Opioid death rate in Orange County eclipses other Southern California counties

Years after opioid-blocking drugs were hailed as the gold standard for combating opioid addiction, less than half of Orange County’s addiction treatment centers currently offer it, according to a new study by the county that details the results of — and some possible solutions to — the opioid epidemic.

Though the total number of all opioid-related deaths dropped slightly since 2016 — coinciding with a drop in opioid prescriptions — heroin and fentanyl overdoses have climbed in Orange County, where the concentration of rehab centers and sober living homes is so high that the county is known in treatment circles as the center of the Rehab Riviera.

The report, titled “Addressing the Opioid Crisis in Orange County,” noted that overdose deaths are more common along the coast and in south county, where the vast majority of state-licensed treatment centers and unregulated sober living homes are located.

It also found that the dead were overwhelmingly white and male and that the rate of opioid-overdose deaths in O.C. far eclipsed that of Los Angeles, Riverside, San Bernardino, San Diego, Ventura and Santa Barbara counties, as well as California as a whole.

County officials laid out plans for a more muscular private-public response to the health care crisis over the next several years, including a heavy emphasis on medication-assisted treatment and community education. But controversial ideas that have reduced deaths elsewhere, such as needle exchanges and safe-injection sites, were not on the immediate to-do list.

The report left some critics yearning for a broad overhaul of addiction treatment — something state legislators from Orange and Los Angeles counties support — frustrated.

“They completely ignore the for-profit treatment sector, and there’s no discussion of the exploitation that happens there at all,” said Laurie Girand of Advocates for Responsible Treatment in San Juan Capistrano.

“Orange County has a massive surplus of ineffective, for-profit (rehab) providers which are contributing to the opioid crisis, the homelessness crisis, and deaths,” Girand added. “The county does not need more of the same.”

Early next year, the county will launch opioid overdose and misuse prevention campaigns aimed at adults and youth. They’ll include education and targeted messaging for high-risk groups using social, digital,and print media, the report said.

There’s also targeted prevention for physicians who prescribe drugs, including guidelines and monitoring, as part of SaferRX OC, a collaborative on prescription drug abuse coordinated through UCI Health. The report noted that there were nearly 1.5 million opioid prescriptions written last year in Orange County, down from an average of about 1.7 million a year from 2014 through 2017.

The report also noted that to reduce opioid deaths, the county has increased access to Narcan, a nasal spray version of the medication naloxone. The drug can reverse the effects of an opioid overdose — essentially reviving a user who otherwise might die — by knocking opioid molecules off the brain’s opioid receptors.

The county joined California’s Drug Medi-Cal Organized Delivery System in July 2018 as part of a pilot program designed to restructure treatment services.

It set up county-funded outpatient treatment programs, increased access to medication-assisted treatment and expanded overall capacity, the report said. The county now funds 14 outpatient treatment sites, eight residential treatment sites, three detox facilities, four medication-assisted treatment facilities and six sober living homes.

And, in perhaps its boldest move, the county is partnering with Kaiser Permanente, Hoag, Providence St. Joseph Health, and CalOptima to develop a public-private Be Well Orange County Regional Behavioral Health Campus. It is expected to open in early 2021 and will provide “a spectrum of mental health and addiction treatment services” to Orange County residents regardless of the type of insurance they have and make sure care continues when they leave hospitals or treatment centers.

More help is on the way to prevent drug-related deaths in county jails, as well, according to the report.

“We are only a few months young, but we’re very, very hopeful we can increase access to treatment that’s effective for the entire county,” said Clayton Chau, a doctor with the Be Well OC initiative.

Medication stigma

The report, which surveyed drug users and treatment providers, among others, pointed to a wish list of items that could reduce opioid-related deaths — more youth-focused prevention programs, more low (or no) cost , evidence-based drug treatment services and more programs that help people who suffer from both drug addiction and mental health problems.

But it also found that medication assisted treatment, now widely viewed as a key to helping people overcome addiction, isn’t yet universally accepted in Orange County. While 56% of the stakeholders surveyed by the county support medical treatment for opioid addiction, 34% are unsure about it and 10% oppose it.

To shift those views, the report said the Orange County Health Care Agency, health plans and others “should collaborate to develop a (medicine-assisted treatment) educational anti-stigma campaign,” to get more people to use that treatment model.

“All treatment and health professionals, regardless of the type of treatment or setting, should provide or link consumers to (medicine-assisted treatment) when clinically indicated.”

That’s exactly what Be Well OC aspires to do, Chau said.

“In the treatment community there are two camps — the people who believe medication-assisted treatment is a life-saving advance, and the people who don’t believe in chemical alterations of any kind. The stigma is really, really strong. That’s what we’re facing.

“We’re working hard to educate the community, overcome the stigma, and get these life-saving treatments to the people who need them,” he said. “MAT alone isn’t the answer — but in combination with other supports, it can make a huge difference. It can save lives.”

Other findings:

• Heroin, hydrocodone, morphine, oxycodone and fentanyl are the most common opioids in opioid overdose deaths.
• Between 2011 and 2018, heroin contributed to 29% of overdose deaths; hydrocodone, 27.8%; morphine, 24.1%; oxycodone, 20.5%; and fentanyl, 14.3%.
• While hydrocodone, morphine and codeine-related deaths trended down, oxycodone involvement remained relatively stable while heroin and fentanyl-involvement increased significantly.
• Opioid related emergency department visits more than tripled between 2005 and 2016 before ticking down, in step with a drop in opioid prescriptions.
• Nearly 1.5 million opioid prescriptions were written for Orange County residents in 2018, down from an average of 1.7 million in the three previous years. Even at the lower number, that’s equal to an opioid prescription for half of the county’s population.
• Seven of every ten drug-related deaths in the county involve opioids.
• Prescription opioids accounted for nearly half of opioid overdose deaths.