Pubdate: Sun, 17 Jul 2016
Source: Chico Enterprise-Record (CA)
Copyright: 2016 Chico Enterprise-Record
Note: Letters from newspaper's circulation area receive publishing priority
Author: Ashiah Scharaga


About this series

The nation is in the midst of a prescription opioid and heroin 
overdose epidemic. The Centers for Disease Control and Prevention 
estimates 44 people in the U.S. die every day from an overdose of 
prescription painkillers alone.

This series examines how the epidemic is affecting Butte County and 
how it will respond.

Today: How did Butte County end up with one of the worst drug-induced 
death rates in the state?

Tomorrow: A man who died from an alcohol and opioid overdose is 
remembered by his mother and a friend.

Those government statistics prove the scope of the drug problem, and 
Butte County is an epicenter. Butte County has the third-highest 
drug-induced death rate in the state among the 58 counties, according 
to the California Department of Public Health. Data from the county 
coroner's office reveals about 63 people die from drug-related deaths 
each year.

The problem is pervasive, with the nation in the midst of a 
prescription opioid and heroin overdose epidemic. In 2014, opioids 
were involved in 61 percent of all drug overdose deaths nationwide, 
according to the Centers for Disease Control and Prevention. Last 
year, 68 percent of drug-induced deaths in Butte County were opioid related.

Professionals in medicine, education and law enforcement speculate 
the reason why the death toll is so high in Butte County is complex, 
involving limited resources, childhood trauma and a historical push 
to prescribe painkillers.

Opioids, which are prescribed for pain relief, can be created 
synthetically or naturally from the resin of poppy plants. Opium was 
extracted from a species of poppy plant for the first time about 
4,000 B.C. in Mesopotamia.

Dr. Shawn Furst, Enloe Medical Center interventional pain management 
specialist and medical director of rehabilitation services, said when 
doctors prescribe opioid pills or patches, they're "basically 
prescribing something that's very chemically similar to heroin," and 
very addictive.

Prescription pain medications involved in the most overdose deaths 
include hydrocodone, known by the brand name Vicodin; oxycodone, 
known by the brand name OxyContin; and methadone, according to the CDC.

Most overdose deaths in the county in the last three years were 
caused by a lethal combination of opioids and other drugs. Some are 
accidental, caused by switching medications, taking too much or 
taking a lethal combination of opioids and benzodiazepines, which are 
sedative drugs prescribed to those with alcohol dependence, seizures, 
anxiety, panic and insomnia.

Pills can be accessed legally through prescriptions as well as 
illegally - through theft, unattended medicine cabinets, prescription 
holders selling pills and even the internet, according to Butte 
County Sheriff Kory Honea. Heroin makes its way to Butte County from 
Mexico. The Sheriff's Office has not found anyone processing opium locally.

Honea said there isn't "a stereotypical addict." County coroner's 
records, however, indicate the drug is claiming the lives of more and 
more people in their 50s, and mostly women.

"Addiction touches people of all walks of life," he said. "All ages, 
all genders and all backgrounds."

Dr. Asad Amir, Enloe Medical Center psychiatrist and addiction 
specialist, said patients risk developing tolerance to prescription 
opioids taken over time, just like they do with illicit drugs.

"As you keep taking these medications, the same dose over time may 
not have the same effect to relieve anxiety or pain," he said. "When 
tolerance develops, higher doses are needed to produce the same 
desired effects."

If a person becomes dependent, opioids will have to be taken daily to 
help them feel normal and keep withdrawals away, Furst said. 
Withdrawals can include increased pain, nausea, vomiting, tremors, 
sweating, irritability and diarrhea.

Dr. Alex Stalcup didn't imagine the nation would be in the midst of 
another opioid epidemic after his term as medical director of drug 
detoxification, treatment and aftercare at Haight Ashbury Free 
Clinics in San Francisco in the 1980s.

"These people walked around the streets one-half to two-thirds dead," 
he said. "I was traumatized by the whole epidemic. It's an 
unbelievably toxic drug. I thought we were leaving that behind."

Stalcup, now medical director of New Leaf Treatment Center in 
Lafayette, has worked with care providers in Butte County for years, 
providing insight in the realm of addiction medicine, his specialty.

"Here's this county full of wonderful people with good hearts and 
good values and despite that, it has some of the highest death rates 
and addiction rates," he said. "I don't get it. I never have got it."

The county, of course, is shaped by the history of opioid use and 
practices that have extended far beyond the region.

Traditionally, opioids were used as relief for acute pain, like pain 
experienced after surgeries, said Amir. In the 1990s, professional 
organizations like the American Pain Society and American Academy of 
Medicine spoke of the urgency of chronic pain treatment, calling it a 
"fifth vital sign" on par with blood pressure and pulse.

Prescription drug companies started pushing pain medications on drug 
representatives and doctors then, with pay increases, seminars and 
vacations as incentives, said Scott Kennelly, Butte County Behavioral 
Health assistant director of clinical services. Some doctors' 
performance evaluations were linked to patient satisfaction surveys, 
compounding the pressure to prescribe.

Doctors, drug representatives and the public were also intentionally 
misled by some pharmaceutical companies about the dangers of the 
drug. Purdue Pharmacy, manufacturer of OxyContin, was guilty of 
misbranding in 2007, paying $600 million in damages.

At the time, it was "the more the pain, the more opioids" you 
prescribe, Amir said. In 2012, 259 million prescriptions were written 
for opioids, enough to give every American adult their own bottle of 
pills, according to the CDC.

Medical professionals agree that rural areas of California struggle 
with addiction partly because of a lack of resources, including 
health care and treatment.

Butte County has only one detoxification center, which opened in 
April and is connected to a residential program, and is starving in 
resources for chemically dependent youth.

"Most communities in Northern California don't have addiction 
services and more are dying as a result," Stalcup said. "(It's like) 
there's a cancer that can be treated, but there's no one to treat it. 
It's not ethical. It's not just. It's not humane."

Carolyn Kimura, Butte County Behavioral Health medical director, said 
convincing doctors with addiction specialties to practice in the area 
has been, bewilderingly, "a chronic issue."

This also has repercussions with prescribing practices, Kennelly said.

"Without the resources or training, it's very easy to see someone 
prescribe something and not necessarily know (the patient is) going 
to have a problem with addiction," he said.

Honea said Proposition 47 has also contributed to the epidemic.

"Now that the simple possession of any drug is a misdemeanor offense, 
people who are arrested for those kind of crimes don't have the 
incentive to go to drug court" to get clean and clear those charges, he said.

Butte County also has the highest rate of people who have had adverse 
childhood experiences in California, according to a Center for Youth 
Wellness study. These experiences include physical, emotional and 
sexual abuse; emotional and physical neglect; and household 
dysfunction, such as divorce, mental illness and substance abuse.

People with four or more adverse childhood experiences are 10.3 times 
more likely to use injection drugs and 7.4 times more likely to be an 
alcoholic. They are more likely to smoke, binge drink and have 
depression and other chronic health issues.

Bruce Baldwin, County Department of Education preventative education 
specialist, said it's not hard to understand why young people who are 
in pain turn to drugs to help themselves heal.

"If your childhood is traumatic, you're stressed and have fight or 
flight going on all the time," he said. "Your body wasn't meant to 
handle that level of physical stress."

Skyway House CEO Jennifer Carvalho said the residential and 
outpatient treatment program is just trying to reach people before 
it's too late.

"Jails, institutions and death, addiction left untreated - those are 
your only options. That's where you're going to end up," she said. 
"The No. 1 thing is to fund and support treatment options. There's 
never enough."
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MAP posted-by: Jay Bergstrom