California’s Opioid Epidemic Needs Tougher Response

Originally posted at CalMatters.
By Dan Walters.

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 their patients’ pain, but overprescription, misuse by patients 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.

State medical authorities have made some efforts to curb abuse through advice and education for prescribers. However, the epidemic continues and the data indicate that through either stupidity or cupidity, too many are blithely prescribing 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 prescriptions for Vicodin for her family, even for relatively minor pains.

“If I had filled a prescription for each of these visits, which averaged one every two years, we would have a dangerously ample supply of the drug in our house, and our children’s brains would have had a disturbing level of repeated exposure to a highly addictive narcotic. It causes me to wonder how many Vicodin pills are on my street or in my children’s dormitories,” she wrote.

Even more disturbingly, she said that when medical providers offered Vicodin “not one of them or their staff asked if there were any issues of addiction in our family history … nor were risks and the impact of addictive substances on the adolescent brain discussed, even when I inquired about them and asked specific questions about risks.” Even if the prescribed drugs were not used “we should have it on hand in case the pain was bad,” she was told.

That’s pretty damning and a report from the state Department of Public Health underscores her concern.

“In the past, prescription opioids (such as hydrocodone, oxycodone, morphine and codeine) were prescribed for relieving short-term (acute) pain,” says the report by 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.”

It also points out that “one of the unintended consequences of this prescription drug epidemic has been the increase in heroin addiction and overdoses, in part due to the transition from prescription opioids to less expensive heroin street drugs.”

As a recent article in the Sacramento Bee pointed out, there are definite socioeconomic and geographic aspects to California’s version of the problem. Data reporter Jim Miller delved into official reports to reveal that overall, 15 percent of Californians were prescribed opioids in 2016, but the 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, but two of them – a measure creating a public awareness campaign and another 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 use and abuse of painkillers.

Brown, in rejecting the measure, acknowledged a “national epidemic that has been devastating for many California communities,” but described the bill as “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 for contributing to the epidemic.

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