In 2017, the California Opioid Overdose Surveillance Dashboard reports that 2,196 people died from an opioid overdose. There were over 20 million opioid prescriptions dispensed to California residents in 2017, and over 4,000 visits to California emergency departments (EDs) for an opioid overdose (not including heroin). Overall, opioid overdose rates in California are below national averages.
The National Institute on Drug Abuse (NIDA) publishes that the fatality rate of 4.9 deaths per 100,000 residents is much lower than the national average of 13.3 deaths per 100,000 people. California is a large and diverse state, and many counties within the state actually have opioid prescribing rates and overdose fatalities that are much higher than both state and national averages. Many rural counties are underserved, and the lack of treatment resources contributes to the crisis.
In addition to prescription opioids, the synthetic and illicit drug fentanyl has become an issue. Heroin is also a drug of concern in California.
Statewide, many measures are being taken to increase awareness on the dangers that opioid drugs pose, to regulate prescribing patterns, and to increase access to treatment. Ultimately, the goal is to expand treatment and recovery resources for all residents of California.
Treatment for opioid abuse and addiction in the state of California is managed through individual county mental health departments, which are overseen by the California Health and Human Services Agency (CHHS). There are many treatment resources for Californians.
➢ California Department of Public Health: They feature a local health care services directory.
➢ Behavioral Health Treatment Services Locator: The Substance Use and Mental Health Services Administration (SAMHSA) operates a national directory that can be used to find local treatment services by zip code.
➢ Substance Use Disorder County Access Lines: This page lists offices and local health services directory by county.
➢ California Health Advocates: This nonprofit organization provides information on Medi-Cal and how to use it for treatment services.
➢ California Health Care Foundation (CHCF): This group advocates for low-income residents, helping Californians gain access to health care.
➢ Medi-Cal Member and Provider Helpline: This offers information for Medi-Cal beneficiaries.
➢ Whole Person Care (WPC) pilot sites: This group hosts information on the 25 pilot sites in California that provide comprehensive behavioral health care for Medi-Cal beneficiaries.
➢ California Hispanic Commission on Alcohol and Drug Abuse (CHCADA): This group advocates for Hispanic residents and offers outpatient drug rehab services.
➢ SHIELDS for Families: This organization features services and resources for southern Los Angeles residents.
➢ Department of Managed Health Care: This group offers help for those applying for, enrolling in, and using managed care Medi-Cal services.
➢ Humboldt Area Center for Harm Reduction (HACHR): This organization provides a clean needle exchange program for local residents.
➢ California Opioid Safety Network: This collection of local coalitions promotes safe opioid prescribing patterns, increased access to naloxone, and expanded medication-assisted treatment (MAT) services.
➢ California Hub and Spoke System: A component of the California MAT Expansion, this interactive map of Hubs shows locations of Spokes in California. The goal is to increase access to MAT throughout the state.
➢ California Society of Addiction Medicine (CSAM): CSAM advocates for and improves policy surrounding addiction treatment medicine and options in California.
➢ Community Alliances for Drug-Free Youth (CADFY): This group promotes drug-free communities and prevention efforts for California youth.
➢ Emergency Department (ED) MAT Bridge Program: This organization expands opioid addiction treatment by addressing the treatment “gap” often formed between ED visits related to an opioid overdose and treatment admission.
Even though California opioid indicators are lower statewide than national averages and than many other states that have been hit particularly hard by the opioid epidemic, several counties in California report much higher overdose and opioid abuse rates. The San Diego Union-Tribune reports the top five California county opioid overdose rates in 2016.
1. Inyo County: 22.9 deaths per 100,000 residents
2. Humboldt County: 22.4 deaths per 100,000 residents
3. Lassen County: 17.8 deaths per 100,000 residents
4. Mendocino County: 17.3 deaths per 100,000 residents
5. Siskiyou County: 17.1 deaths per 100,000 residents
The northern coast of California is largely rural and has a hefty population of homeless residents, many of whom struggle with heroin addiction, per The New York Times. These communities often face extreme barriers to treatment, including financial hardship, homeless status, less access to treatment, and fewer local options.
According to the California Strategic Plan, the rate of opioid prescriptions per resident exceeded national averages in 36 of California’s 58 counties. Opioid prescription rates are highest in rural Northern California counties as is past-year nonmedical use of prescription medications. These rural Northern California counties include Shasta, Mendocino, Lake, Humboldt, Tuolumne, and Plumas.
Central and southern rural regions of California are also struggling with the opioid epidemic. The Center for Health Journalism publishes that several zip codes in the San Joaquin Valley report opioid prescription and overdose rates higher than state averages. Kern County, which contains the city of Bakersfield, saw a 30 percent jump in opioid overdoses between 2016 and 2017. These rural communities often have fewer treatment options and services, which compounds the issue.
As prescription opioids have become harder to get and more closely monitored, heroin and illicit opioids have become more in demand. The plant-based opiate heroin is often cheaper and easier to get than prescription drugs in many cases. Heroin is a powerful drug that is regularly injected.
In California, most of the heroin comes up from Mexico in the form of black-tar heroin, which may be less desirable to people switching from prescription opioid pills than the white powder form that is typically found on the East Coast. Black tar heroin is harder to lace with the synthetic and man-made drug fentanyl than powdered heroin; however, this does not seem to be stopping fentanyl from making its way into the California illicit drug market.
Methamphetamine, another drug commonly injected, has long been an issue in rural and Northern California. In recent years, The New York Times reports that heroin use in these communities has exploded. It may be an easy switch to go from one injection drug to another.
In Humboldt County, and the city of Eureka, much of the heroin use is related to the large homeless population, a particularly vulnerable population that is often underserved. The opioid overdose death rate is five times higher in Humboldt County than the California state average.
Fentanyl is made in illegal labs, often coming from chemicals sold in China that are shipped to Mexico and manufactured into fentanyl. It is then brought up across the southwestern border into Southern California and then spread throughout the state and country.
Fentanyl is extreme potent, highly addictive, and very deadly. Deaths related to fentanyl have skyrocketed around the country and also in California, where it may be found in methamphetamine and cocaine as well as laced into heroin and counterfeit prescription pills.
The San Francisco Chronicle reports that the number of California residents who died from a fentanyl-related overdose in 2016 (373 deaths) was quadruple the amount of fatalities from 2013 and the highest number of deaths involving fentanyl ever recorded in California. Fentanyl-involved overdoses doubled from 2016 to 2017, the Sacramento Bee publishes, as two out of every ten drug overdose deaths involved the powerful opioid.
Fentanyl is more potent and powerful than most other opiates. It is often used to cut other drugs, unbeknownst to the person taking it. Since fentanyl is cheap, fairly easy to make, and does not rely on a plant or environmental factors to be manufactured, it is commonly making its way into the drug supply, often with tragic results. Fentanyl and heroin are driving the opioid overdose numbers up in California in recent years.
Prescription opioids started flooding the market in the United States in the late 1990s with claims of pain reduction with few side effects, including addiction. Thousands upon thousands of Americans were subsequently hooked as it turns out that these drugs are indeed highly addictive. NIDA publishes that around a quarter of people prescribed opioids for chronic pain misuse them, and about 10 percent will struggle from an opioid use disorder.
In California, CHCF is striving to reduce opioid overdose deaths by 20 percent by the year 2020. They aim to do this by advocating for safer opioid prescribing practices and expanded access to opioid treatment resources.
The California Prescription Drug Monitoring Program (PDMP) Controlled Substance Utilization Review and Utilization and Evaluation System (CURES 2.0) has been in place since 1997, making California one of the first states to establish a system to track the prescriptions of controlled substances. Up until October 2018, reporting was not mandatory for prescribers. Today, prescribers are required to report the dispensing of opioid painkillers, which can help to prevent doctor shopping and other potential misuse of these addictive substances.
Opioids have traditionally been overprescribed on reservations and within tribal communities. Capital Public Radio publishes that some of the $90 million California received in federal funding in 2017 has gone to the Tribal Medication Assisted Treatment Program to increase MAT options and access to buprenorphine. Buprenorphine is a partial opioid agonist medication that can be helpful in treating opioid addiction.
Funding from the SAMHSA State Targeted Response (STR) grant goes to the California Medication Assisted Treatment Expansion Project, which helps to minimize unmet treatment needs across California while increasing MAT options and expanding naloxone access and utilization. Naloxone is an opioid-overdose reversal drug that the San Francisco Chronicle reports is now available in California to all residents who need it via a standing order. This makes it available at local pharmacies without a prescription.
California also has a Good Samaritan law that protects residents from drug-related criminal charges if they report, or attempt to revive, someone suffering from an opioid overdose.
In fall 2018, several bills, including SB 823, took aim at improving the landscape of addiction treatment in California, per the Orange County Register. SB 823 requires that licensed drug treatment facilities in the Golden State adopt the evidence-based treatment criteria laid out by the American Society of Addiction Medicine (ASAM) in an attempt to regulate and improve care. The pilot program, Drug Medi-Cal Organized Delivery System, ensures that all California residents have access to quality substance abuse treatment.
California addiction treatment options are continuously expanding and improving. They offer residents a wide continuum of care and many choices for treatment and recovery support.