San Diego Conference Addresses Epidemic Of Opioid-Related Deaths

California has a nation's seventh lowest rate of drug overdoses and even so because of the large population more people die of a drug overdose each year in California then in any other state. Opioid -related overdose deaths and how to reduce them to our topics of discussion at the 2017 statewide opioid policy Summit now taken place in San Diego. Kenny Goldberg spoke with a policymaker at the summit Doctor Karen Smith the. The director of the California Department of Public Health.So you say the opioid epidemic is changing in California. In what ways?We are just beginning to see a slight decrease in overdose admissions to hospitals and deaths largely reflecting fewer prescriptions that exceeds safe doses. At the same time we are seeing very steep increases in heroin and fat no related deaths. -- And fentanyl related deaths. People who are addicted have access to available very inexpensive and very dangerous drugs like heroin and fentanyl on the street. That's part of why we partner with law enforcement to make sure that we are approaching this from a variety of different levels.I understand California has the seventh lowest overdose rate in the country. How do you account for that?It is a little bit of a misperception. The per capita rate is low but if you look county by county, you find there are areas in California where the rate is much higher than the national average. I think that reflects the fact that the state is doing relatively well. Opioid addiction and deaths in overdoses trap to areas of less economic opportunity, poverty, low employment. That's where we see excessive use of opioids in our counties.What about the prescribing patterns of doctors in these counties?We are working to address that and working hard. The only thing we have in California that's not true of many other parts of the country is that we have a large percentage of our population that is in some form of managed care. Managed care plans have the ability at a policy level to incentivize patterns. So they can decide that for every physician who want to prescribe above a certain dose of opioids, they can do that but they have to request permission and make a case for it. We are ready do that with other drugs. This is a way of using an accepted practice to actually both put a barrier in a risky does but also to educate physicians because most physicians they say there's a reason that is there. I need to think twice about do I really want to prescribe this many pills or this higher dose? That we think is really making a difference in terms of prescribing practices. When those barriers have been put in place even in a couple of counties in California that have very high rates, we saw a very steep drop in overdoses of prescription opioids.Why did doctors prescribe these medications at all given that they are so addictive and dangerous?It is a complex situation but there really is a role for opioid medications. They are extremely effective in acute pain. So surgical pain, broken bones. They are very good and used over short period of time and safe. What is happening is that increasingly physician saw them working in those situations that safety was we could do this for chronic pain. It turns out they are neither effective nor safe for chronic pain. We don't really know that to start with. We do now so the goal is to make sure that everything a physician who prescribed the medications is aware of that.You've called this epidemic a complex medical social problem. What do you mean by that?We been talking about the medical aspects of it in the role of inappropriate prescribing practices. There's not medical piece. There are people with real conditions that are being given opioids that's not effective. And underlying question is why do we have so many people in America with chronic pain? If you look at other countries, we have more people that report chronic pain in their lives than any other country. We don't necessarily work harder in the fields and there's no really obvious explanation for that. If you look at that fact and you look at who is it that is most affected by opioid overdose and deaths in this epidemic and it's those people with limited economic opportunities who also have a number of other addiction issues and they may have broken homes. These are combination of factors that make people vulnerable to chronic pain in other circumstances that lead them to look for a solution. Opioids seem like a solution but the problem is they make things work -- worse. People have called this an epidemic of despair and while that is a pretty dramatic statement. To some extent I think that is true. The people who are most voluble are those who don't have the resources and the social circumstances that can give you resilience. The family connections, the community connections. We've lost a lot of that.It's not to say opioid and its addictive qualities affect people who are down and out.That is true. We wouldn't see the number of deaths that we have if that were the only case. We also have a lot of diversion opioids and an illicit market.. Youth are always looking for the next fun thing. That is part of being young is experimenting. So it's really important that we control opioids both the legal prescription opioids but also the illegal market in order to protect kids and other young people.What gives you confidence that California will be able to turn the corner on this problem and really tried to bring it down.So many different partners have come to the table in a very real way. Putting real effort and real resources on the table and we are attacking this in multiple sectors with mutually reinforcing types of interventions. We are already starting to see an impact in the areas where we can most easily impact. So I'm confident that if we can keep up the momentum in the resources that we will be able to turn a corner on this epidemic.That was Karen Smith the director of the California Department of Public Health speaking with Kenny Goldberg.