing chronic pain have been “cut off” by local providers, leaving them with no clear pathway to slowly and safely deescalate their dosage, she said.
“Some patients have been on opioids for 20 years,” Jay said. “They thought what they were taking was the right thing because their doctor said so, and in two months you take away something they’ve been stable on and they don’t have a plan for how to come to terms with that.”
In the Sacramento region, opioid prescription rates remain particularly high in parts of rural El Dorado and Placer Counties, as well as some socioeconomically-disadvantaged sections of urban Sacramento.
Henry said that as the rate of opioid prescriptions continues to decline, doctors must continue to find ways to improve access to alternative treatments for chronic pain — such as non-addictive pain medication, acupuncture or physical therapy — particularly in areas where prescription rates remain disproportionately high.
“Chronic pain is a major public health that is not going to go away,” he said. “It’s critical that patients who have developed problems are treated like other patients with chronic diseases rather than be stigmatized or shunted to the criminal justice system.”