First, the number of accidental drug overdose deaths attributed to Marin County declined to 10 in 2014, the last year for which such mortality data are available. That is down from 27 accidental drug overdose deaths in 2012 and 2013.
Second, average narcotic prescription doses have dropped 41 percent since 2013 among Marin’s Medi-Cal population, according to Partnership HealthPlan of California, a managed care organization that contracts with the county of Marin to oversee the medical care of Marin’s Medi-Cal population.
But those leading the effort in Marin to curtail prescription drug abuse and prevent opioid overdose deaths in the county caution against complacency.
“It’s too early to celebrate,” Marin County Public Health Officer Dr. Matt Willis said in a statement. “We still see more deaths from overdoses than from motor vehicle accidents. One year of improvement isn’t enough to call this a trend.”
Mark Dale, who spearheaded the creation of a Marin County prescription drug abuse task force in 2013, said, “There really is still a lot to do.”
Dale said local statistics on overdose deaths may not capture all of the deaths that are occurring, because the coroner’s division of the Marin County Sheriff’s Office investigates far fewer than half of the deaths that occur each year. In addition, Dale said, Marin County college students who die of an overdose while away at college aren’t added to Marin’s totals.
In a report issued in December 2015, the federal Centers for Disease Control and Prevention reported that the United States is experiencing an epidemic of drug overdose deaths. The CDC said, “Since 2000, the rate of deaths from drug overdoses has increased 137 percent, including a 200 percent increase in the rate of overdose deaths involving opioids.”
According to the CDC report, past misuse of prescription opioids is the strongest risk factor for heroin use.
Drug task force
The impetus to form Marin’s prescription drug task force, which now operates under the name RxSafe Marin, came from parents whose children had been touched by the epidemic. Dale’s son has struggled with drug abuse, nearly dying after overdosing on dextromethorphan, a cough-suppressant contained in a variety of over-the-counter cold and cough medications.
Other active Marin parents, such as Ric Torchon and Britt Rosenmayr, have lost their sons to the epidemic. Jason Rosenmayr overdosed on heroin on Sept. 18, 2010, two days before his 25th birthday, after a struggle with an OxyContin addiction. Alec Torchon died of an overdose of Opana, a prescription opioid medication, on Dec. 1, 2012, at the age of 19.
Willis said when he joined the county at the end of 2012, he was shocked by the number of drug overdoses occurring in Marin. With the support of the Board of Supervisors, Willis expanded the task force into a countywide initiative that now includes the county Department of Health and Human Services, the District Attorney’s Office, the Public Defender’s Office, the county Office of Education, local pharmacists and health providers.
Timi Leslie, a Greenbrae health care consultant who serves as RxSafe Marin’s co-chair, said, “It’s so important that it has both public and private participants who have come together. It’s definitely serving as an example for other communities across the state as well as across the country.”
Willis said one of the factors contributing to the epidemic of opioid overdose deaths nationwide has been doctors’ well-intentioned but seemingly misguided effort to rid patients of all pain.
“We’re learning that we’ve created an epidemic of dependence and addiction to narcotic painkillers through that way of doing medicine over the past 15 years,” Willis said.
The number of narcotics prescribed in Marin County doubled between 2004 and 2014 and this increase was accompanied by an increase in narcotic-related emergency room visits, treatment admissions for narcotic addiction and overdose deaths.
In 2013, 412,356 prescriptions for controlled substances were issued in Marin County, enough medication to provide about 60 pills to every adult and child in Marin.
In an effort to reverse this trend, Willis sent out a set of new guidelines for treating chronic pain to Marin County prescribers and pharmacists in the fall of 2015.
One of the things that prescribers and pharmacists are advised to do is periodically check a state database of controlled substance prescriptions to ensure that patients aren’t obtaining multiple prescriptions for purposes of abuse. Prescribers are advised to carefully consider if doses above 100 mg per day of oral morphine or its equivalent are indicated.
“We know that mortality rates increase significantly when someone is being prescribed more than 100 mg per day of morphine,” Willis said.
He said one of the reasons for the decline in average narcotic prescription doses among Marin medical patients since 2013 has been Partnership Healthplan’s success in getting patients “off those super high doses.”
Dr. Robert Moore, Partnership Healthplan’s chief medical officer, said since 2013 there has been a 57 percent decline in the number of Marin Medi-Cal patients taking 120 mg of morphine a day or more.
Moore said major factors in reducing opioid use among Medi-Cal patients have been the education of doctors and pharmacists about the risks of over-prescribing opioids and the use of pharmacy benefit managers to monitor dispensation of painkillers.
“Our goal is not to have people who need this for bona fide pain to be denied their medication,” Moore said. “The goal is to get folks who are on unsafe doses, or escalating doses where there is no benefit, to stop that.”
Doctors now know that opioids lose their effectiveness when used over a prolonged period of time and can actually cause increased pain, a condition known as hyperalgesia.
The new guidelines also warn doctors about prescribing opioids to patients who are also taking sedatives, such as alcohol, benzodiazepines and antihistamines, since they increase the risk of over-sedation.
Willis said, “When we look at overdoses, we often see combinations of medicine present in the blood.”
The guidelines also urge prescribers to educate patients about how to store opioids securely and dispose of unused opioids. National Prescription Drug Take-Back Day is April 30. A list of locations that will be accepting unused medications is on the county’s website.