Savannah O’Neil says, for her, knowing someone who has battled an opioid addiction started with a family member. Most recently, she says, one of her friends had a stint at sobriety, but fatally overdosed on a combination of prescription opioids and benzodiazepine.
“It’s heavy to think of all the people we’ve lost, but that’s why it’s so important to do the work,” O’Neill says. She’s the coordinator of Overdose Prevention Education and Naloxone Distribution (OPEND), a new nonprofit program serving Alameda County that emphasizes harm reduction practices. These methods include allowing intravenous drug users to exchange used needles for clean ones, reducing the likelihood of disease transmission, and distributing the overdose-reversing drug naloxone.
O’Neill was one of a few dozen people who gathered Wednesday at Frank Ogawa Plaza for Oakland’s first time participating in International Overdose Awareness Day. A memorial of paper flowers lay on the stairs, adorned with the names of people who died of drug overdoses, while a DJ played music solely by artists who died of them, including Michael Jackson, Whitney Houston and Prince.
Opioid deaths include those from prescription drugs—oxycodone, hydrocodone, methadone, and fentanyl, mostly—and heroin.
One of the driving forces in the opioid addiction epidemic, experts say, is that doctors overprescribe these highly-addictive medicines or keep patients on them for too long. Some who did it merely for profit have been convicted of Medicare fraud. Others have been convicted of murder.
Since 1999, prescriptions for opioid painkillers have quadrupled, while overdoses have tripled since 2000, according to the U.S. Centers for Disease Control and Prevention (CDC). In Alameda County, there was an opioid prescription for one out of every two people, and yet it was still on the low end among California counties in 2013, according to the California Health Care Foundation, (CHCF) a nonprofit that focuses on increasing access to healthcare.
Six years ago, Dr. Kathleen Clanon, medical director of Alameda County Health Care Services Agency, learned she prescribed the opioid Vicodin more than any other drug to her patients. She’s since changed that practice.
“I am a doctor and a prescriber, which means I was part of the problem,” she told those in attendance Wednesday. “We now know this is a problem largely created by doctors and their prescribing pads.”
The World Health Organization estimates that 69,000 people worldwide die every year from opioid overdoses. In 2014, 40 percent of those deaths—half of which involved prescription opioids—occurred in the U.S., according to the CDC.
According to the Alameda County Public Health Department, opioid-related fatal drug overdoses tripled between 2005 and 2014. In 2013, the latest year for which data is available, 174 people in Alameda County died of drug overdose deaths, 31 of which were due to prescription opioids, according to the Opioids Safety Coalition Network, an arm of the CHFC that focuses on opioids in California.
Clanon says these estimates are likely low, as the Alameda County Coroner’s Bureau doesn’t track opioid-specific deaths. The Drug Enforcement Agency has a data analyst combing through the last five years of county data to get more accurate statistics, Clanon says.
The data is needed so healthcare workers know what kinds of services are needed in a community, O’Neil says.
“Opioid overdoses have been killing people in Oakland and Alameda County for a long time,” she says. “People will be surprised when the numbers are released.”
Overdoses are becoming increasingly less lethal due to the increased awareness of opioid addiction, as well as the increased availability of naloxone, a life-saving opioid antidote.
Naloxone, better known by one of its brand names, Narcan, is available as a nasal inhalant and as a single-dose, preloaded auto-injector shot similar to the EpiPen. Naloxone is sold without a prescription in California and other states, and an increasing number of law enforcement agencies equip their officers with it. It was historically a cheap solution to combatting the effects of an overdose, and is considered by public health officials to be the best tool available in combatting potentially deadly opioid use.
During Wednesday’s event, advocates trained people to load a syringe with naloxone from a vial and administer it. They handed the kits out free of charge to whoever wanted one.
But the drug’s rising price tag amid the opioid abuse epidemic is stretching the limited budgets of community groups like OPEND, a child of the HIV Education and Prevention Project of Alameda County, also known as Casa Segura.
OPEND staffers buy the glass vials in naloxone kits for $15, a discount the retail price of $28, through a direct-buy contact with Hospira, the maker of that specific version of naloxone. The contract is negotiated through the national Opioid Safety and Naloxone Network, O’Neil says. As a “Narcan bank,” she distributes the kits in Oakland, Hayward, and Berkeley.
Groups like OPEND do get donations from some drugmakers. The pricier auto-injectors go to family members of drug users, namely those uncomfortable with needles. Some come with built-in visual and verbal instructions, making it easier for anyone to deliver naloxone and reverse the effects of an overdose.
In June, Sen. Claire McCaskill (D-Missouri) and Sen. Susan Collins (R-Maine), chair of the U.S. Senate’s Special Committee on Aging, asked the heads of Amphastar Pharmaceuticals, Pfizer, Adapt Pharmaceuticals, Kaleo Pharma, and Mylan, among other things, why prices for some versions of naloxone increased 17-fold over two years. The companies defended themselves separately, saying they were investing to ensure the drugs’ high quality or covering expenses to make it easier to administer, according to the Los Angeles Times.
Loris Mattox, Casa Segura’s executive director, says the organization’s $250,000 budget goes to two things: O’Neil’s salary and purchasing naloxone. It comes from 2004’s Measure A tax increase and tobacco lawsuit settlements. The half-cent tax was passed to fund medical and mental health services to those in need.
“Before we secured these funds, there were no formal naloxone distribution programs in Alameda County,” Mattox says. “Of course when the epidemic started, they raised the prices.”
Naloxone has been criticized for potentially enabling addicts to continue using in larger doses. In April, Maine Governor Paul LePage vetoed a bill that would increase access to naloxone to people at risk of an overdose in his state.
“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote in his veto. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”
The state legislature overturned that veto, granting the state’s attorney general the authority to negotiate the price of buying naloxone in bulk, much like how OPEND buys the drug at a discount.
In Alameda County, 20 people have returned for more Narcan since April because they used up their first kit, which O’Neil says is why the drug’s availability is a good thing.
“That’s 20 people who were brought back who would have died,” she says. “To me, someone’s life is worth saving, even if they’re using drugs.”