We are seeing glimmering signs of progress in the fight against the opioid epidemic, according to newly released figures on California’s opioid overdose dashboard. The California death rate has not declined for the last two years, but it is holding steady compared to hard-hit states like Ohio and West Virginia, where overdose death rates continue to rise.
The dashboard shows how complicated the situation is. While the number of California deaths from prescription opioids and heroin was stable last year, fentanyl deaths increased 47%. Fentanyl is an exceptionally potent synthetic opioid frequently found in counterfeit pills and cut into heroin. It’s not unusual for users to have no idea the deadly drug is there.
Check out the state’s dashboard, created by the California Department of Public Health (CDPH), to see the stats in your own community. When behavioral health officials in Ventura County did this, they found Ventura was one of the few California counties where overdose deaths declined — a credit to their years of coordinated work. As Margaret Mead so famously said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”
Besides the death rate, there are positive changes in prescribing and treatment access, both key to turning the tide on the ongoing epidemic. Compared with the previous year, the 2016 results were impressive, including:
A 12% decline in the volume of opioids dispensed in California, as measured by average morphine milligram equivalents (MME) dispensed per resident per year
A greater than 11% drop in the rate of people on high-dose opioids (greater than 90 MME per day)
An increase of more than 7% in the number of buprenorphine prescriptions — a measure of access to effective addiction treatment
We are committed to continuing this crucially important work. As a statewide partner in the fight against the epidemic, the California Health Care Foundation (CHCF) works on multiple levels. One key strategy is to build local leadership through opioid safety coalitions. Culture is local, and we recognize that prescribing patterns and attitudes about addiction treatment play out within that geographic context. With this in mind, in 2015, CHCF launched a program of training and technical assistance for 16 opioid safety coalitions in 23 counties. This support includes coaching, webinars, and in-person convenings in service of sharing strategies across the coalition network.
Coalitions Making a Difference
The coalitions have focused on reducing prescribing rates, increasing availability of the overdose reversal agent naloxone, and expanding critical access to addiction treatment. To better understand what worked, CHCF asked the Public Health Institute (PHI) to formally assess the first year of the California Opioid Safety Coalitions Network.
The report was encouraging: PHI found greater progress against the epidemic in counties with CHCF-backed coalitions than in those without, and I’m thrilled that we are starting to see a payoff from this work. The rate of decline in opioid prescriptions and the decrease in average annual opioid dose were faster in counties with CHCF-backed coalitions, compared to those without such coalition support. In addition, counties with CHCF-supported coalitions had nearly double the increase in buprenorphine prescribing rates than counties without coalition support, a marker for faster increase in access to effective addiction treatment.
Opioid safety coalitions are emerging across the country, but few states offer strategic support, PHI found. Massachusetts and Pennsylvania are two notable exceptions, and PHI outlined some of their successes to further inform our work in California.
Threat of a Staggering Burden
Within only 18 months after CHCF launched the California Opioid Safety Coalitions Network, more than 35 of California’s 58 counties have active coalitions. CHCF is convinced that local coalitions can be a powerful force, and we are taking what we learned from the PHI assessment to launch a new phase of coalition training and technical support, which will be announced in October.
We all know this problem is urgent. The national news publication STAT recently published a forecast of the future of the opioid epidemic, and the worst-case scenario was a staggering 650,000 overdose deaths over the next decade. That’s about the number of people who live in Washington, DC. To bend down the death curve would require a major expansion in the availability of addiction treatment along with a dramatic reduction in opioid prescribing, STAT reported.
I was heartbroken to hear recently from a county in northern California that several people were lost to overdose while they were on treatment waiting lists. Getting to the point where no one has to wait for treatment is the goal of many coordinated efforts across the state: the Statewide Opioid Safety workgroup led by CDPH, and two projects led by the California Department of Health Care Services, the California Hub and Spoke System and the effort to ensure addiction treatment access in Medi-Cal called the Organized Delivery System.
We all are striving to achieve the same goals — fewer deaths, less untreated addiction, better and safer pain management, and fewer people started on the unfortunate path of long-term opioid dependence. We saw encouraging trends in 2016. We can do even better.
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.