LA's Opioid Problem Is Big, But Also Relatively Small. Follow The Map Of Pain Pills

(grumpy-puddin/Flickr Creative Commons)

Over the course of six years, 76 billion opioid pills spread out across America leading to an epidemic of abuse and addiction. A database released last week deepens our understanding of who, how and where those pills went.

The database — obtained from Drug Enforcement Administration (DEA) by The Washington Post and the Charleston Gazette-Mail after a year-long legal fight and court order — was requested more than three years ago.

What it reveals is a "roadmap," of the opioid crisis as it unfolded, said Post investigative reporters Steven Rich and Scott Higham, who worked on the project.

It also gave the DEA a "bird's eye view" of what was going on. "The database shows what DEA should've known and could've done and didn't," continued Higham.

The depth of the opioid crisis in West Virginia and other areas in Appalachia is well-known. This dataset, however, shows that communities in Nevada, South Carolina and other rural areas across the country have also been hard hit by opioid addiction and abuse, though they've received far less media attention. (The Washington Post)

For California, the data confirms what we already knew: the most pills per capita flooded into the state's northernmost counties, which are also the counties with the state's highest overdose rates.

Southern California — especially Los Angeles — has largely been spared from the worst of the opioid crisis.

Los Angeles County has one of the lowest rates of opioid pain pills per capita in California. By contrast, Lake County has the highest yearly rate per person. (The Washington Post)

WHAT'S NEW WITH THE POST'S DATABASE?

The newly released database tells us how many oxycodone and hydrocodone pills drug companies shipped to individual pharmacies between 2006 and 2012. Oxycodone and hydrocodone accounted for three-quarters of the total opioid pill shipments to pharmacies during that time period.

The data comes from the DEA's Automation of Reports and Consolidated Orders System, known as ARCOS, and includes nearly 380 million transactions. Laid out on a map, It allows the public — for the first time — to see which manufacturers, distributors and pharmacies were selling the most pills where.

It's no surprise to most people who have studied the opioid crisis that the maps line up closely with overdose rates.

On the left, the dark pink sections of the map show the highest concentrations of opioid pills per person. On the right, the dark blue sections of the map show the highest concentrations of opioid deaths. (The Washington Post)

WHAT DOES THE DATA TELL US ABOUT CALIFORNIA?

Manufacturers distributed more than 8 billion pain pills within the state over a six year period. The most pills per capita went to Lake County, a small, rural county northwest of Sacramento. Enough pills were sent to the county to supply each of its 65,000 residents with 97 pills per person per year.

(The Washington Post)
(The Washington Post)

In comparison, Los Angeles County received the fifth lowest number of pills per capita in the state during the same time period — 22 pills per person per year.

The Post database is invaluable for tracking the distribution of pain pills across the country as the opioid epidemic began to take hold. But in California, we've had access to a similarly powerful database for years: the California Public Health Department's Opioid Overdose Surveillance Dashboard.

The Public Health Department's database details opioid-related deaths and hospitalizations across the state from 2006 up to the third quarter of 2018. It also includes a wealth of information about opioid prescriptions. The data comes from the California Justice Department's Controlled Substance Utilization Review and Evaluation System Data, or CURES.

HOW HAS LA ESCAPED THE WORST OF THE OPIOID CRISIS?

According to the state opioid dashboard, L.A. County's overdose rate per capita is one of the lowest in the state.

(Opioid Overdose Surveillance Dashboard via California Public Health Department)

Why? It could be because of our ethnic diversity. Public health experts have theorized that for Latinos and Asian Americans — who together make up more than half the population — taking pain pills just isn't a cultural norm.

Secondly, some studies have shown that doctors are more likely to discount the pain of their Latino and black patients and less likely to prescribe them opioids than they are to white patients. In other words, in this case, racial bias and discrimination may have an unintended, positive outcome: Fewer Angelenos are addicted to and dying from opioids.

The rate of opioid-related deaths in L.A. County is highest among Native Americans. However, the actual number of deaths among this group is small because the population of Native Americans and Alaska Natives is just 0.2% of L.A.'s total population, according to the 2017 American Community Survey 1-Year Estimates. (Opioid Overdose Surveillance Dashboard via California Public Health Department)

One study on racial discrimination and prescribing practices for opioids, from the American Medical Association Journal of Ethics, found:

White people are more likely to misuse drugs.

  • Blacks and Latinos were more afraid than whites of opioid addiction.
  • Blacks and Latinos were less likely than white people to misuse prescription opioids.
  • The overall rate of drug-related deaths was highest among whites.

Whites receive more and better pain treatment than blacks and Latinos.

  • Blacks and Latinos were less likely than white patients to receive any pain medication and more likely to receive lower doses of pain medication, despite higher pain scores.
  • They had their pain needs met less frequently in hospice care than whites.
  • They were more likely to wait longer to receive pain medications in the emergency department than whites.

BUT OPIOIDS ARE STILL KILLING HUNDREDS OF PEOPLE IN LA

Even though addiction rates in L.A. are low relative to the size of the population here, because L.A. is so large — more than 10 million residents — far more people overdose on opioids here than anywhere else in California.

In 2017, 447 people died of opioid overdoses in L.A. County.

WHERE HAS THE OPIOID CRISIS HIT CALIFORNIA THE HARDEST?

The California counties with the highest rates of opioid overdose deaths and hospitalizations are concentrated in the northern, mostly rural parts of the state, according to the Public Health Department's opioid data dashboard.

In stark contrast to Southern California, some counties in Northern California have opioid overdose rates on par with hard-hit places elsewhere in the country. These are also the counties with the highest number of pills distributed per person, according to the DEA database.

Opioid prescriptions in L.A. have fallen dramatically in recent years, thanks to increased recognition of the high risk of opioid addiction and death. Nevertheless, opioid-related deaths continue to rise. Among the culprits? Heroin and fentanyl, a synthetic opioid that is 80 to 100 times stronger than morphine.

(Opioid Overdose Surveillance Dashboard via California Public Health Department)
(Opioid Overdose Surveillance Dashboard via California Public Health Department)

Opioid manufacturers are now being taken to task for theirrole in unleashing a public health crisis. In June, California joined other states in suing opioid manufacturer Purdue Pharma over its opioid marketing and sales practices.

SO WHAT CAN BE DONE?

Public health experts are working to train doctors on how to responsibly wean patients off prescription opioids so that if they develop addiction or dependence, they don't turn to recreational street drugs. And there are some promising tools for curbing opioid addiction and dependence:

Buprenorphine/Suboxone: A drug that medical professionals are increasingly prescribing as a more benign replacement for people who are addicted to dangerous opioids.

Buprenorphine prescription rates for L.A. County, 2015-18. (Opioid Overdose Surveillance Dashboard via California Public Health Department)

Cannabis: Some patients, especially seniors, are using it as an alternative to pain pills.

Naloxone/Narcan: The LAPD is arming more police officers with Naloxone, an overdose reversal drug. Using federal grant money, LAPD has received more than 10,000 kits of the life-saving spray and is poised to get another 10,000 kits to expand the initiative, which began in 2018.