The New York Times just published a bleak story describing devastation wreaked by the opioid epidemic in California’s rural north. The May 8 article may leave the impression that little is being done to address this crisis, yet overdose death rates have been flat for years in Humboldt while they are rising in rural areas across the nation. Aggressive efforts on treatment access may offer an explanation.
“No doubt there is a really difficult problem, no doubt that lives have been devastated,” said Dr. Bill Hunter, chief medical officer of Open Door Community Health Centers, a network of 13 sites in Humboldt and Del Norte Counties and a key provider of care for people of all incomes. But there is also “a whole group of accomplished people who have been working hard on this for a long time.”
Hunter started prescribing buprenorphine, an effective treatment for people with opioid addiction, more than a dozen years ago. Doctors need special training and a US Drug Enforcement Administration license, known as an X-waiver, to prescribe the medication. Because it has been proven to cut death rates in half for people with opioid addiction, it’s “practically a requirement” that providers who come to work at Open Door get their waiver, Hunter said.
Humboldt’s overall opioid prescribing dropped 39% over the last six years, and buprenorphine prescriptions doubled from 2014 to 2016, according to data from the state’s opioid overdose dashboard.
Although Humboldt’s total opioid overdose death rates have not declined, the county has resisted national trends, and death rates have not risen in the last six years. For context, the opioid overdose death rate in hard-hit Ohio was similar to Humboldt’s in 2014 but increased by 72% over the next two years. Had there not been such aggressive efforts to increase treatment and decrease opioid prescribing, it is not hard to imagine that rural Humboldt County might have taken a similar course.
While Humboldt’s total opioid overdose death rates have not declined, the county has resisted national trends, and death rates have not risen in the last six years.
Open Door has more than 700 people currently in treatment. “I’ve got patients now I’ve been taking care of for a bunch of years,” Hunter said. When they first came in, their lives were chaotic, and they were driven to seek the next fix. “Now they’re raising their kids. They’re working. They are productive members of society. It’s a remarkable thing.”
Increasing Access in the Rural North
Hunter said he is puzzled by the Times reporting that 700 people are on a waiting list for treatment in Humboldt, Trinity, and Del Norte Counties. Most Open Door clinics have no waiting list, he said. One site in Eureka currently has about 30 people on a waiting list, but overall, the system is starting 12 patients a week on buprenorphine, and almost everyone gets into treatment with at most a three-week wait. Other local health officials we talked to also were unfamiliar with the number cited by the Times.
Efforts to increase treatment access in the rural north extend beyond Open Door. Local hospitals provide access to buprenorphine, and the California Health Care Foundation provides technical assistance to support these efforts in emergency departments and inpatient settings so patients can receive lifesaving treatment wherever they seek care.
St. Joseph Hospital in Eureka offers buprenorphine in its emergency department before referring patients to Open Door for ongoing treatment. Redwood Memorial Hospital in Fortuna offers buprenorphine to patients who are hospitalized.
Hunter also pointed to the success of the local opioid safety coalition, RxSafe Humboldt, which is composed of leaders from the health department, the medical community, needle exchange providers, law enforcement, health insurers, and more. The coalition has led many efforts, including educating physicians and other prescribers on safer and more effective nonopioid chronic pain management. The coalition also has installed six medication disposal bins around the county to accept controlled substances, ensuring the safe disposal of hundreds of pounds of drugs.
$89 Million Federal Grant Extends Treatment Options
Humboldt will benefit from the California Medication Assisted Treatment Expansion Project, launched with an $89 million federal grant to expand access to medication-assisted treatment (MAT) across the state. Aegis Treatment Centers is identifying a location to open a treatment center in Humboldt County that would offer all FDA-approved forms of MAT including methadone, which Open Door cannot offer due to state licensing requirements.
“There is definitely a lot of movement,” said Marlies Perez, chief of the California Department of Health Care Services substance use disorder compliance division, who is overseeing the project. “We obviously need to continue to do more, and a lot of people are committed to make that happen.”
The CHCF Blog photo of Humboldt Bay: Robert Campbell, GFDL or CC BY-SA 3.0, via Wikimedia Commons
Kelly Pfeifer is director of CHCF’s High-Value Care team, which supports policies and care models that align with patient preferences, are proven effective, and are affordable. She leads CHCF’s efforts in maternity care, end-of-life care, and the care of populations with complex behavioral health and medical conditions. Kelly was named the 2017 recipient of the Beverlee A. Myers Award by the California Department of Public Health for her work addressing the opioid epidemic. It is the agency’s highest annual award given to an individual exhibiting outstanding leadership in public health.
Prior to joining CHCF, Kelly served as chief medical officer for the San Francisco Health Plan — a managed Medicaid health plan — and medical director and family physician at Petaluma Health Center. She also served as the medical director for access for Redwood Community Health Coalition, a network of community clinics in four North Bay counties. She continues to practice family medicine. Kelly received a bachelor’s degree in English literature from Oberlin College and a medical doctorate from the Medical College of Pennsylvania. She trained in family medicine at the University of California, San Francisco, program at Sutter Santa Rosa.