Humboldt County is making progress in dealing with the opioid crisis in several critical areas: overdose deaths are down, opioid prescriptions are down and emergency room visits are down, according to 2018 data released by the California Department of Public Health earlier this month.
“There was a time that Humboldt had the highest prescribing rate in the state,” said Rosemary Den Ouden, the Humboldt Independent Practice Association CEO and chair of Rx Safe Humboldt, a coalition of organizations and agencies working to fight the overdose epidemic.
It was a different situation in the late 1990s and early 2000s, said Dr. Bill Hunter, a family practice physician at Open Door Community Health Center in Eureka who has more than four decades of experience as a doctor.
“Back in the day, we were all being urged and encouraged to prescribe high doses,” he said this week. “… It was just pervasive in those days. There were people who crusaded to treat pain.”
From 2006 to 2012, an estimated 70 million opioid pills were dispensed in Humboldt County. That meant about 76 distributed oxycodone and hydrocodone pills for every person in Humboldt County each year. Even as late as 2016, there were more prescriptions for opioids in the county than residents.
But now it appears the county has turned a corner. For the second consecutive year, opioid prescriptions are down. So are deaths and ER visits.
In 2016, Humboldt County saw 33 opioid overdose deaths. Two years later, that number is less than half with 15 deaths, a figure Den Ouden refers to as “too many.”
“Through the collaborative efforts of the partners in RX Safe Humboldt, doctors, nurse practitioners and physician assistants to make sure they understand safe prescribing and when it is appropriate and when it is not,” said Den Ouden. “In addition to working really closely with health care providers, we have … developed a fairly comprehensive resource guide for alternatives to the treatment of chronic pain: acupuncture, massage, mindful breathing. … It’s a tool for both providers and patients.”
Humboldt County agencies and organizations are tackling the opioid crisis from multiple avenues, something that is credited with making a dent.
Health care approach
Health care providers have heavily curtailed the number of prescriptions provided to patients dealing with pain in the past few years. While in 2016, there were an estimated 114 prescriptions for every 100 residents, that figure is now around 76 prescriptions for every 100 residents.
Hunter points to the use of a system called CURES that helps California doctors check to see if a patient has received opioid prescriptions from another physician.
“We look at that every four months,” Hunter said. “We are able to identify people who have a substance abuse problem.”
He added there are “very few” patients remaining at Open Door who receive high dosages of pain medication. Lowering or eliminating the dosages of opioid pain medications can have a positive effect on patients, he added.
“Opioids are not the best treatment for chronic pain,” he said. “It’s very often the case if you can get people off the high doses, they experience less pain.”
He also said there is an emphasis on “alternative treatments” for pain.
“We recommend a lot of physical therapy,” he said. “We do antidepressants and gabapentin (to treat neuropathic pain). We are starting this multidisciplinary wellness center.”
He believes that the path health centers like Open Door are on are contributing to curbing use.
“We continue to work on it every day,” he said. “The things we have in place are the right things. We are not starting (patients) on chronic opioids. We are limiting prescriptions for injuries or surgeries to a week. We are mindful if they get it for more than a few months, it’s hard to get people off.”
Community education, resources
Den Ouden touts resources available throughout the community have made an impact on changing the course of the opioid crisis, including educating the community on being able to recognize the signs of an overdose and providing opioid overdose reversal drugs to various agencies across the county.
“In the last 18 months, over 4,000 (naloxone) kits have been distributed,” she said. “This allows for us to have the medication to reverse an overdose. That, in itself, has done a tremendous amount in reducing the overdose rate.”
Those kits go to agencies and organizations that request training on dispensing naloxone, but also to individuals who should have them handy.
“Just like we encourage everyone to be CPR certified, everybody should be carrying naloxone,” she said.
She also pointed to the presence of medication disposal boxes as a factor.
“We have worked really hard to place medicine disposal bins across our county,” she said. “Four years ago, there were no bins that accepted controlled substances. Now there are 12. … That really helps in diversion. What we learned a lot of times, especially youth, their first time is because they took it out of a loved one’s medicine cabinet. Disposing (of the pills) or locking them up is a good strategy we have been working on for years.”
Yurok Judge Abby Abinanti, who has been vocal about fighting the opioid epidemic that disproportionately affects Native Americans in Humboldt County, noted strides are being made in the tribal approach to the crisis.
“We have a re-entry house. We have more advocates in the field,” she said. “We’re getting more people into treatment.”
But she said more can be done to reach out.
“What I would really like to see is more access to health care,” she said. “You are going to need some expanded health care delivery systems. .. In rural areas, not just ours, you are going to need mobile health units. … If people need it, we have to figure out how to provide it.”
The front lines
The Humboldt Area Center for Harm Reduction is one of the organizations dealing directly with those hit hardest by the opioid epidemic. As one of the organizations that is part of the Rx Safe Humboldt coalition, it’s been one of the key players in distributing the more than 4,000 naloxone kits Den Ouden mentioned. And HACHR tracks the reports of fatal overdoses prevented by the use of naloxone.
“This year alone, we distributed 1,181 kits of naloxone. Each of those kits has 2 doses,” said Jessica Smith, the executive director of the organization. “We had 62 reported reversals. … A lot of those kits get out to really rural places and those people might not get in to tell us (about overdose reversals).”
Last year, 204 reversals were reported to HACHR from the distribution of naloxone. Each of those was potentially a life saved.
Smith said that while the county is making strides in dealing with opioids, there are other drugs that are becoming a bigger problem.
“The biggest thing we are noticing is our methamphetamine and polysubstance use rates,” she said. “That is now surpassing our opiate uses.”
Smith said she hears a similar story from many local opioid users.
“A lot of the folks that we talk to, they are very candid about how they started on prescription opioids and then they couldn’t get those prescriptions anymore so they had to switch to heroin,” she said. “It is amazing that these prescriptions are decreasing. But we have to consider the unintended consequences. … They were getting a controlled substance that was easier to regulate and keep them safe. Now with fentanyl-laced drugs, they are at greater risk … It’s a balance. It’s a dance. They need what they need and they will do anything to not feel that pain or feel better.”
At least three lawsuits by Humboldt County entities have been filed against pharmaceutical companies that are blamed for the widespread use of opioids.
The Yurok Tribe filed the first lawsuit in March 2018.
“Without these pharmaceutical manufacturers and wholesalers, the widespread abuse of prescription pain pills on tribal lands and across the entire U.S. would never have reached the terrifying level it is at today,” the tribe’s General Counsel and tribal member Amy Cordalis said in a prepared statement at the time.
The three are part of more than 2,000 lawsuits a federal judge is contending with against pharmaceutical companies.
“It’s like the giant tomato that ate Chicago at this point,” said Abinanti this week. “… Those lawsuits are huge across the county. The federal judge supervising it is trying to get a grip on it.”
She said it’s hard to assign blame in something as big as the opioid crisis has become.
“Somebody needs to take responsibility for this,” she said. “The fact of the matter is that people knew how dangerous this was, and they did it (anyway). … That’s not OK. There is no possible way to justify that.”
Ruth Schneider can be reached at 707-441-0520.