Previous back injury. History of drug abuse. Coping with PTSD. (Some of the reasons people who died of overdoses in Shasta County became addicted to opioids in the first place, according to county health documents).
Shasta County Sheriff’s Lt. Gene Randall knows how to find the pulse of a neighborhood, and what he uncovers can be disheartening. In his 18-year law enforcement career, which started in Plumas County and continued in Red Bluff before he moved to Shasta County in 2010, Randall spent considerable time on patrol. It gave him insight on crime trends in communities and behavioral changes in people.
He has seen prescription opioids cause a dark ripple across the country, resulting in the rise of heroin. From 1999 to 2015, the number of prescription opioids sold and the deaths linked to powerful painkillers such as methadone, hydrocodone and oxycodone quadrupled, according to the Centers for Disease Control and Prevention.
Shasta County was not immune from the disturbing trend. Between 2007 and 2016, 213 residents died from an opioid overdose, according to data prepared by Shasta County Health and Human Services Agency for the Record Searchlight.
Randall, now Shasta County’s chief deputy coroner, is familiar with drugs and overdoses from his time on patrol. He got to know the families of numerous people with a prescription drug addiction — and how their lives changed.
“You can almost see the slow descent, when the families (start to go into) turmoil,” he said.
But there is one promising trend happening in Shasta County. Fatal opioid overdoses are falling, from a high of 29 in 2009 to 15 in 2015 and 16 in 2016.
Deputy Chief Coroner Gene Randall talks about what he’s seen both in law enforcement and now at the Shasta County Coroner’s Office in the opioid epidemic.
The Record Searchlight analyzed overdose and drug use data provided by the Shasta County Health and Human Services Agency for the previous decade and the Shasta County Coroner’s Office from 2007 and 2016 to find where the county stands in the opioid epidemic.
Those records showed a significant shift in the circumstances of people who died from an overdose:
- The lid got tighter on opioid prescriptions.
- Methadone went from the No. 1 opioid killer in 2007 to a treatment for opioid addiction as medication-assisted treatments became more accepted.
- While overdoses have declined overall, other signs point to addicts turning to heroin in addition to prescription drugs.
- Long-term dependence and addiction to prescription opioids took a human toll, mostly among older people. Pharmaceutical opioids, sometimes mixed with methamphetamine and alcohol, were the leading cause of overdoses in 2016. In 2007, heroin wasn’t found in any overdoses in Shasta County.
Shasta County health officials point to a variety of reasons why fatal overdoses are down, including new restrictions in prescribing opioids, improved communication among doctors treating pain patients, local acceptance of medication-assisted treatment such as methadone and buprenorphine, and heightened awareness about the problem.
Still, the county’s rate of overdoses is high. At 8.97 per 100,000 people, it remains almost double the state’s rate of 4.73.
“We have a big problem, but we are working on it,” said Dr. Andrew Deckert, Shasta County public health officer.
2007 vs. 2016
The Record Searchlight’s analysis of opioid-related overdoses in 2007 and 2016 show sharp contrasts between the two years. Those who overdosed in 2016 skewed a little older and were less likely to have family present in their life. The average age for those who died in 2007 was 43; the average in 2016 was 48. Prescription medications, most prominently methadone and hydrocodone, were supplanted by heroin and morphine, itself a byproduct of heroin.
While 2007 overdoses mainly involved prescription-based drugs to control pain and treat depression, 2016 showed victims were self-medicating due in part to the absence of mental health care, said Susie Foster, chief medical director for Hill Country Health and Wellness Center.
“As you can see, you can’t just take away the pain medications. It does not work that way,” Foster said. “You have to taper them off the pain medication (followed by) regular mental health appointments or at least contact with somebody who can help them through the process from a behavior standpoint so that they don’t turn around and go to heroin.”
The analysis also looked into the root causes of why people took opioids in the first place, which didn’t change much between the two years. Many victims were originally prescribed opioids for pain caused by injuries, surgeries or accidents. Others were on drugs to treat depression and other mental health issues.
An injury led David Horstman to opioids after he tore his ACL 17 years ago. After five months of physical therapy in Phoenix, Horstman, now a counselor and program director at Right Road Recovery Programs in Anderson, said the withdrawal was too agonizing when he tried to quit. It eventually drove him to the black market to find opioids, specifically OxyContin, “and that was it,” he said. “Within eight months, I was committing crimes to buy pills.”
What’s driving the decrease
Local health officials, at first surprised to realize that opioid overdose deaths had dropped over the past 10 years when shown the Record Searchlight’s analysis, offered up explanations why. Besides changes in medications and how they’re prescribed, they note public awareness of opioid abuse, antidote shots and the closure of a pain doctor’s practice contributed to the drop. Data also show that the number of people entering rehab in Shasta County has risen.
Tony Brigman, a counselor at Right Road Recovery Program’s satellite office in Redding, said increased awareness of the opioid crisis has reduced stigma associated with the addiction, leading more addicts to seek help.
“I see a lot higher functioning people,” he said. The people coming through the doors have jobs, are still in relationships and function as parents, he said. They are doing “the best they can as far as getting their children to school, feeding them.”
Right Road’s Redding campus is seeing more functioning addicts walking through the door, counselor Tony Brigman says.
Deckert and Lt. Jeff Wallace of the Redding Police Department say wider access to Narcan, which can reverse an opioid overdose, also reduces deaths. The shots, once available only to paramedics and health professionals, are now available to addicts and their family members. They’re free for people on Medi-Cal and Medicare. The county also distributed Narcan to the HOPE Van and the Shasta Community Health Center.
In 2016, medics gave 143 shots, roughly in line with previous years. In the first six months of this year, 49 have been administered.
Deckert also credits drives to collect unwanted and expired medication. The county has collected 4,500 pounds of medication at 10 events since 2011, he said.
Another factor in play is the kind of heroin available on the West Coast. The black tar is different from the powder heroin found on the East Coast, said Dan Ciccarone, a professor with the University of San Francisco’s Department of Family and Community medicine who has studied heroin for 20 years. The powder heroin is easier to cut, particularly with fentanyl, a painkiller deadly at low doses found more often in heroin in the eastern part of the U.S.
Changes in prescriptions
Other efforts have had some success in controlling opioid access, Deckert said. This spring, Partnership HealthPlan of California, which administers Medi-Cal in the North State, reported an estimated 9.6 prescription opioids were filled per 100 members in Shasta County. That represented a 65 percent drop since January 2014. Partnership officials said several factors drove the decline, including new prescribing guidelines.
Nonetheless, Shasta County still has plenty of opioid pharmaceuticals: For every Shasta County resident, there were 1.3 opioid prescriptions, including patients with private insurance, a prescription-tracking database reported in 2013, according to HHSA.
When it comes to opioids, however, the most dangerous prescriptions are the long-lasting variety, Deckert said.
As they linger longer in the body, there’s more time for a bad interaction or overdose through combination with another medicine, Deckert said. That may explain the average overdose age being 43 in 2007 and almost 50 in 2016. Older individuals are more likely to have health problems, thus more medications and a greater chance to combine the wrong drugs, Deckert said.
Redding police Lt. Jeff Wallace describes what officers see on the street with overdoses, including a 60 percent spike in overdose calls.
Long-acting methadone is especially worrisome if not tightly controlled, said Dr. Leonard Soloniuk, who operates The Pain Solution Center on Airpark Avenue and works at Redding Opioid Recovery Medical Clinic.
Methadone went from Shasta County’s No. 1 fatal opioid in 2007 to registering in just two cases in 2016, according to data from the coroner.
Between 2007 and 2015, emergency room visits for methadone fell from 19 to six. But heroin emergency room visits shot up from one to 56, HHSA data show.
The closure of one pain doctor’s office appears to have also contributed to a drop in methadone available on the street. James Gregory White pleaded guilty to failing to maintain records in 2014 after his arrest on suspicion of overprescribing. He prescribed a large amount of methadone, RPD’s Wallace said. The Medical Board of California also yanked White’s license after several patients overdosed.
“Methadone is a unique danger,” Soloniuk said. “(With oxycodone), Norco, you feel it working in 45 minutes or so. Methadone is very slow, subtle. If you’re used to taking Norcos or oxycodone, you might take a dose and feel nothing. You take a dose, and feel nothing. You take a dose and feel nothing,” Soloniuk said. “You take a dose, and you’re dead.”
Rehab rates rise
While opioid overdoes deaths have dropped, the number of people entering rehab, especially for heroin, has risen dramatically over the past 10 years.
In 2007, 86 people entered rehab for heroin addiction. In 2013, a sharp rise started, with 341 seeking rehab for heroin abuse. By 2015, the most recent year such data are available, 501 people were in treatment.
But many people addicted to opioids take more than one drug, and treatment centers say they are seeing more people coming in seeking help to get of multiple drugs.
“My patients don’t come in and are just positive for heroin,” Foster said. “They’re positive for heroin, PCP and methamphetamine, and they say, ‘Oh I just took this one thing.’ Well, that’s because the (drug dealers) are just mixing them all together.”
Right Road’s Brigman said he’s seen more opioid addicts seeking treatment for two or more drugs, usually benzodiazepines or methamphetamine, at the Redding office.
Nine out of 10 clients who came for detox to Empire Recovery Center last year were abusing more than one drug, said Margene Stone, executive director. Fewer than 10 percent of the clients were using alcohol only.
“Almost everything is polysubstance (abuse),” Stone said.
Health officials are working to continue to reduce opioid addiction and overdoses.
A methadone clinic operated by Aegis Treatment Centers out of Chico opened in April, and it serves more than 100 patients daily who take a single methadone dose to curb opioid cravings for the day.
Shasta County continues efforts to reduce over-prescribing opioids through a coalition of health professionals called NoRxAbuse launched in early 2016. The coalition provides information about lethal drug combinations among muscle relaxers, opiates and anti-anxiety drugs to local doctors. The program also requires local pharmacists and physicians who prescribe controlled substances to use a federal prescription drug-monitoring program, the Controlled Substance Utilization Review and Evaluation System. It’s a database that reveals patients who have double prescriptions or are doctor shopping.
Another measure points to some success in curtailing excessive prescriptions, public health’s Dr. Deckert said. Between 2010 and 2015, the amount of opioids prescribed declined 28 percent, according to CDC data.
“That’s another sign we’re starting to make progress,” Deckert said. “Do we still have a problem? Yes. … We’re still way above California.”