No Easy Fix
Inyo County struggles to provide treatment options for residents addicted to opioids
“In the last couple of years, we have just seen an explosion with opioids,” said Merry Brown, Supervisor of Inyo County’s Drug and Alcohol Program, on January 10. Brown said she also sees people seeking help or being incarcerated for abusing prescription painkillers, such as OxyContin. Even more alarming, said Brown, is an emerging trend of people crushing and liquefying prescription painkillers to inject them. “The high is much more significant when you do that. Of course, this brings a whole host of health risks,” said Brown, who said that opioid addiction occurs across all ages and socioeconomic classes of Inyo County residents.
Brown has been a certified substance abuse counselor in Inyo County for 13 years. “When I first came on board, it was methamphetamines… now, we are seeing heroin use,” she said.
Brown also said that, in recent years, she has witnessed an increase in the number of high school students abusing prescription painkillers, often in conjunction with alcohol.
As the number of people abusing prescription painkillers increases, so does the number of heroin users. “Black tar heroin is pretty cheap, and persons who are poor might be able to get that more readily… than pain pills,” said Brown.
According to data from the California Opioid Overdose Surveillance Dashboard, a project of the California Department of Public Health, Inyo County had the highest rate of opioid overdose deaths of any county in the State of California in 2016, though Inyo County’s small population contributed to that high rate.
There were six opioid overdose hospitalizations in Inyo County in 2016, and three deaths. This brought the overdose rate per 100,000 residents to 22.91, which is well above California’s statewide average of 4.6 overdoses per 100,000 residents.
According to Anna Scott, Deputy Director of Health and Human Services for Inyo County, there is more demand for opioid addiction treatment in Inyo County than can currently be met by providers. Scott said that Medication-Assisted Treatment (MAT), or treatment of opioid addiction and withdrawal symptoms using pharmaceuticals, is not widely available in Inyo County, and that her department is looking to recruit more licensed providers to the region.
In order to provide MAT, a physician must obtain a waiver and undergo special training from the Substance Abuse and Mental Health Services Administration (SAMHSA), which then allows him or her to prescribe and dispense schedule III, IV, and V narcotic drugs under the Drug Addiction Treatment Act of 2000.
The drug buprenorphine was approved by the Federal Drug Administration for the treatment of opiate addiction in 2002, but only with a federal waiver. Prescribing an opioid painkiller, such as OxyContin or Percocet, does not require this additional training or licensure.
According to SAMHSA’s website, physicians may treat no more than 30 patients during their first year of MAT certification. According to a 2017 report by SAMHSA, there are just over 1,000 physicians certified to provide MAT in California.
According to a report by the Pew Charitable Trusts, more than 900,000 physicians nationwide can write prescriptions for opioid painkillers such as OxyContin, Percocet, and Vicodin. In contrast, fewer than 32,000 physicians are authorized to prescribe buprenorphine to people who people who have become addicted to opiates.
When asked why there is a shortage of MAT providers in Inyo County, Scott said that the treatment requires collaboration. Many of the region’s certified substance abuse counselors are not physicians, and cannot prescribe medications, let alone apply for a waiver to provide MAT. She said that many local physicians can’t even provide all the counseling services needed to make sure an addict using MAT to get clean does so safely.
Scott said that State funding for MAT has been focused on California’s urban centers. “There is a hub and spoke model for funding,” said Scott on Tuesday. “The hub is where the expertise is held by a particular provider group… the spokes are providers that receive additional support.” Scott said those resources have not yet become available in the Eastern Sierra.
To make matters worse, healthcare professionals cannot further their education in addiction counseling services or MAT locally. Those local providers who have the skills to treat patients using MAT don’t have the support of a large medical center or university, and Scott said it is difficult to retain them.