Public Health
Update
New Resources to Combat Opiod Overdoses in san Joaquin County As a follow up to the article entitled “Public Health Update: A Look at the Opioid Crisis in San Joaquin County” in the Winter 2019 issue of San Joaquin Physician, this Update will share new opportunities for physicians in helping to mitigate the evolving opioid overdose epidemic. In early 2016 in California, the epidemic began to see a steep rise in fentanyl overdose deaths. Fentanyl is a powerful synthetic opioid that is about 100 times more potent than morphine, 30-50 times more potent than heroin. Just two milligrams of fentanyl can be lethal depending on a person’s body size. It is often mixed in with heroin and/or cocaine and meth as a combination drug with or without the user’s knowledge. Illicitly produced fentanyl has also been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone.1 While pharmaceutical fentanyl has been around for years as a transdermal patch or lozenge used to treat severe pain, such as in advanced cancer, the number of overdose deaths as a result of diversion to misuse and abuse had been relatively low. However, cases of fentanyl-related overdoses and deaths have now been associated with illegally made fentanyl and its analogs. As a result, the state saw a 9.5 times increase in overdose deaths from synthetic opioids (excluding methadone) through the third quarter of 2020. Locally, San Joaquin County also saw a steep 15-fold increase in the rate of overdose deaths in just a short period, between the end of 2018 (0.37 per 100K residents) to quarter 3 of 2020 (5.63).
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SAN JOAQUIN PHYSICIAN
In December 2020, the Centers of Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Advisory to alert public health departments, healthcare professionals, first responders, harm reduction organizations, laboratories, and medical examiners and coroners that substantial increases in drug overdose deaths starting in 2019 through now have primarily been driven by synthetic opioids (excluding methadone) such as fentanyl. In addition, the advisory also noted that the acceleration of increase in overdose deaths occurred from March 2020 to May 2020, coinciding with the nationwide implementation of COVID-19 mitigation strategies. Finally, CDC provided targeted recommendations for communities and organizations to respond to the evolving overdose crisis. The need for broadly disseminated overdose prevention education was emphasized. The recommendations also urged expanding the provision of naloxone, a drug antagonist that is easy to administer as a nasal spray and reverses the effects of opioids within minutes, albeit temporarily.
Naloxone Distribution Program (NDP)
Three years ago, the California Department of Health Care Services (DHCS) created a Naloxone Distribution Program (NDP) to provide free naloxone, in its nasal spray formulation, Narcan. Doses have been distributed broadly across the state, ranging from first responders, fire and law enforcement to harm reduction organizations and homeless programs, to religious organizations, and schools, as well as
FALL 2021
