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cvm_mag_vol6_no3

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12 | CENTRAL VALLEY MEDICAL | WINTER 2017-18 rooms. Other brand names of opioids people might recognize are Demerol, Oxycontin, Percoset, Vicodin, Butrans and Hycodan, to name a few. Dr. Karen Haught, Tulare County Public Health Officer, said the majority of opioid overdose deaths are due to a state of extreme re- laxation. The first two warning signs of an overdose on prescription pain pills or opiate-based illicit drugs is contraction of the pupils and then unconsciousness. As the body is unable to detoxify from an oversue of the medication, the drug begins to directly affect the region of the brain that controls breathing. A person's breathing pat- tern becomes erratic and then shallow before ceasing altogether. Nearly half (45%) of all overdose deaths in Tulare County over the last decade are due to opioids, according to the California De- partment of Public Health. Nearly two-thirds of opioid deaths in Tulare County are attributed to prescription medication, a number that doesn't include if the patient was taking the drugs as directed or if the medication was being used by someone other than the per- son for whom the prescription was written. Heroin is responsible for about 13% of opioid overdose deaths in the last decade, the highest percentage among illegal drugs. But does that mean Tulare County has an opioid epidemic? Not exactly. When compared to surrounding counties and the state average, opioid overdose deaths in Tulare County are currently at their low- est level since 2008 while the state, Kings and Kern County have seen a slight increase. Similarly, deaths from overdose of all drugs has seen a slight decrease in the last 10 years in Tulare County, while the state as well as Fresno, Kern and Kings Counties have seen in increase. Dr. Lester Love, medical director for Tulare County Health and Human Services Agency's Mental Health branch, said the reason for Tulare County's low opioid abuse and death rates are probably three-fold – public perception, physician outreach and partner- ships. Public PercePtion Love said many Baby Boomers are entering substance abuse pro- grams at an increasing pace because they have both money and free time in their retirement years. They are also mindful of their privacy and unwilling to admit they have a problem with a drug they likely obtained through a prescription. "The number of people who seek care is much smaller because there is so much shame and stigma associated with it. It takes an incredible amount of courage to raise your hand and say you need help, especially with legal drugs." That's probably true given that three in four adults in Tulare County have a prescription for opioids. After a significant drop in early 2009, the number of opioid prescriptions filled at Tulare County pharmacies have steadily increased. In summer 2014, opi- oid prescriptions reached a high of 897 for every 1,000 adults. But last fall, the number of prescriptions had dropped to its lowest point (755 per 1,000 adults) since fall of 2010. While there are less people using opioids in Tulare County than the state average, there are more people with multiple and overlap- ping prescriptions in Tulare County. Nearly twice as many Tulare County residents have at least two overlapping opioid prescriptions in a 30 day period than the state average, a statistic that measures the number of people on a "high-risk" opioid regimen. Tulare County's rate is also higher than surrounding counties. Doctors in Tulare County are also prescribing stronger medica- tions than their counterparts across the state. Tulare County has more residents being prescribed long acting, extended release opi- oids who had not been on opioids for at least two months. People suffering from chronic pain build up a tolerance to opioids but pre- scribing the narcotic long term to those that have not built up a tolerance could put them at higher risk for addiction and overdose. Fresno has similar rates to Tulare County while Kings County is lower and Kern County is higher. Physician outreach In the last two years, Dr. Love said that they have seen a reduc- tion in the number of patients with opioid prescriptions at county Health Care Centers in Visalia and Farmersville. He said family practice physicians and psychiatrists at both the health care centers and other non-profit and private providers hold monthly meetings to discuss best practices for prescribing opioids. "We've talked about the problem on more than one occasion and steps we can take to address it," Love said. Recent studies show that high-volume subscribers, often referred to as "pill mills," and patients shopping around for multiple pre- scriptions are only a small part of the problem. In a study of 4 million residents in five states (including California), researchers at Johns Hopkins Bloomberg School of Public Health found that doc- tors who prescribe a low volume of opioids accounted for nearly half of all prescriptions to high-risk patients, those with a history of overdose, history of substance use disorder, higher opioid dosages "There's no poster child for opioid addiction. In the case of many seniors, they don't know that they are addicted." PATRICIA HAMILTON supervisor for Tulare CounTy's alCohol and drug prevenTion programs Since 2008, the number of people being prescribed more than 90mg of opioids per day in Tulare County has been cut in half and is at a 10-year low. Cover Story

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