Prescription drug abuse is a national epidemic and Marin County has been deeply affected.

RxSafe Marin is a broad-based community coalition dedicated to reducing harm from prescription drug abuse and saving lives. 

The RxSafe Marin Report Card shows information from multiple datasets to gain a broad perspective of the impact of prescription drug misuse and abuse on our community. The elements displayed here were selected by members of the RxSafe Marin Data Team to describe the scale and scope of prescription drug misuse and abuse in Marin County, inform strategy, and track progress. The data have limitations and there may be alternate explanations for these findings.  

Drug Overdose Deaths

We've lost too many people to this epidemic. So many families have been deeply affected by drug misuse. I almost lost my son to this.

Mark Dale
Founder, Marin County Prescription Drug Abuse Task Force
RxSafe Marin Law Enforcement Action Team

*Note: Data for 2020 are provisional and may not be complete.

A central goal of RxSafe Marin is to reduce fatalities due to prescription drug misuse.  Drug overdose deaths should also be viewed as the tip of the iceberg in terms of harms caused by drugs to the community. 

The Centers for Disease Control and Prevention (CDC) estimated that nationwide, for every one death from prescription painkillers, there are 130 people who abuse painkillers and 825 people who are non-medical users. [1] 

Approximately 75% of overdose deaths in Marin County are accidental.  

Note that data presented on the left include overdose from all drug types.  Nationwide, fentanyl is now the drug most frequently involved in overdose deaths. [2]  

Additional information on opioid activity statewide can be found in the California Opioid Overdose Surveillance Dashboard

Opioid Overdoses

*Note: Not all overdoses that involve opioids are reported, and may not be represented in chart below.  Data below do not include poisoning and other physical and mental health injuries where the opioid use was part of the subsequent diagnoses. While the emergency department visits counted here result from misuse, they can also result from opioid use as directed by a prescriber.  

The Centers for Disease Control and Prevention (CDC) reports that in 2011, drug misuse and abuse caused about 2.5 million emergency department (ED) visits. Of these, more than 1.4 million ED visits were related to pharmaceuticals. [3]  

In the United States, prescription opioid abuse costs were about $55.7 billion in 2007.  Of this amount, 46% was attributable to workplace costs (e.g., lost productivity), 45% to healthcare costs (e.g., abuse treatment), and 9% to criminal justice costs. [4]  

The chart on the left shows that while the number of Emergency Department (ED) visits due to opioid overdose (excluding heroin) has remained relatively stable, the number of ED visits due to heroin overdose has more than doubled in the past five years.  

Additional information on what is happening statewide can be found in the California Opioid Overdose Surveillance Dashboard

Student Pharmaceutical Misuse

The School Board realized that we had a growing problem with prescription drug abuse among our kids. There are stories of pill parties, where kids would raid the medicine cabinet, throw all the pills they found in a bowl, and just start taking them and see what kind of effect they would have.

Greg Knell
Trustee, San Rafael City Schools Board of Education
RxSafe Marin Community-based Prevention Action Team

Preventing health-risk behaviors among adolescents is a public health priority.  Prescription pain medication and other drug misuse in high school students can lead to impaired learning, decision-making, and poor health outcomes--including addiction and overdoses.[5] 

This indicator, self-report of drug use, is from a statewide survey administered in public schools in collaboration with the California Department of Education.  The question asks: "During your life, how many times have you used the following substances? (Prescription pain medications [opioids], tranquilizers, or sedatives"[6]  Additional information about the California Healthy Kids Survey, and findings can be found here.  Over the last three survey periods we have seen a decrease in the percent of eleventh grade students reporting use of lifetime prescription pain medication.  


Morphine Milligram Equivalent (MME) per Resident

Years ago, we were being told that clinicians were not taking pain seriously enough. Fast forward ten years - we have this epidemic of prescription drug abuse. Now we're looking in reverse, seeing that maybe we went too far.

Babak Ettekal, MD
Site Director, Marin Community Clinic
RxSafe Marin Prescribers and Pharmacists Action Team

The amount of narcotic prescriptions in a community can be used as a proxy for the amount of narcotics available for misuse.  Some opioid medications are more potent than others. To accurately measure the total community burden of narcotics it is important to look at both the potency and quantity of prescribed opioids.  

Morphine Milligram Equivalent (MME) is a standard that allows us to compare the potency of different prescription opioids.  In 2016, RxSafe Marin established the SMART goal of reducing opioid prescriptions by 15% in two years.  That goal was met, with a 28% reduction in opioid prescriptions. 

Tracking the total MME per resident per year allows us to see trends in opioid prescription burden, or the negative health impacts, over time.  Additional detail can be found in the California Opioid Overdose Surveillance Dashboard.

High Dose (≥90 MME) Opioid Prescriptions

ER visits, hospitalizations, deaths due to overdose, and addiction are just the tip of the iceberg. Underneath all of that is the severe quality of life that individuals on high-dose opioids experience.

Marshall Kubota, MD
Regional Medical Director, Partnership Health Plan
RxSafe Marin Data Collection & Monitoring Action Teams

The CDC recommends that clinicians should avoid prescribing more than 90 MME per day due to the increased risk of death, misuse, and abuse associated with taking high dose opioids. [6]  

Tracking the number of high dose prescriptions per year allows for communities to identify and address risky prescribing patterns. 

Reducing the number of individuals on high dose prescriptions supports the SMART goal of reducing the number of opioids prescribed.   The chart on left shows that there was a 28% reduction in high dose prescriptions between 2016 and 2018. 

Additional detail can be found in the California Opioid Overdose Surveillance Dashboard.

Patient Activity Reports (PARs) generated by Marin Providers with CURES  

Clinicians who prescribe controlled substances are required to register with the California Controlled Substance Utilization Review and Evaluation System (CURES) and to review patient histories, called Patient Activity Reports (PARs) before prescribing controlled substances. 

By actively reviewing PARs, prescribers and pharmacists can limit harmful drug combinations, and prevent "doctor shopping".  Prescribers and pharmacists can view all controlled substances prescribed to any of their patients and can identify and communicate with other colleagues caring for a patient who is receiving medications from multiple sources.  

November 2009 was the first time a Marin county user generated a PAR.  Since then, RxSafe Marin has partnered with community providers and pharmacies to support widespread use of the CURES system to keep our communities safe.

Additional information about the CURES system, can be found here.

Pounds of Safely Disposed Medications

We lock up our guns. If you can $80 a pill for Oxycontin, why don't we lock up or properly dispose of our narcotics?

Fred Mayer, RPh, MPH
President, Pharmacists Planning Services, Inc.
RxSafe Marin Prescribers and Pharmacists Action Team

Almost all prescription drugs involved in overdoses come from prescriptions originally; very few come from pharmacy theft.  The amount of unused prescription medication in a population contributes to drug abuse, diversion and overdoses.  In the U.S., 55% of people who abuse prescription painkillers got them from a friend or  relative. [7]  



Drug take backs provide the opportunity to properly dispose of unused prescription medication on a biannual basis.  

The Marin County Environmental Health Services is the designated local enforcement agency (EA) implementing the medical waste program in Marin County in accordance with the Medical Waste Management Act where the community can dispose of medical waste year-round.  Additional information on the program can be found in the Med-Project website.  


Drug Possession Cases

Assigning responsibility and intervening when prescription drugs are misused is often difficult.  The complex legal and enforcement challenges related to drug diversion - the use of legally prescribed drugs for unintended or unlawful purposes - can best be addressed by establishing protocols to efficiently identify the sources of prescription drugs, establish a non-punitive mechanism to notify associated prescribers, and reduce availability for misuse and abuse. 

There used to be stigma about taking prescription drugs, and now it's almost the opposite. It's not going out and just drinking anymore, now it's going out and taking Xanax along with drinking.

Officer Andrew Barclay
Public Information Officer, Highway Patrol
RxSafe Marin Law Enforcement Action Team

The number of drug possession cases shows how prescription drug misuse interacts with law enforcement.   

This measure reflects both the prevalence of prescription drug diversion and the local law enforcement effort to control the problem.  

Note that these data reflect possessions of prescription drugs as well as some illicit drugs, including cocaine and methamphetamine.

Naloxone Doses Administered by Emergency Medical Services

A non-fatal opioid overdose is a strong predictor of a fatal overdose.  Furthermore, patients may be more receptive to substance use interventions in the immediate aftermath of an overdose.    

In May 2018, the Marin County Department of Health & Human Services (HHS) implemented a new system to help identify and connect survivors of an opioid overdose with substance abuse treatment.   

Tracking the number of EMS calls involving potential opioid overdoses helps us assess need in the county.  The graph in this section represent all EMS calls suspected to involve an opioid overdose in patients 18 years and older, since the implementation of the pilot program. Counts include fatal overdose cases as well as other patients that may be ineligible for outreach (e.g., prison inmate).

Additional information on this project can be found here.


Total Adult Treatment Admissions

Misuse and abuse of prescription drugs costs the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs, and currently only one in 10 Americans with a substance abuse disorder receives treatment. [8]  

This indicator shows adult treatment and detoxification admissions by county-contracted providers and providers with Drug Medi-Cal certification. The graph also shows the proportion of admissions due to opioids, including heroin. Most new heroin users initially abused prescription narcotics before transitioning to heroin. [9]

Buprenorphine Prescriptions Rates

Tracking buprenorphine prescriptions can be a proxy for tracking the use of medication assisted therapy (MAT) in our community.  Buprenorphine is used in MAT to treat opioid addiction. Unlike methadone, which requires administration in a controlled clinical setting, buprenorphine can be prescribed by authorized physicians in various settings, including in an office, community hospital, health department, or correctional facility. [10]   

The goal is to not get anybody else on the high doses of opioids. We're hoping that with the right strategies, less people than ever will get to those high levels. People should not only be supported but also have access to treatment.

Lynn Scuri
Regional Director, Partnership Health Plan
RxSafe Marin Data Collection & Monitoring Action Teams

Action Teams

Sources

1. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

2. Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018

3.  Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2013. Available from URL: http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm3.

4. National Institute on Drug Abuse.  Understanding Drug Use and Addiction.  https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

5.  Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, and Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Medicine 2011; 12: 657-667

6. California Healthy Kids Survey, 2013-14, 2015-16, 2017-18: Main Report. San Francisco: WestEd Health & Human Development Program for the California Department of Education.

7. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain -- United States, 2016. MMWR, Vol. 65, No. 1. 18 March 2016.

8. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

9. Trust for America. http://healthyamericans.org/reports/drugabuse2013/. Accessed June 13, 2014.

10. Substance Abuse and Mental Health Services Administration, SAMSHA.  https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine Accessed February 27, 2019.