Last year marked the first year in which the number of opioid overdose deaths decreased nationwide, but a recent surge in opioid cases in Mono and Inyo counties have officials worried that the Eastern Sierra is going in the opposite direction.
In response to the recent outbreak of opioid-overdose related cases, a community generated Opioid Awareness Event took place in Bishop on the evening of August 20 which sought to educate and equip the community with the means to strike back against substance use disorders.
The event was organized as a joint effort between Antonio “Tony” Cardenas, a harm reduction advocate who specializes in community healing, and Arlene Brown, a recovery-support navigator who works in the medication-assisted treatment (MAT) program at Northern Inyo Hospital. Both are members of the Bishop Paiute Tribe.
Held at the Barlow Street Gym, the event featured naloxone training and distribution as well as presentations on addiction, stigma, and MAT. Presenters ranged from Anne Goshgarian, a doctor at Northern Inyo Hospital, to Brown and Cardenas to Bishop Police Sergeant Ron Gladding.
“Nobody has addressed our community members like that”, explained Brown in reference to the event on Tuesday. “People were angry at organizations who are supposed to leading the fight”.
Cardenas, who spoke on the benefits of MAT, explained that opioid use disorder disproportionally affects the Native community and stressed the importance of culture awareness and inclusion when constructing treatment programs. He pointed to promising data in Native communities in the Northwest United States and Canada that showed the success of tailoring treatment to specific cultures.
Brown and Cardenas held an initial awareness event last fall. As Brown explained, “The whole community had been silent and no one was addressing anything”, adding “Frustration was everywhere.”
The goal for that event in the fall, the event on Tuesday and for their work within the community has been to save lives, said Brown.
“We can’t treat people if they’re dead.”
In an August 17th “Public Health Mono-Gram,” a report issued by the Mono County Office of Public Health, titled “Outbreak of Opioid Overdoses in the Eastern Sierra”, Public Health Officer Tom Boo and Public Health Director Sandra Pearce disclosed that they have seen a spike in overdoses in Bishop and Mammoth Lakes in the past few weeks.
An estimated 6-8 overdoses over the course of a few weeks in the Bishop area resulted in two deaths, and the Mammoth Hospital Emergency Room saw two non-fatal overdoses within the past two weeks. The Mono-Gram described these new cases as, “alarming numbers for our rural area,” and Dr. Boo noted that he, “has been working towards increased availability [of resources] since last year”.
“I’m not satisfied with the progress”, he stated.
Last week, Dr. Boo travelled to a statewide Substance Use Disorder Conference in Long Beach.
The Mono-Gram reported that, “it is rumored two of the deaths, and presumably some of the other overdoses, are linked to a dangerous batch of heroin” and that outbreaks in overdoses can often be linked to the presence of fentanyl, a notorious and highly potent opioid.
According to the federal Drug Enforcement Administration, Fentanyl is between 80 and 100 times stronger than morphine and was originally developed as a means of pain management for cancer patients. It more recently has risen to prominence as a culprit in a large number of overdose deaths including those of musicians Tom Petty, Prince, Mac Miller, and Lil Peep.
In short, this is a remarkably nasty drug.
To that effect, the Mono-Gram outlined an initial series of steps and resources aimed at saving lives and reducing harm in the area, primarily centered around two areas: a) presence and availability of naloxone or Narcan, a medication that combats the effects of an overdose and b) treatment of opioid-addiction disorder via MAT.
Narcan spray is now available Mono County agencies, Northern Inyo Hospital in Bishop, and the Toiyabe Indian Health project, as well as from Paramedic Trainer Ray McGrayle.
Advocates for Narcan availability stress that it is an essential step in preventing the deaths of those experiencing an overdose.
The other aspect of the two-pronged approach, as detailed in the Mono-Gram is access to medication-assisted treatment (MAT). This approach pairs medication aimed at preventing withdrawal cravings with counseling, with the potential to drop the relapse rate down to 25% as compared to 90% for most non-medication treatments of opioid use disorder.
Inyo Hospital is the only option for MAT but the cogs are in motion at other facilities, and MAT should soon be widespread at medical facilities throughout Mono county.
The strategy implemented here closely aligns with strategies outlined by the California Health Care Foundation’s recommendations for intervention. The only piece missing: safe prescribing practices regarding opioid prescriptions, something that Antonio “Tony” Cardenas, a harm reduction advocate who specializes in community healing, pointed to as a major problem in our area.
The California Opioid Overdose Surveillance Dashboard lists the rate of opioid prescriptions in Inyo County at an average of 606.62 prescriptions per 1,000 residents. In Mono County: 258.06 prescriptions per 1,000 people. That’s almost 61% of people in Inyo and over a fourth of Mono County.
The San Diego Tribune reported that in 2016, Inyo county had the highest overdose rate of any county in California: 22.9 deaths per 100,000. Although the county’s low population contributes to that high rate, it remains concerningly high when adjusted.
Until the MAT program at Northern Inyo, there had been very few resources for individuals battling opiod and substance use disorders in Inyo and Mono county. The list of resources is now rapidly expanding, but other resources such as in-patient care, sober-living homes and rehabilitation centers are still not available.
In the packed gymnasium, people spoke candidly about the toll that this epidemic has had on the community and related personal stories of friends and family who struggle with opioid use disorder. It seemed as though everyone had at least one story or knew someone who was battling with this disease; many fought back tears as they spoke and listened to one another.
The strong community presence spoke to the desire to, as Brown said, “Change the narrative on addiction” and save lives.
“We want patients to be supported on the other side as well”. In organizing the events, she and Mr. Cardenas hope to lift up the community and give them voices and resources in the fight against opioid abuse. They likened their goal to a bridge connecting a disadvantaged community to resources tailored to the community and supported by community members.
“Community response is what’s needed”, Cardenas stated.
Dr. Boo and Ms. Brown explicitly stressed the importance of making events like this more common.
Brown and Cardenas directed those interested in helping to Eastern Sierra Harm Reduction, explaining, “Grassroots organizations are essential … Because they can do things that bigger organizations can’t”.