PD Editorial: Opioids, the other public health emergency

The No. 1 public health emergency over the past 14 months has, of course, been the coronavirus pandemic. But the opioid epidemic, which was raging long before most of us heard of COVID-19, hasn’t gone away.

In Sonoma County, among other places, it has gotten worse.

Opioids are powerful painkillers with brand names like Vicodin and Percocet that doctors prescribe for serious injuries or end-of-life palliative care. The problem is they’re highly addictive. And when people get hooked, they often turn to illegal drugs such as fentanyl, an especially potent synthetic opioid that’s driving a spike in local overdose deaths.

In a sobering report published Sunday, Staff Writer Nashelly Chavez details the North Bay’s fentanyl epidemic, its tragic repercussions for local families and the burden on substance-abuse counselors and law enforcement officers.

“It’s gripped this country,” Santa Rosa Police Sgt. Brian Boettger told Chavez. “It’s the focal point of most of our investigations.”

Fentanyl is often mixed with other drugs, so people may not know there are taking it. Yet even small amounts can be lethal.

In 2017, two people died of fentanyl overdoses in Sonoma County. The number climbed to six in 2019. Last year, it shot up to 29.

Fentanyl was detected along with other drugs in 12 fatal overdoses in Sonoma County in 2017. By last year, that figure was 80, an almost sevenfold increase in just four years.

The numbers by themselves are grim. But a per capita comparison with other California counties illustrates the scope of the local opioid crisis: In 2019, Sonoma County ranked third among the 58 counties for fentanyl-related overdose deaths, trailing only San Francisco and Mendocino.

With the social isolation and economic instability that have accompanied the coronavirus, people are experiencing a great deal of stress. Various surveys indicate that drug abuse is up, so it isn’t entirely surprising that overdose-related deaths increased in 2020.

But the trend already was established, locally and at the national level.

The Centers for Disease Control and Prevention reported an unprecedented 81,000 drug overdose deaths in the United States between May 2019 and May 2020, a 12-month period that included only a brief overlap with the pandemic. About 70% of overdose deaths are opioid-related, according to the CDC.

Police and prosecutors are focused on manufacturers and traffickers. Sonoma County District Attorney Jill Ravitch’s office received a $340,000 grant from the U.S. Justice Department to help with opioid-related cases.

A supply-side approach is important, but it only goes so far. It’s also necessary to reduce demand.

President Joe Biden’s American Rescue Plan includes $1.5 billion for treatment of substance abuse — money that would support community organizations like the Santa Rosa Treatment Program, which offers opioid users counseling and methadone — which reduces cravings for illicit drugs like fentanyl.

Other potential solutions include improving management programs for chronic pain so people might be less likely to self-medicate, and requiring that health plans include abuse-deterrent opioids, such as delayed-release tablets, in their formularies. Also important is removing the stigma of addiction, so people are less reticent to reach out for help.

The coronavirus trend lines are pointing in the right direction: infections are down, vaccinations are up and, unless things change dramatically, most of California’s restrictions will be gone by mid- June.

But we must stay focused on our other public health emergency: opioid abuse. Lives depend on it.

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