When Gov. Jerry Brown vetoed Assembly Bill 715 last week, he closed the book on even token legislative efforts to confront California’s epidemic of opioid abuse.
Last year, California doctors and dentists wrote 23.7 million prescriptions for opioids, supposedly to relieve patients’ pain. But overprescription, misuse and/or backchannel diversion of the drugs are rampant, and California recorded 1,966 opioid-related deaths last year, 44 percent more than its gun-related homicides.
The key to curbing the epidemic is to curb the eagerness of too many medical providers to write too many prescriptions without fully weighing the consequences.
State medical authorities have made some efforts to curb abuse through advice and education for prescribers. However, the data indicate that through stupidity or cupidity, too many still prescribe too many doses.
Last year, the Medical Board of California, which licenses physicians, published a first-person account of overprescription in its newsletter, written by a doctor’s wife. The anonymous author described how physicians and dentists repeatedly wrote Vicodin prescriptions for her family, even for relatively minor pains.
“Not one of them or their staff asked if there were any issues of addiction in our family history,” she wrote. “Nor were risks and the impact of addictive substances on the adolescent brain discussed, even when I inquired about them.” Instead she was told that even if the Vicodin was unused “we should have it on hand in case the pain was bad.”
That’s pretty damning. A state Department of Public Health study underscores her concern.
“In the past, prescription opioids (such as hydrocodone, oxycodone, morphine and codeine) were prescribed for relieving short-term (acute) pain,” reports the Statewide Opioid Safety Workgroup. “Today, they are increasingly being used to treat chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.”
“Unintended consequences,” it notes, include increased heroin addiction and overdoses as users move from prescription opioids to cheaper street drugs.
The Sacramento Bee’s Jim Miller found that 15 percent of Californians were prescribed opioids in 2016. Concentrations were heaviest in rural, low-income counties, topped by 27 percent of Lake County’s residents.
Three bills on opioids were introduced this year. Two – creating a public awareness campaign and levying a fee on opioid manufacturers for treatment and prevention – died before final votes.
The one survivor, AB 715 by Assemblyman Jim Wood, D-Healdsburg, a dentist and chairman of the Assembly Health Committee, would have directed the Department of Public Health to convene a panel of experts to study abuse of painkillers.
Brown, in rejecting the measure, acknowledged a “national epidemic that has been devastating,” but said the bill was “unnecessary” because the departmental working group was already established.
That’s probably true, but a more aggressive effort is still needed. The key to curbing the epidemic is to curb the eagerness of too many medical providers to write too many prescriptions without fully weighing the consequences.
They should face consequences themselves.
Dan Walters is a columnist at CALmatters. Reach him at firstname.lastname@example.org.