How Contra Costa County, CA is Tackling the Opioid Crisis

The coronavirus pandemic dominates headlines across the country. Meanwhile, the opioid epidemic continues to disrupt the lives of families and individuals in every state. It hit midwestern states, such as Ohio and Pennsylvania, the hardest, but no state is immune – certainly not California.

According to Contra Costa Health Services in Contra Costa County, California:

  • 45 people in Contra Costa County died due to opioid overdoses in 2017.
  • In 2016, about 5.4% of teens and adults abused opioids in Contra Costa.
  • Of those 53,889 people, approximately 10,000 of them had an opioid use disorder (OUD).
  • There were about 700,000 opioid prescriptions issued in CC County in 2017. That’s about a 14% decrease from 2015, when the number was 830,000.

Since officials tell us that over-prescribing was an element in creating the crisis, that last bullet point is good news.

What is the East Bay Doing About this Problem?

In 2017, several organizations in the East Bay (including Contra Costa Health Services and Alameda-Contra Costa Medical Association) aimed to tackle the opioid crisis by getting to the root of the problems: those prescribing the painkillers.

These agencies came up with the East Bay Safe Prescribing Coalition, which urges doctors to adopt a set of guidelines before prescribing opioids. This initiative warns doctors to balance the need for painkillers with the risk of opioid addiction and prescription drug abuse. For example, the coalition recommends doctors and urgent care centers adopt the following safe prescribing practices:

  • Ask for all of a patient’s medical records during the visit
  • Ask for photo ID during the visit
  • Refrain from prescribing medication if the patient already receives pain medicine from another healthcare provider
  • When prescribing pain medication, limit the amount/dosage
  • Refrain from prescribing long-acting medications such as OxyContin, Fentanyl, Methadone and others

The coalition encourages physicians to recommend alternative, nonmedical treatments to manage pain – such as yoga, acupuncture, massage, and chiropractors.  They also promote Medication-Assisted Treatment (MAT) to help treat opioid use disorder.

Medically Assisted Detox in the East Bay

Medically assisted detox is a method of ceasing opioid use with the help of specific medications. For teens and adults addicted to heroin or other opioids, traditional detox – cutting off all the substances from their system at once – feels terrible and can be dangerous. That’s why it often leads to relapse. In medically assisted detox, teens can take daily doses of specific, physician-prescribed medication to reduce their cravings to opioids and lessen the pain of withdrawal. This also decreases the risk of relapse.

Once medically assisted detox is complete, some patients transition to Medication-Assisted Treatment (MAT) for opioid use disorder. MAT is an aspect of the harm-reduction approach to addiction treatment. MAT is known for reducing the negative behaviors and emotions associated with the disorder use of opioids. During MAT, a patient takes a medication that binds to the same opioid receptors in the brain that a drug of misuse, such as heroin or oxycontin, thereby reducing cravings and enabling them to participate in the therapy and counseling offered during treatment.

MAT: Buprenorphine

The most commonly prescribed medication for teens with an opioid use disorder is Buprenorphine. Buprenorphine was approved in 2002 by the Food and Drug Administration (FDA) for use in medication-assisted treatment (MAT) for adolescents age 16 and over.

Buprenorphine is a type of opiate called a partial opioid agonist, meaning it binds to the brain’s opioid receptors. This tricks the brain into accepting this new medication instead of heroin or other illegal drugs, and stops regular opioid cravings.

Physicians and pediatricians can prescribe buprenorphine in their offices after receiving specialized training and a waiver from the U.S. Drug Enforcement Agency (DEA). However, physicians can only treat one hundred patients at a time. For this reason, buprenorphine-prescribing doctors are not always easy to find.

Which is why the East Bay Safe Prescribing Coalition trains and provides waivers for physicians to prescribe buprenorphine. Evidence shows it will help MAT efforts in the long run.