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Santa Clara County heroin poisonings continue to rise

Overdose numbers prompt Foothill-DeAnza police to carry antidote on college campus

The number of people who end up in hospital emergency rooms from heroin overdoses has continued to rise as use of the potent narcotic deepens in Silicon Valley and elsewhere, according to data recently released by the California Office of Statewide Health Planning and Development.

Poisonings or overdoses have jumped by more than 100 percent in Santa Clara County and other parts of the state, fueled in large part by prescription painkiller abuse. As addiction to the painkiller increases, users often switch to cheaper and more easily obtainable heroin, medical professionals said.

The problem has escalated to the point that Foothill-DeAnza Community College District police began carrying Naloxone on Aug. 1, an over-the-counter drug used as an overdose antidote, the department announced last week.

Foothill-DeAnza is the first law-enforcement agency in Santa Clara County to carry the drug, which is commonly known as Narcan. The drug is used as a nasal spray, which makes it easy to administer, and it has long been used by paramedics to treat heroin and other prescription opioid overdoses.

Misuse of heroin and other opioids has become an epidemic across the nation, prompting President Barack Obama to sign legislation on July 26 to help reduce the number of deaths. The legislation includes $181 million to states to fight heroin and opiate addiction and death, including providing Naloxone to first responders and law enforcement.

Santa Clara County has seen a 126 percent increase in the number of heroin poisonings between 2011 and 2015. There were 19 cases in 2011 and 43 in 2015. The spike began in 2012 with a 115 percent jump, according to the California Office of Statewide Health Planning and Development, which tracked hospital emergency department data for heroin overdoses between 2005 and 2016. The first quarter of 2016 indicates the year is on track to match the trend, with 11 cases documented from January through March.

But those numbers only tell part of the story. They don't include the number of overdoses from other sources of opioids, such as prescription pain medications, nor do they parse out the number of deaths.

Since July 2015, the Santa Clara County Medical Examiner has reported 11 deaths from drug overdose related to fentanyl, including two in April 2016 with fatal levels of fentanyl combined with other opioids and illicit drugs, according to a May 11 advisory to hospitals and physicians by Dr. Sara Cody, county public health director, and Toni Tullys, director of behavioral health services.

The county's age-adjusted rate for opioid-related deaths gradually rose from 4.2 per 100,000 in 2005 to 6.5 per 100,000 in 2015, a more than 50 percent increase, according to the advisory.

"Some had a known history of buying prescription drugs off the street, including one person who bought counterfeit Vicodin, and another, counterfeit Norco. The emergence of illicitly produced fentanyl and fentanyl compounds are a new threat to public health and safety," they wrote.

The rise is the reason that Santa Clara and Orange counties filed a suit in May 2014 against five of the nation's largest opioid manufacturers for false and misleading advertising, which, they allege, underplayed the dangers and caused doctors to over-prescribe the drugs. That case is still in the court.

Foothill-DeAnza police Chief Ronald Levine said the increase in overdoses in the county led to the decision for officers to train in and carry Narcan, which is effective in preventing overdose deaths.

"I was surprised to learn about the number of overdoses in the communities that surround our campuses. It is important that our officers be prepared to address any medical emergency they might encounter during their shift," he said.

Invariably, overdose patients end up in hospital emergency rooms if they aren't found dead. Stanford Health Care hasn't seen an increase in heroin poisoning -- just one overdose so far in 2016, spokeswoman Lisa Kim said. But that doesn't mean there should be complacency, said Dr. Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford School of Medicine and former senior policy advisor to the White House Office of National Drug Control Policy.

In the 1970s, an opioid epidemic, mainly heroin, affected mostly urban black populations. The over-prescription of narcotics such as OxyContin started a new wave of addiction, which is evident in the emergency room reports in the Office of Statewide Health Planning study. And this time it is affecting whites and wealthier populations.

"It's not an urban epidemic, it's suburban and rural. And because they have better access to health care and insurance, your dealer becomes your doctor -- although maybe not on purpose," Humphreys said.

The problem is also attributable to a culture that believes one shouldn't be in pain, and there is a quick fix for anything, Humphreys said.

"Pain is a part of living, like disappointment in life," he said.

The switch from prescription drugs to heroin often happens when the person becomes increasingly addicted. As their tolerance builds, it becomes more difficult and expensive to obtain. But heroin, brought into California by enterprising Mexican cartels, is potent and cheap, Humphreys said.

But overdoses on prescription opioids are no less lethal. Overdose on pills usually occurs among users in their 30s and 40s who have been using for a while. In middle age, it is easier to get a drug prescription because many physicians can accept that an older person has pain, Humphreys said. But "younger people have a harder time to do that, so they go straight to heroin," he said. The shift to heroin isn't difficult. OxyContin, in particular, when its extended release is altered, acts very much like heroin, he said.

Heroin and other opioids can be so deadly because they bind to a set of receptors that reduce respiration. Overdoses can be swift and fatal. The danger increases if alcohol or tranquilizers are also in the system, which many people do take in combination, he said.

But having Naloxone or Narcan on hand can save a life. The drug is available without a prescription, and it is available over the counter at some local pharmacies, said Humphreys, who recommends keeping the drug on hand if anyone knows a person with an opioid addiction.

"Get it and keep it in the house. If they overdose, you can spray it up their nose. It's not a cure, but it knocks the opioids out of the receptors to get the person breathing again until the ambulance comes," he said.

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Comments

12 people like this
Posted by VS
a resident of Another Palo Alto neighborhood
on Aug 11, 2016 at 9:43 am

VS is a registered user.

Sue,
Thank you so much for beginning the coverage on this critical problem that is occurring in Santa Clara County and across the US. There are so many aspects of this issue that require increased understanding. I hope coverage on this topic continues, and that a healthy conversation ensues. Thank you.


10 people like this
Posted by YSK
a resident of Community Center
on Aug 11, 2016 at 9:55 am

Unbelievable what I just read. People who live their lives in daily chronic pain would have a big issue with Humphreys statement that people believe they shouldn't live in pain and that pain is part of life. Modern medicine should be better equipped to handle pain and people who genuinely need the pain relief should not be punished for the actions of addicts.


3 people like this
Posted by Anonymous
a resident of University South
on Aug 11, 2016 at 10:42 am

So apparently many of the drug addicts are regular people who work normal jobs. But the twist is, they cannot be on job without taking some kind of pain killer dose, which is particularly strong sometimes. Should these people be working jobs while on their "medication" legal or not? I would believe it is not such a good idea to be working a job while taking drugs, but on the other hand some of these people are even more functional on the pain killer.


Like this comment
Posted by vmshadle
a resident of Meadow Park
on Aug 11, 2016 at 5:52 pm

Hold your horses, YSK. Those of us in the health care professions can't always correct for every public statement filtered through lay writers and lay readers.

Keith Humphreys is a professor of psychiatry at Stanford and a nationally known expert on addiction disorders and mental health.

What he is addressing is the problem of prescription overuse instead of reasonable use. Some patients insist that they should be in no pain whatsoever at any time, and that is unrealistic. These types pressure physicians to prescribe and some threaten to sue if doctors don't comply.

Clinicians know that pain doesn't have to disappear completely to be tolerable. If you're recovering from surgery, pain diminishes on its own, and opiates/opioids are titrated accordingly. People with chronic pain, however, need to know that increasing opiates/opioids over time increases tolerance, requiring increasing amounts of drug to get the same relief; and these drugs at high doses are just plain dangerous.

The problem of overuse is why pain specialists are now a part of the medical landscape. Pain needs to be co-managed by the patient and the clinician so no one gets killed.

It's about use, not overuse. Get it?


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