MONTEREY COUNTYOPIOID SAFETY DATA REPORT:
Preventing Opioid Overdose Deaths and Managing Pain Safely
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Since the late 1990's, opioid use has skyrocketed across America. In 2014, 18,893 Americans died from prescription opioid overdoses—more deaths than any previous year, and more than quadruple the deaths in 1999. Almost no other major cause of death in America has increased so rapidly.
Those who lose their lives from opioid overdoses are not the only ones affected. The opioid epidemic hollows out families and communities. It presents a grim challenge to health care providers, to law enforcement, and to society as a whole.
This story examines opioid use in Monterey County, tracking data for the following indicators:
- How many opioids are being prescribed, and how are residents using the drugs?
- How many people die, or visit the ER, from opioid overdose or opioid complications?
- How quickly are officials adopting measures to counter opioid overdose, such as naloxone, and offering better access to addiction treatments, such as buprenorphine?
Video: April Rovero, executive director of the National Coalition Against Prescription Drug Abuse, speaks about the opioid crisis at a 2015 Fed-Up Rally in Washington, D.C.
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Overview of an Epidemic
What is an opioid?
Opioids are natural and synthetic forms of opium that are widely used as painkillers. Opioids include prescription medications, such as hydrocodone (Vicodin or Norco), oxycodone (Percocet or Oxycontin), fentanyl, codeine, morphine, and methadone. Since the 1990's, clinicians have prescribed opioids for more conditions, longer durations, and higher doses than at any other time in the past, largely due to misleading claims from pharmaceutical companies about the risks of harm and addiction.
The illegal drug heroin is also an opioid. As prescription opioid overuse has risen, so too has heroin addiction.
Source: CDC, 2015 Report (pdf)
California's Opioid Landscape
Opioid prescribing and overdose patterns vary widely among California's 58 counties, with the northern counties bearing the brunt of the epidemic. Certain parts of California have some of the highest opioid overdose death rates in the United States.
Hover or tap on a county to see its local data.
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Use the "Who is affected" and "Why does it matter" sections below to highlight personal stories from your community. Connect readers with someone touched directly by the crisis, such as a paramedic, a police officer, a parent, or a person in recovery from opioid addiction.
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See "Jason's Story" below as an example. You can simply replace the text, image, and quotation below with your own material.
Who is affected?
[SPOTLIGHT ON THE COMMUNITY] For many people in |County|, opioid overuse is not an abstract statistic. Jason was a drug- and alcohol-free high school athlete until he found himself hooked on the opioids he was prescribed after a car accident. He recovered—after 17 years of addiction to pain pills—and now gives talks to state officials and doctors about his experience.
What I learned was that doctors are encouraged to prescribe narcotic pain meds, but they don't understand how to help people stop the medications they encouraged and started.
Why does it matter?
The opioid epidemic may cost more than $70 billion dollars annually. This figure includes loss of workplace productivity and law enforcement costs related to diversion of drugs, as well as health care expenditures.
The epidemic is also taking its toll in local communities, like the cities and towns in Monterey County. And together we can address this epidemic, through coalition work, uniting providers, health plans, prescribers, law enforcement, and also public health advocates, treatment center workers, victims, and concerned citizens. Together we can change how pain is managed and still treat people in pain.
Opioid Use in Monterey County
The charts below show two bleak indicators of opioid overdoses: emergency department visits, and deaths.
Note: The charts throughout this section compare local county indicators (dark bars) with the same data for all of California (light bars.)
Tracking the quantity of prescription opioids in circulation.
Below, the left chart shows the number of opioid prescriptions per 1,000 residents. The right chart shows the total quantity of opioid medication taken each year, per resident. This quantity is measured in morphine milligram equivalents. (Potency varies among different types of opioids, so measuring in terms of their morphine equivalencies provides a consistent measure.)
Tracking prescriptions and dosage.
Another indicator of opioid overdose risk is the use of high doses. Opioid users taking higher doses are much more likely to die of accidental overdose. The chart on the right shows residents taking more than 100 morphine mg equivalents of opioid medication each day.
Likewise, people who take opioid medication for long periods of time, or who get prescriptions from several prescribers or pharmacies, are at higher risk. The two charts below track these risk factors.
Reducing opioid overdose deaths is an urgent health policy concern.
Two approaches have been proven to lower death rates: widespread access to an overdose antidote (naloxone), and addiction treatment with medication (e.g. buprenorphine).
Naloxone is a medication that immediately reverses the effects of opioids, preventing death in someone whose breathing has slowed or stopped due to opioids. Naloxone can be given by nasal spray or injection by a lay person with some basic training on its use. It is harmless if used accidentally. It can be furnished at a pharmacy without a prescription and can be dispensed to friends and family at community events. It can also be put in the hands of first responders, to make sure this life-saving medication is given in time. By the time someone gets to a hospital, it is often too late.
Buprenorphine is a medication used in the treatment of addiction or pain. It has been proven to dramatically lower the risk of death for people with addiction, compared to addiction treatment without medication. Only about 1 in 4 people with opioid addiction can stay sober without medication, but only 10-20% of people needing addiction treatment are able to find it. The measure of buprenorphine prescriptions per county is a way to understand how available treatment is to local people who need it.
Buprenorphine has been proven to dramatically lower the risk of overdose death for people with addiction, compared to addiction treatment without medication. Buprenorphine reduces normalcy to a chaotic lifestyle, reduces cravings and withdrawal symptoms, and reduces illicit drug use, criminal activity, and transmission of HIV and hepatitis C.
The data in this story come from two main sources:
Controlled Substance Utilization Review and Evaluation System (CURES), a database of Schedule II, III and IV controlled substance prescriptions dispensed in California.
The California Department of Public Health (CDPH), which provides access to public health data, including opioid-related death and emergency department statistics.