Civil grand jury says county should do more to prevent opioid deaths

01/06/2021

Opioid-related deaths reached their highest levels of the decade in 2019, prompting the Marin County Civil Grand Jury to push for a stronger local response to the epidemic. Twenty-two Marin residents died from an opioid overdose in 2019, the most recent year for which data is available. For the first time ever, fentanyl, not heroin or prescriptions, was the leading cause of death. Emergency department visits for opioid overdoses also increased, and an estimated 4,400 residents are suffering from opioid use disorder. According to the 19-person jury, the county has taken important steps to prevent opioid misuse: monitoring prescribing patterns of health care providers, forming an organization dedicated to reducing use called RxSafe Marin, and adopting a managed-care plan for treating MediCal-eligible patients. But despite these laudable programs, the misuse of opioids in Marin continues. Since 2006, opioids have contributed to over 200 deaths in Marin. During the beginning of that period, prescription pain relievers such as hydrocodone and oxycodone accounted for almost two-thirds of total overdose deaths. Then, opioid-related death fell around 2010 for several years but have trended upward again, with heroin and fentanyl as the prime contributors. Health and Human Services has led the charge to curb the epidemic, with several programs targeted at both prevention and treatment. To do more, the grand jury suggests that Marin make doses of naloxone—a medication used to block the effects of opioids—more widely available. Ambulance crews administer naloxone about 200 times a year, and recently the county has made the medication available to police officers, firefighters, family members of known substance abusers, pharmacies, libraries and schools. “Because of its immediate lifesaving properties and given that there are no adverse medical effects when it is administered to individuals who do not use opioids, even wider availability of naloxone could help reduce the opioid death toll,” the jury wrote. The jury recommends placing bystander-friendly kits of naloxone in more public places, which is consistent with guidelines from the American Medical Association. The jury cautions that although naloxone is an important tool for preventing death, it is not a treatment for opioid use disorder: Studies show that the majority of users continue to use opioids after an overdose. The grand jury had a few ideas to improve treatment and said medication-assisted treatment is the most effective tool. Such treatment uses methadone and buprenorphine, two drugs that reduce opioid cravings and the symptoms of withdrawal, alongside counseling. To administer these drugs, health care providers must complete 24 hours of training and supervised practice. A study by the Urban Institute found that in 2019, more than 2,000 health care providers in Marin were licensed to prescribe medications, but just 97 were certified to treat patients with methadone or buprenorphine. The grand jury urged the county to appeal to providers about the importance of this unmet need. It also recommended expanding the number of people who work with patients. Substance use navigators work in hospitals, encouraging overdose patients to initiate treatment and enter recovery programs. The MarinHealth Medical Center has a navigator who covers one shift spread over five days, leaving long periods of time without his or her services. The grand jury recommends that MarinHealth conduct a detailed cost-benefit analysis to determine if more navigators are justified. Recovery coaches work with patients throughout their recovery, keeping them engaged in treatment. The county health department contracts with five coaches, and public health officials told the jury that more would be helpful.