The Opioid Epidemic in Sonoma CountyBy: Meghan Brewer, Kayla Allen, Thomas Lopiparo, Leah Albaracin, Spenser Rey
Opioid use, misuse and addiction has become a nationwide epidemic that is currently affecting a vast majority of communities in the United States. Misuse of the drugs can often lead to substance use disorder or even overdose, and the rates of abuse have continued to climb. Due to the epidemic’s wide influence, regulations and treatment centers have started to emerge to help put an end to this ongoing crisis, though opioid use does still continue to flood the market. Opioids can very easily be prescribed to patients in need of pain relief and have also been found to be passed around through communities by friends and family members. In the past, prescription opioids were widely believed to be a non-addictive drug, and due to how easily attainable they are, this allowed for large populations of patients in need of any type of pain relief to quickly become overly dependant, and addicted to these drugs. In this study, we will go into various aspects such as gender, race, age, socioeconomic status, along with treatments and prescription, and how each may influence the growing rates of use in regards to the epidemic locally and nationally.
In parts of the west coast, such as Sonoma County, the rates of emergency visits to medical facilities due to opioid use has gone up 50% between the years of 2010 and 2017. Over the last 20 years addiction and overdose due to the use of Opioids has increased significantly in Sonoma County. Sonoma County has one of the highest rates of Opioid use in the state of California, continuously affecting those prescribed and those who are easily able to find the drug. Sonoma County’s current rate of hospital visits as a result of opioid mistreatment at an astounding 80% above the statewide average of California as a whole. In 2014, statistics show that 1 in 4 residents in Sonoma County were prescribed opioids by doctors. As of this year, around 53% of those individuals were prescribed one opioid medication and 25% were prescribed around four or more.
How does the increasing rate of opioid use in Sonoma County connect to the growing epidemic in the United States? The methods used in search of answers to this research question, is a survey with students at Sonoma State University and interviews with multiple scholars who had intensive knowledge about opioid use in Sonoma County. Our survey consisted of questions about race, gender, age, and employment status to get a demographic of SSU. The following questions on the survey that were asked was if you knew someone with a opioid prescription, if you knew someone affected by opioid addiction, how easy would it be to gain access to a form of prescription opioids, and have you ever used a form of prescription opioids. For our interviews we covered prescription use between gender, race, age, and socioeconomics.
We also asked if they noticed any changes when they began working in the field to today's use of opioids, access to them, and treatment centers. Over the last twenty years, males have been more affected with the Opioid Epidemic vs. females. In 2017, Over 1,600 males in California overdosed, misused and abused opioids and only around 700 females overdosed, misused and abused opioids. Studies show that White males from ages 18-35 have higher rates for using opioids. The reason for this being is because men have a lower pain tolerance than females and use opioids to cope as well. In recent studies, it states that males are prescribed for surgeries, injuries or are even have them distributed to them without prescription and they abuse them. In 2011, 33% of admissions to rehab facilities were women, while nearly 67% were male. The male ratio for opioid epidemic is very high and continues to increase. Although the male ratio is much higher than the female ratio recent studies show that females are more likely to use opioids rather than males. The reason why is because females are known to have more health problems and medical issues vs. males. They are seen more often and prescribed painkillers for their issues. Females however aren’t as likely as males to misuse, abuse or distribute to others. However, female celebrities are more likely to abuse opioids vs. male celebrities. Female celebrities are insecure with their bodies, have mental health issues and use opioids as well to cope with their problems. Recent studies indicated that women are starting to catch up to males with using opioids more frequently.
Through the research we conducted as a group, we conducted a survey questionnaire regarding the availability of opioids around the students of Sonoma State University. After surveying 258 students, we found that 179 of those students were female, 77 were male, and 2 identified as other. Of the 179 female student responses, 92 students claimed they knew a way to attain a form of prescription opiate. That is over 50% of the female population. These numbers are staggering to examine among college students. Each year it continues to increase as well for women and has different effects on them.Even though females are commonly more prescribed opioids, males are more common to abuse them and become addicted. In Sonoma County 67.5% males use opioids and have easy access to them and only 32.5% of females use and have easy access to opioids. This being the reason why drug misuse is so high in Sonoma County because males are more common to abuse them and a majority of those males are White. Even after conducting surveys at Sonoma State University and interviews with professionals the most common answers for gender use were in males. The opioid epidemic affects every gender but it is mostly striking males at a higher rate.
The opioid epidemic is destroying large parts of the American population and has been called the worst drug crisis in American history. But some races are being hit harder than others. The numbers show that white communities seem to be suffering and are impacted the most by the opioid epidemic. For example, in the poorest and whitest communities in California analyzed by researchers, 44.2% of adults, defined as those 15 and older, received at least one opioid prescription per year on average, compared with 16.1% of adults in the richest, most racially diverse communities. Whether you're looking at overdose deaths or emergency room visits for opioid use problems or treatment admissions for opiate addiction, it's very clear that this epidemic is overwhelmingly white. In an interview on NPR podcast, All Things Considered, the host, Noel King, talked to Dr. Kolodny who was part of the Opioid Policy Research Collaborative at Brandeis. Dr. Kolodny said, “in study after study, doctors in primary care, emergency rooms, and orthopedic care have been found to prescribe less medication, and less potent medication, to minority patients who describe the same symptoms and intensity of pain as do white patients. Medical professionals bring an unconscious bias with them to work” (Kolodny, 2017).
While discrimination, hopelessness, and poorer health are widely believed to make chronic pain a more common condition among minorities than among white patients, this bias leads doctors to mistrust or minimize a minority patient reporting of physical and mental distress. Their doubt maybe be unconscious, but many studies have documented it.Therefore, there are more opioids prescribed to white people, so addiction rate is higher amongst white Americans. Sonoma County is 64% white, which is one of the reasons why the misuse of opioid prescriptions is so high in Sonoma county. Within Sonoma County, the addiction and overdose rates of individuals between adolescent to elderly has continuously risen as a result of the epidemic. Recently, studies have shown a shift in the age groups that are most commonly affected by opioid misuse and addiction, changing from the elderly population to the youth and young adult populations (Rush 3). Especially for younger individuals who may listen to their doctors prescribing them these drugs, many young individuals do not understand the disadvantages that come with taking the highly addictive drug. Though the elderly populations continue to be affected, it is currently not increasing as fast as the youth and young adults.
For the youth and young adults, however, in the article, Confronting the opioid epidemic in Sonoma County written by Laura Hagar Rush, it is indicated: “The number of emergency room visits for opioids was up 64 percent for 25-29 year olds and up 40 percent for teenagers aged 15-19” (3). This goes on to show how Sonoma County has one of the highest rates of opioid misuse in California. With growing numbers of young users, the rates of this ongoing crisis has only continued to increase and continues affect many communities. Though addiction and overdose rates has continued to increase for elderly populations, it has been found that younger generations are now suffering from misuse at a much larger extent from health problems ranging from dental and other medical surgeries to mental illnesses. In the article, Opioid Misuse Behaviors in Adolescents and Young Adults in a Hematology/Oncology Setting, the authors indicate: “In one study of adolescents with noncancer pain who were publicly and privately insured, patients were 41 and 37%, respectively, more likely to be prescribed opioids if they had comorbid mental health diagnoses… misuse among users of prescribed opioids were medicated partially by mental health problems such as anxiety and depression” (Jennifer Harman Ehrentraut et al. 1156).
Opioids have been used to aid patients who may suffer from mental illnesses, though it has been found that younger individuals who begin to use opioids easily become dependant and more prone to addiction (Ehrentraut et al 1156). In such cases such as medical or dental surgical procedures, prescription opioids are often first introduced to patients to relieve pain, but are usually given more than needed. In the article, Improper Disposal of Prescription opioids Among young Adults, author Caroline E. Halsted states: “I worked with a young man who described being prescribed 25 codeine pills after his wisdom teeth removal. Although he did not feel he needed 25 pills, he filled his prescription, used two pills and then gave the rest to his friend” (3). Opioids can easily be distributed among friends, family members, and so on. It has even been found that most individuals who are given opioids from friends or family tend to first initiate the addiction more easily.
Whether it be mentally or physically, the fact that most can legally get their hands on these drugs is just another problem faced regarding the ongoing epidemic.The opioid crisis continues to affect older and elderly individuals, though less rapidly than the younger generations, it is commonly because of issues such as chronic pain and other medical problems that cause most within this community to fall vulnerable to opioid use. In the article, Use of Opioids and Other Analgesics by Older Adults in the United States, 1999-2010, the study notes: “However, the potential benefits of opioid use are accompanied by risk for harms including constipation, nusea, and potentially increased risk of falls, fractures, and cardiovascular events” (Michael A. Steinman et al. 323).As the use of opioids increases nationally, the amounts of patients prescribed the drug also increases, causing those who face any types of pain or mental problems to fall dependent on the drug and allows them to continuously rely on it.
Though the rates of addiction are a lot more slim in comparison to younger individuals, the ongoing use of opioids may affect these older individuals in the long-term. Opioids, especially to most elderly communities, are more commonly distributed to easily treat whatever medical problem they face. In the article, Patterns and predictors of chronic opioid use in older adults: A retrospective cohort study, the authors state: “Also, previous studies have shown that long-term opioid use is highly prevalent in nursing home residents compared to people in a community setting, and having depression was associated with long term opioid use in older adults” (GYeon Oh et al. 14). Prescription opioids are so easily attainable and commonly found amongst the older and elderly communities. Whether it be to help with pain or mental illnesses, in community settings such as nursing homes and through ongoing doctors visits, older and elderly communities can easily fall victim to the harmful effects of opioid use and misuse.
A number of social characteristics such as racial identity, socio-economic status, age, and gender do play a significant role in our current opioid situation, but how we’ve been prescribing the opioids themselves should not be ignored. There are quite a few different understandings in how this epidemic “started”, but, according to Dr. Nicole Wolfe, the primary responsibility can be laid at the feet of Purdue Pharma through how they advocated and pushed for the pervasive use of Oxycontin. Then, when an uptick in prescriptions for Oxycontin became problematic, prescriptions were stopped and regulations were set. It was thought that such a course of action would be beneficial, but people who were already addicted, dependent on this drug, just turned to getting it illegally, which in turn increased the likelihood of overdose or other complications associated with their drug use.
This is concerning as Opioid analgesics are currently responsible for more deaths in the U.S. than the number of deaths from both suicide and motor vehicle crashes combined. Overdose deaths from prescribed medications exceed those from illicit substances including cocaine and heroin. This trend is mirrored by the rise in per capita prescribing and dispensing of pain medications by licensed physicians (Redwood Community Health Coalition).In the ER department especially there was a lot of pressure to pay close attention to a patient’s pain, resulting in a demand to prescribe more pain medication. There is a strong desire in this country for people to have something to treat their pain, a pill to make things better. This is not solely limited to an individual’s physical pain, but also a mental and emotional pain. Dr. Marshall Kubota, a regional medical director at Partnership HealthPlan claims, “If people were needing more, you just prescribed more. That was a recipe for Disaster” (Lurie 2017).
However, our current opioid situation has hit certain pockets much harder than others. Income inequality, unemployment, and struggling to make ends meet are all very real concerns that can lead to depression, anxiety, and can cause different manifestations of pain. If you introduce an opioid to an individual or a population that is already struggling, then it shouldn’t be surprising that they become dependent on it. They’re being comforted and if you take away that comfort without changing the surrounding context of an individual’s life, then you’re only making the situation worse. For example, “In Lake County, a poor, rural area bordering Sonoma, enough opioid painkillers were prescribed in 2013 to medicate every man, woman, and child with opioids for five months, according to a report by the California Health Care Foundation” (Lurie 2017).
It is no coincidence that this is a poor, rural community that is being affected. This is the result of the part drug companies have played in broadening our current opioid situation.Drug treatment, in general, is quite abysmal in this country and what passes for drug treatment isn’t really treating anybody. To help those that are struggling with addiction we have to recognize what people are struggling with in their lives. They need to be helped there first before their drug use can be addressed, because if an individual is struggling, then asking them to give up the drugs that are providing them comfort first is not helpful, is not effective, and is not going to work. This is because: Opiates can become highly addictive and have a high potential for dependency because they produce a “high” similar to other drugs of abuse. After you exercise or exert yourself, your body releases natural chemicals called endorphins – which produces the “runner’s high,” that we are all familiar with. Opioids hijack this system producing feelings of sedation, euphoria, and pain relief.
It is not unlikely that a person can become dependent on opiates after they have been prescribed them for chronic pain or even after surgery. It is also common that these drugs are sold on the street in the form of heroin or other stronger variants (Olympia House Rehab).So we must ask ourselves the question: how can we first improve people’s lives? Improve an individual’s social situation and the drugs will naturally follow. Addiction is primarily about coping. It is a symptom of larger problems, so if we address what those problems are then the addiction becomes easier to treat. If you try to address it the other way around, then you are left with what we have today. More Clinically, Buprenorphine has had a lot of success in treating opiate addiction. The properties of Buprenorphine may allow for the suppression of opioid withdrawal symptoms, decrease cravings for opioids, reduce illicit opiate use, and help patients remain in treatment. Special certification is required to administer and prescribe Buprenorphine, but once that certification is obtained it can be administered by physicians or prescribed to take home.
However, like it was stated earlier, Buprenorphine may have had a lot of success so far, but it is only treating the symptom of addiction. It is counteracting the damage caused by the prescriptions of the 90s, but very little to address why people are coping to begin with.The opioid crisis has struck a socioeconomic class that would take many people by surprise. In America, we tend to correlate drug abuse with low-income communities and minorities; however, this judgment is completely untrue. This epidemic has plagues communities of all different socioeconomic statuses and ethnicities. Communities with a majority of Caucasian individuals have been reported among the highest in usage and abuse of opioid prescription pills in America. According to the Foundations Recovery Network, as of 2017, Alabama, Arkansas, Tennessee, Louisiana, and Mississippi have the highest prescription rates per 100 people. As of 2016, Alabama has a 66% Caucasian population statewide. This statistic directly correlates to the epidemic that has sprouted in Sonoma County.
This problem has little to do with the types of communities and people who are involved in them, but rather the accessibility that these prescription pills are in certain areas. Sonoma County ranks among one of the highest opioid affected counties in California. Sonoma County is a majority caucasian community. Due to the previous leniency in prescriptions that were being given to patients, predominantly whites, these pills became an instant hook for many. Laws and regulations have recently been implemented to make it harder for patients to get prescribed these opioids, but the problem still plagues communities nationwide. Much of what we learned throughout the course of our research can be traced back to our qualitative interview data. In the beginning, we suspected that the defining social characteristics that we have previously referred to would be to blame for how this epidemic has plagued Sonoma County, but the results of our interviews revealed a more systematic problem.
Throughout the county, we interviewed experts in this opioid crisis and while we did find evidence enough to reasonably support the claim that social factors and demographics play an important part in how this epidemic has exploded here, we uncovered an underlying narrative as well. In the early nineties, opioids had already been in use for a number of years but only in limited use. It was Purdue Pharma pushing opioids, advertising and incentivising their prescription to doctors, that allowed for this current epidemic to take root. And now, decades later, we are still left treating the diagnoses of that time. Awareness is one thing, but we have yet to change the culture behind it all. In many cases, alternatives to opioids are prescribed, but coming out of surgery, the the go-to is still Oxycontin and that is a dangerous precedent. We asked question such as “how have the rates of opioid use changed?”, “have you noticed an increase in accessibility?”, “what are the more common reasons that have led to the current state of this opioid epidemic?”, and “what is your opinion on the current state of the opioid epidemic is Sonoma County?”
Our interview results were able to share with us a much more interpersonal relationship with the opioid epidemic than we would have had otherwise. In all our interviews conducted throughout the research for opioid misuse in Sonoma County they say White, non-Hispanics are where most overdose deaths are observed in Sonoma County. Also, in a conducted survey done at Sonoma State University showed that the population is over 50% White and they had easy access to prescription opioid pills if they wanted them. This epidemic has affected all racial communities, but is taking over white communities.Opioid abuse and addiction is a serious condition that needs to be more widely spoken about.
There are several different factors that are involved in this world-wide epidemic, but change must start on a micro level. In a county such as Sonoma, a place that has gone through tremendous adversity in recent years, change is a norm. During the Santa Rosa fires, we saw people from all over the state come together to bring comfort and help to those in need. During this time, it showed the true passion and care that the people of Sonoma County have for each other when adversity strikes. It is time we bring that same compassion and care in the fight against opioid abuse. Awareness and education are the key factors that need to be stressed around the community in order for individuals to see the severity of this problem. This problem has gone on long enough and taken the lives of many innocent people who were unaware of the severe implications that these pills had on their overall physical and mental health. Through this research, it is clear that opioid use and abuse is at a peak but it can be stopped. It is time to take accountability for where we have let this problem go, and have a true passion to bring it to an end. Become the light in the lives of those who can not yet find that light themselves.
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