Dr. Aaron Chapman, medical director for Alameda County Behavioral Health Care Services told Action Alameda News that the abuse of opioid painkillers is a nationwide, statewide, and county-wide problem.
“We are seeing increases in emergency room visits related to opioids over the past six years or so. We continue to see deaths related to opioid toxicity, although it’s hard to say there’s been an increase. Some numbers may be undercounted, due to mis-coding,” he explained.
In 2014, the latest year for which Chapman could provide data, there were 2,091 emergency room visits related to opioids, of which 593 were related to overdose or poisoning. Some of the visits may reflect a legitimate need for a prescription painkiller refill, he said, but that would be a failure of the health system. “The emergency room is not where we like to see patients going for refills. It should be co-ordinated with a doctor as an out patient service,” he said.
Looking at 2015 data, Chapman said the county recorded 725 emergency medical services patients who were treated with naloxone hydrochloride, also known by its trade name Narcan, to counteract presumed opioid intoxication. That’s about twice per day.
Paramedics err on the safe side when it comes to apparent opioid intoxication. “Because naloxone is a pretty safe agent to give, it’s recommended to administer it as the safe thing to do. I can’t say in every one of those cases that the patient was at risk of death, but certainly in the majority of cases,” he said.
The increase in emergency room visits is due to prescription opioid painkillers, whether they are purchased on the street or prescribed by a doctor, and street heroin, Chapman said.
“Addiction to heroin after painkillers are cut-off is a real problem,” he said. “The pendulum swung to the aggressive treatment of non-malignant pain with Oxycontin, Percocet, and we’re looking back on those times now as having made mistakes. We may have accidentally created a number of opioid addicted patients. We need to educate physicians.”
However, the severity of the problem within Alameda County is on par with, and not out of proportion to, what the rest of the country is seeing, Chapman said.
Within the City of Alameda, naloxone is used often by Alameda Fire Department paramedics, according to Chief Douglas Long, by way of City Manager Jill Keimach. The department has been equipped with naloxone since the inception of the paramedic program.
Paramedics respond on all medical emergencies in Alameda with emergency medical technicians (EMTs) assisting them. Administration of naloxone by EMTs has been approved by the State of California, but that practice hasn’t yet been adopted by Alameda County emergency medical services, and consequently not by the Alameda Fire Department.
The drug can be administered by injection into a muscle using a syringe, intravenously, or as a nasal mist, the most common method used by Alameda Fire Department paramedics.
The opioid problem is a multi-factoral one that requires answers on many levels, Chapman said. “There needs to be a different approach for those already dependent and who have a substance abuse issue. We need to give treatment, not cut off access to pain medication. We need more money committed to treatment for people who already have dependencies.”
“On the other hand,” he continued. “We need to change the practice of prescription. We need to change the aggressive practice of prescribing painkiller medication. We now know that it’s incorrect to think that the treatment of pain with opioids does not lead to addiction.”