Opioid Epidemic

Naloxone Reversing Overdose in California’s Coastal Communities

Editor’s note: This is the second story in a series on the opioid epidemic in America

If it weren’t for naloxone, Alameda County would have added two more bodies to its climbing opioid overdose death toll in May.

The pair were together, overdosing on an Oakland street after using an opiate drug when a bystander injected them with naloxone. It saved their lives.

Pfizer is working with Direct Relief to make up to 1 million doses of overdose-reversing Naloxone available at no cost to qualified nonprofit health providers and public health departments nationwide. (Lara Cooper/Direct Relief photo)

The naloxone came from Alameda County Health Care for the Homeless, which received over 600 packs filled with doses of naloxone from Direct Relief. The donations are part of a four-year commitment by Pfizer to provide up to 1 million doses of the life-saving drug.

“We’ve already moved a thousand doses, getting them out to a wide range of persons at risk of experiencing or witnessing overdoses, and we are very grateful for this resource,” said David Modersbach in May, who works with Alameda County Health, which serves a large homeless population.

Where Do Opioid Overdose Deaths Occur Most Often in Alameda County?

Stats are for 2015,  from the California Opioid Overdose Surveillance Dashboard.

Though homelessness does not equate to substance abuse, there is a correlation for at-risk populations. The northern California health program has a mobile clinic, which makes routine stops at 10 destinations, to provide healthcare services to the county’s homeless population of more than 4,000 people.

Unfortunately, few substance abusers are brought into a clinic while overdosing. As a preventative measure, some doctors send naloxone home if the patient has a high risk for overdose. Risk can be determined by the level of opiate prescribed, whether the patient is likely to drink while on the medication and if the patient has a history of abuse in the past. Mortality rates have been on the rise in Alameda County, providing a snapshot of the country as a whole.

The medication is administered through a syringe, which can be daunting for inexperienced bystanders who may have to administer the drug to a friend or family member. Although many of Direct Relief’s partners prefer the nasal inhalant version of naloxone (which is not covered by Medi-Cal), the physicians say they are glad to have another option for patients who can’t spare the extra expense.

Many drug users’ opiate of choice is the cheap and illegal street drug heroin, but others have become addicted through the use of prescription painkillers.

Traveling south leads to the next largest California recipient of naloxone. St. John’s Well Child and Family Center in Los Angeles, a free and low-cost health clinic, received 2,000 doses of naloxone, and Brandon Doan, director of pharmacy at St. John’s said the multi-site clinic had already given half of the donated doses to at-risk patients earlier this summer.

Similar to Alameda, St. John’s has a mobile clinic for the area’s homeless population, as well as other patients who cannot make it to a brick-and-mortar clinic.

The mobile clinic from St. John’s Well Child and Family Center serves patients that can’t make it to a brick-and-mortar location. The center received the third-largest donation of naloxone in the U.S. from Direct Relief. (Photo courtesy of St. John’s Well Child and Family Center)

“We know that the number of overdoses have increased and (this is) according to organizations from clinics and dispensaries, and all the way to our corporate office,” Doan said. “It’s growing and it’s growing rapidly, too.”

There were 1,966 opioid overdose deaths in California in 2015. An additional 3,935 opioid overdoses resulted in emergency department visits in the state, excluding heroin overdoses.

Between May 2010 and April 2011, Californians reported 1.4 million opioid drug claims, representing over $105 million in dollars paid for the drugs through Medi-Cal.

Few California communities have avoided opioid abuse, including the more affluent areas like Santa Barbara, where the median income is $64,400 (well above the national) and the city in which Direct Relief is based.

There were 34 opioid overdose deaths in Santa Barbara County in 2015.

In 2015, the Los Angeles Times reported Santa Barbara County doctor, Julio Gabriel Diaz, known as “the candy man” due to the sheer volume of prescriptions he gave to patients, was arrested and found guilty on 79 charges for writing prescriptions for powerful painkillers. Authorities say as many as 20 of his patients died from an overdose.

The Santa Barbara County Public Health Department received 320 doses of naloxone. The Goleta Neighborhood Clinics within Santa Barbara County received 100 doses. Goleta started a medically assisted treatment center for substance use disorder in 2016.

A crash cart is shown at the Eastside Neighborhood Clinic in Santa Barbara. Vials of naloxone, provided by Direct Relief and pictured in the top left tray of the cart, are included in case anyone overdoses at the clinic. (Olivia Lewis/Direct Relief photo)

From 2008 to 2015, the opioid mortality rate in Santa Barbara County doubled. In 2015, Santa Barbara news reports said the Sheriff’s Department made a public warning about the dangers of heroin and mixing it with other drugs after two people overdosed on the same day.

Though substance abuse isn’t new to healthcare providers, many were unprepared financially for the uptick in opioid abuse and required care among patients.

As the problem continues to grow nationwide, clinics and federally qualified health centers say they depend on programs like Direct Relief and Pfizer’s to supplement treatment options.

“We will continue to get the product if it’s available through donations,” Doan said. “We don’t have a set-up for this and this is why we went to Direct Relief.”

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