doctor shopping in northern californiaHospitals in California treat one heroin or prescription opioid overdose every 45 minutes.The recent epidemic is affecting the entire nation and California, the most populated state in America, has felt its effects keenly, particularly in the northern counties. The explosion of opioid addiction is largely due to “an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry,” according to a widely-cited 2012 academic study. Other studies have noted wide variations in how doctors prescribe opioids. Also, illicit use of heroin has risen sharply, particularly among young adults, state ER visitation data show.

From the rich suburbs to the desert towns, Northern Californian doctors are struggling to control a wave of overdoses that have been fueled by a black market of prescription medication and heroin. The war on drugs is ongoing but it’s important to recognize that the supply is rising to meet a demand caused by legally prescribed medication: opioid pain relievers.

What is the California Department of Public Health Doing?

One of the key factors recognized as a contributing factor to the epidemic is lack of education. People tend to believe that drugs prescribed by their doctor are safe, and do not proceed with sufficient caution when taking prescription opioids.

The California Department of Public Health (CDPH) and its state partners convened a Prescription Opioid Misuse and Overdose Prevention Workgroup with the intention of improving collaboration and expanding joint efforts among state agencies working to address this epidemic. Goals include:

• Promote safe and effective prescribing and dispensing policies and practices.
• Guide appropriate patient use, storage and disposal of prescription drugs.
• Support proper pain management methods.
• Minimize the unintended consequence of increased heroin use.
• Promote the expansion of medically assisted treatment opportunities.
• Workgroup membership is representative of many agencies and disciplines, bringing diverse perspectives and valued content expertise.

The workgroup included task forces to address specific aspects of the problem, focusing on: Communications and Outreach, Data Gathering and Sharing, Integrated Health Care and Policy, and Treatment.

In 2015, the California Department of Public Health was awarded a four year grant from the Centers for Disease Control and Prevention (CDC) to implement a comprehensive program addressing opioid misuse and abuse in California’s counties most impacted by the opioid epidemic. The Prescription Drug Overdose Prevention Initiative (PDOP) focuses on three primary interventions, including promotion of safe prescribing policies and increased use of naloxone; outreach and education to local health departments and other community-based interventions; promoting the use of the Controlled Utilization Review and Evaluation System (CURES), which tracks and monitors all opioid prescriptions within California.

This last was given a big boost recently: on September 27, Gov. Jerry Brown in California signed into law Senate Bill 482, which legally requires a health care practitioner to consult the CURES database and to review a patient’s controlled substance history no earlier than 24 hours, or the previous business day, before prescribing a Schedule II, III, or IV controlled substance. This is a big step in the direction of curbing so-called doctor shopping i.e. a patient obtaining controlled substances from multiple healthcare practitioners without the prescribers’ knowledge of the other prescriptions.

The concern is that laws making it harder for patients to obtain the pharmaceuticals may simply open the doorway for desperate addicts to seek out heroin as an easier to obtain (and sometimes cheaper) substitute. Increased awareness of the signs of addiction, and fast intervention on the part of those in a position to recognize it, will be key to effectively addressing this epidemic.

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