Treat, Educate And Revive: The Valley’s Three-Pronged Approach To Opioid Overdose Prevention

Feb 7, 2017

Host intro: Last week, we brought you a story about the San Joaquin Valley’s opioid epidemic, which manifests in inordinately high rates of painkiller prescriptions and hundreds of overdose deaths every year. This week, we explore three strategies that health officials and advocates are using to take aim at the problem. FM89’s Kerry Klein begins at a safe space for drug users.

For over 20 years, meth and heroin users from around Fresno County have relied on the Fresno needle exchange for free medical care and all the clean syringes they need.

Now, users can also get something else here: a nasal spray that can reverse an opioid overdose. Three months ago, volunteers began handing out Narcan prescriptions as users walk up to the exchange. Like an Epi-Pen to an allergic reaction, Narcan can stop an opioid overdose in its tracks.

Doug, a heroin user, has seen the antidote in action.

“I had a friend, he had overdosed. He was dead, heart stopped, turned blue,” he says—then a neighbor ran in with Narcan. By the time the ambulance arrived, Doug says, his friend was already breathing and awake.

“And just to see him the next day after coming home from the hospital, it was surreal. Because I was looking at him and he was dead. And to see him up and walking around the next day, it was just unbelievable.”

Narcan doesn’t work with meth or other non-opioid drugs. But Jeff Wells, a volunteer and medical student at UC San Francisco, says they offer a prescription to every person here—no matter their drug of choice.

UC San Francisco med student Jeff Wells greets users at the Fresno Needle Exchange with a prescription for Narcan and a survey about how it affects their drug use.
Credit Kerry Klein / KVPR

“We also started handing out these prescriptions with the herd immunity effect, where even if people who don't use opioids have access to Narcan, then they can save someone's life,” he says.

Making Narcan visible is one of three tactics being followed by the Central Valley Opioid Safety Coalition, a group of health officials and advocates from Fresno and Madera counties. The Coalition’s other priorities include increasing access to addiction treatment and teaching doctors how to better prescribe painkillers. Fresno County health officer Ken Bird says the overall goal is not just to reduce opioid deaths, but also to educate everyone on how to prevent addiction in the first place.

“Educating providers and making sure they have the knowledge they need to deal with pain management is one thing,” says Bird, “but we want the public to be aware that they have a role in this as well.”

The first tactic of the Coalition, Narcan has been widely hailed as an essential weapon against opioid overdoses. It’s been around for decades, but hasn’t always been cheap or readily available. Just this past October, the nasal spray gained coverage under Medi-Cal—and the Fresno needle exchange, which is not currently a part of the Coalition, immediately began prescribing it. Since October, volunteers estimate they’ve handed out close to 700 prescriptions. When it comes to actually using Narcan, Fresno County estimates that its paramedics administered the drug about 250 times in 2016.

Narcan nasal spray can reverse an opioid overdose within minutes.
Credit Kerry Klein / KVPR

The Coalition’s second overdose-fighting tactic is to increase access to medically assisted treatment, though they’re still strategizing how that will happen. Dr. Marc Lasher is thrilled about the potential. He’s medical director of Aegis Treatment Centers in Fresno and Merced, where he’s been treating addicts with methadone, buprenorphine and counseling services for over a decade.

“This is the war in drugs,” he says. “This is the front line.”

Lasher says prioritizing this kind of work represents a culture shift in how we approach addiction.

“We're just starting to come to the conclusion that this is a brain disease,” he says—“that this is something that’s in the health realm and not something that should just be dealt with as lock ‘em up and send ‘em away.”

But the Coalition’s third priority, and their focus for the last few months, has been educating doctors about the problem. In January, the county presented the third in a series of lectures on safely prescribing painkillers.

“Guess what? The pills that we write for with good intention and we fill with good intention do not always end up in the hands that we expect them to,” said Dr. Roneet Lev, an emergency room physician in San Diego, to an audience of about 200 doctors and pharmacists.

“Start low, go slow, don't prescribe if it's not needed and don't start without a plan to stop,” advises Roneet Lev, an emergency room physician, during a Fresno lecture for doctors on safely prescribing opioids.
Credit Kerry Klein / KVPR

She advises doctors to look out for tell-tale signs of addiction, and to prescribe opioids cautiously and only when necessary.

“I really believe that patients and physicians are victims of this epidemic,” Lev says. “It's not that we've trained all these bad physicians in the United States. In a way, the issue of pain has been legislated upon the medical community, but now we have a serious problem on our hands.”

She’s excited about the work she’s seeing done in the San Joaquin Valley, but she cautions that there’s a long road ahead.

“Once you have a problem, you're always behind,” she says. “We all are behind. I think that nobody’s ahead.”

Now that their medical lectures have finished, the Coalition’s next steps include getting more word out to the public about opioid addiction, and bringing in groups from counties beyond Fresno and Madera.