An insidious affliction that often starts out as an effort to treat a medical issue now has the United States facing a growing epidemic of opioid abuse that is claiming the lives of tens of thousands of people every year.

Seeking to stem the tide, El Dorado County leaders hosted a Treatment and Prevention Convention at the fairgrounds Sept. 27 that attracted between 150-200 attendees.

Led by a panel of experts, the assemblage examined the drug abuse problem in the country, with a particular emphasis on opioids, from a medical, legal and societal perspective as well as what resources are available to those seeking treatment.

Consisting of legal and illegal drugs, opioids make up a class of drugs that include heroin, synthetic opioids such as fentanyl and pain relievers available legally by prescription such as oxycodone, hydrocodone, codeine, morphine or related drugs.

The extent of the problem nationally was summarized by Brian Glaudel, a diversion investigator with the U.S. Drug Enforcement Agency in Sacramento.

He noted that America has only five percent of the world’s population yet consumes 99 percent of the hydrocodone (Vicodin) and 85 percent of the oxycodone (OxyContin). There is also a cycle of drug abuse with 80 percent of heroin users starting with opioids and four out of five new heroin users turning to heroin after using an opioid painkiller for non-medical purposes.

One of the reasons for such excessive use of opioids seems to be how freely they are available by prescription. According to Glaudel, California is the state where the most prescriptions for hydrocodone were written, in 2015, more than 837 million were written followed by Texas with 518 million and Michigan with 362 million.

Friends and relatives are the most frequent source (66.4 percent) of an abuser’s prescription painkillers. Another 17.3 percent are prescribed by a doctor, 7.1 percent are other sources, 4.8 percent are taken from a friend or relative without permission and 4.4 percent are from a drug dealer or stranger.

With so many pills and other drugs available, the number of people dying from a drug overdose has also increased. Provisional numbers show that 72,206 people died of an overdose in 2017, which is double the number 10 years ago.

Heroin use has increased more than 60 percent (114 percent in whites) in recent year with one of the concerns being that heroin and prescription opioid epidemics could lead to new HIV outbreaks.

Continued drug use also leads to a heightened risk of death. James Gasper, a psychiatric clinical pharmacist with the El Dorado Community Health Center, noted the trajectory of untreated heroin addiction in a sample of 581 males. Those in their 30s still using were 71 percent, in jail 18 percent and dead 14 percent. Those in their 40s still using were 75 percent, in jail 12 percent and dead 28 percent. By the time someone was in their 50s, those still using were 77 percent, those in jail 6 percent and those dead 49 percent.

An even worse problem is how the heroin epidemic is now being overtaken by addiction to fentanyl, which is a powerful synthetic opioid analgesic similar to morphine.

According to Glaudel, fentanyl is 50-300 times more potent than morphine. Other versions of fentanyl such as lofentanil is 7,000 times more potent than morphine and ohmefentanyl is 20,000-50,000 more potent.

Ohmefentanyl is used to tranquilize large animals such as elephants.

Terri Stratton who works at the El Dorado Community Health Center, also reported there is a change in who is starting to inject drugs. Nationally, in 2005 it was 38 percent of blacks, 19 percent of hispanics and 28 percent of whites. By 2015 it was 19 percent of blacks, 21 percent of hispanics and 54 percent of whites.

El Dorado County statistics



Looking at the problem of drug abuse locally, Dr. Nancy Williams, El Dorado County’s (EDC) public health officer, noted that EDC’s opioid prescription rate is consistently above the average rate for California by 39 percent. The overall drug-overdose death rate (including non-opioids) in the county is also above the average for the state although the death rate from opioid overdose is below the state average. In addition the rate of prescribing buprenorphine is higher in the county than in the state.

Buprenorphine, along with methadone, is used to prevent withdrawal symptoms in people who are addicted to opiate drugs. Another drug, naltrexone, is used to manage alcohol or opioid dependence.

Sgt. Troy Morton, who is with the EDC Sheriff’s office, said while there was a spike in heroin use beginning in 2011, currently there is more abuse of OxyContin with many people admitting their addiction began with a prescription. They are also seeing a wider distribution of fentanyl, which is far stronger and more addicting than heroin.

Morton noted that the reasons people give for using opioids are varied. Common ones include to get high, in response to peer pressure, for pain relief, in response to mental or physical problems, because of addiction or for other reasons.

According to Morton, in 2017 there were 25 accidental overdose deaths in the county due to all drugs, 20 were multi-drug overdose deaths where opioids were present in the victim and one overdose death was due to opioids only. There were also seven suicides by overdose in 2017.

Morton reported that drugs also contribute to vehicle fatalities. In 2017 there were 21 fatal vehicle collisions related to drugs. In about one-fourth of those deaths the person had opioids in their system.

Something of a generational problem, there is evidence that a majority of people who abuse or who are dependent on psychoactive substances began to abuse alcohol and drugs as teens.The children of parents who use are more likely to use themselves which suggests a genetic link to drug abuse. In addition, the children of parents with a substance abuse problem are at an increased risk for abuse and neglect and for poor academic, health and psycho-social outcomes.

Services and treatment options

Conference attendees were also briefed on local services for drug abusers and in particular those with an opioid addiction.

EDC Behavioral Health offers a variety of services including screening and assessment, referrals to treatment, recovery and support services. In addition there are special programs for youths including peer council prevention programs, programs for those incarcerated and other services.

The county also has a syringe services program where it provides free sterile needles, safe deposit of used syringes, referrals to mental health services or treatment, HIV and hepatitis testing, overdose treatment and education and vaccinations.

Because of a rise in chronic Hepatitis C cases, the syringe program is seen as way to serve marginalized communities and increase the use of naloxone, a medication that blocks the effects of opioid medications and decreases the spread of Hepatitis C and HIV.

Hospitals have been hit particularly hard nationally by those with substance abuse problems, resulting in one million ER visits per year with drug use being the primary problem. Drugs also make up 20 to 40 percent of the reasons for hospital admissions and 50 to 75 percent of trauma visits.

Drug and opioid abuse treatment is available through Marshall Medical Center and Barton Health System. Progress House also operates extensive detox, residential and outpatient services at its different facilities throughout the county.

Aegis Treatment Centers, which is an outpatient center for heroin and opioid painkiller addiction and one of the sponsors of the conference, has centers throughout California and will be opening a new center in Placerville early next year.

The conference also noted that an Opioid Coalition of El Dorado County has been formed. Made up of different agencies involved in responding to the problem of drug abuse and specifically opioid use, it is funded by a grant from Aegis and will be meeting regularly to share information and to collaborate on addressing the issue of opioid abuse in the county.