Transcription:
Rx Safe Marin: Addressing the Opioid Epidemic at a Local Level

Bill Klaproth (Host):  It seems like opioid addiction is in the news every day. So, what do you need to know about this? We’ve got answers for you. Here to talk with us about opioid addiction and Rx Safe Marin is Dr. Matthew Willis, Public Health Officer for Marin County. Dr. Willis, thank you for your time. So, how big of a problem is opioid in prescription drug misuse in Marin County?

Matthew Willis, MD (Guest):  Well, really every community in the US has been affected by this epidemic and Marin has been deeply affected really going back to about 2010 when we started to see significant increases in the number of opioid overdose deaths in Marin. When I became health officer in 2013; we were seeing about one accidental overdose death to opioids every two weeks, just in our Marin County population. And this is a pattern that was being seen all over the nation. So, we decided that this was not only a healthcare issue but actually a public health priority requiring a community wide integrated effort.

Bill:  Wow, Dr. Willis, one death every two weeks. Let me ask you about this statistic then, Americans constitute 4.6% of the world’s population and consume approximately 80% of the world’s opioids.

Dr. Willis:  Yes. We are an outlier as a nation. The next highest opioid prescribing nation is Canada and they themselves are facing a huge epidemic and they prescribe about half as much as we do. You know partly it’s important to know a little bit about the history of how we got here. In 1996, the Purdue Pharmaceuticals was able to actually get FDA approval for the use of oxycontin for the management of chronic pain which was a new indication for opioids. We hadn’t been using opioids for chronic pain up until that point. And over the next 15 years, or so, there was a quadrupling in the amount of opioids being prescribed partly because clinicians like myself who were working in primary care settings at that time; were encouraged to think about opioids as a safe and effective remedy for pain. We have learned since then that that was actually a misunderstanding. The opioids were not nearly as safe or as effective as we had thought they were and were in fact, much more addictive than we had realized. So, over that period of about 15 years of over prescribing; we have rendered an entire piece of our population dependent or addicted to opioids and now we are working to try and clean that up.

Bill:  You know you mentioned overprescribing, there’s another statistic there are enough prescribed opioids for each American to take a prescription opioid every 4 hours for a month. I mean that really illustrates what’s going on here.

Dr. Willis:  That’s right. Those are national statistics. In Marin County, we are seeing that there was almost a tripling in the opioid prescribing between the year 2000 and the year 2013. We have data that allows us to measure very specifically the number of opioids being prescribed in Marin down to the pill through a database that’s maintained by the Department of Justice for all controlled substance prescribing; so we know that we had 11,300,413 pills of opioids prescribed in Marin County last year which is enough for each person to have about 44 pills, every man, woman and child, in Marin and that’s after having made some significant improvements in our opioid prescribing rates over the last three years. So, it still remains a significant overall burden in terms of just the amount of opioids being supplied and dispensed into our community and the corresponding concern around harms whether it’s overdose deaths or addiction.

Bill:  Unbelievable. So, what are the risk factors then for becoming opioid dependent?

Dr. Willis:  Well one of the difficult things about addressing this epidemic is that it’s really affecting every community. When we look at demographic factors, we see people in all age groups being affected by this from high school students up into seniors and then all demographic groups, all genders  and ethnicities and races. So, we really need to make sure that we are taking that holistic approach in recognizing that every family, every community is potentially at risk. These medicines when used for even just short courses for acute pain, can in some people lead to long-term addiction. There are some factors we can look to, to determine what that risk might be. For example, history of substance use disorder, either personally in that person’s life or someone in their family, history of mental illness for that person or someone in their family are probably some of the most important factors for physicians to take into account when they are considering prescribing opioids. But really, we need to make sure that we are judiciously prescribing and every time because it is actually hard to predict who may develop an unhealthy relationship with these if they are given an opioid prescription.

Bill:  And you mentioned that you are addressing the problem. So, can you tell me about Marin’s prescription drug misuse and abuse initiative called Rx Safe Marin?

Dr. Willis:  Yes, RX Safe Marin is a community wide coalition to address the opioid epidemic at the local level. We recognize that this is a complex social problem. It may have its roots in healthcare and prescribing patterns historically, but the solutions are going to have to be beyond healthcare. We need to work with our law enforcement partners. We need to work with our educators. We need to work with our prescribers and our pharmacists, our elected officials and so Rx Safe Marin has created an infrastructure for all of those necessary partners to come together and have a conversation about what our goals actually are and what strategies we should employ working together across systems. A recent example of a success with the district attorney. The district attorney sees when people are misusing opioids or using them illegally and so for example someone is selling opioids that they have been prescribed; they can actually correspond and send a letter back to the prescriber to say just so you know, your patient John Doe was arrested for selling medications that you are prescribing. You may want to take this into account in your future prescribing for John Doe. We actually had no mechanism for that kind of communication to occur. So, an example of how a coalition kind of across sectors can find new strategies that can mutually beneficial.

Bill:  So, it sounds like you are coordinating local options and support systems kind of putting them together to try to treat the problem and the patient.

Dr. Willis:  Exactly, yeah, I mean another example is people who are unfortunately struggling with addiction can end up in our criminal justice system, in jail. And we are working now with our jail in new ways to make sure that people who end up in jail as a result of opioid use disorder or criminal activity associated with that, can get treatment while in jail and when they are released from jail that they have access to the medication called naloxone and can reverse an overdose when it occurs. This is a strategy that really comes out of a coalition approach where we are bringing our law enforcement partners into the mix.

Bill:  So, Dr. Willis how can someone take advantage of Rx Safe Marin?

Dr. Willis:  Well everyone has a part to play. The opioid epidemic is affecting all communities and we really think that everyone from our consumers, our patients to our providers and across the community have a role to play in RX Safe Marin. We have action team meetings on a monthly basis around different sectors, so we have law enforcement team, we have a community-based prevention team that helps us design educational materials for community members. We have a team dedicated to working with people who are in recovery from addiction and other teams. Those all can be seen on our website rxsafemarin.org, that’s rxsafemarin.org. And anyone who is interested in joining our effort and learning more about it can look on the website and see when the next meetings are.We have a community-wide convening on April 12th with one of our Marin General Hospital experts in pain management Dr. Ramana Naidu will be one of the participants in this gathering dedicated to healthy pain management. So, helping us think about how we can address the pain that people are experiencing without prescribing opioids that may be causing more harm than good.

Bill:  Well it sounds like a wonderful initiative and Dr. Willis thank you so much for talking to us about it. Once again, for more information visit www.rxsafemarin.org that’s www.rxsafemarin.org . This is the Healing podcast brought to you by Marin General Hospital. I’m Bill Klaproth, thanks for listening.