Marin Grand Jury Recommends Strengthening Opioid Misuse Response

Drug overdoses are the leading cause of accidental death in Marin and almost half involve opioids, according to a Marin County Civil Grand Jury report released last week.

The report, Opioid Misuse: Strengthening Marin County’s Response, reveals grim statistics. It estimates 4,400 people in Marin suffer from opioid use disorder. Last year, 43 people died from drug overdoses and opioids contributed to 23 of the deaths. Ambulance crews in Marin respond to three to five opioid-related overdose calls each week.

The United States recorded the most overdose deaths, over 81,000, for the 12-month cycle ending in May 2020, provisional data from the Centers for Disease Control and Prevention shows.   

Unfortunately, the number of opioid overdoses in Marin is on the rise. Hospital emergency department visits for opioid overdoses more than tripled from 2006 to 2019. The opioid overdose death count in 2019 topped each of the previous eight years. 

Opioids, a class of drugs used to relieve pain, are found naturally in the opium poppy plant. Regular use can cause dependence and long-term use may result in addiction, the most severe condition of opioid use disorder. Prescription opioids include OxyContin, Vicodin, morphine and fentanyl, a synthetic opioid 50 to 100 times stronger than morphine. Heroin and illegally manufactured fentanyl are the most common opioid street drugs.

Though the county has taken measures to prevent and treat opioid misuse, more must be done, the report concluded. The grand jury issued five recommendations.

Marin County Department of Health and Human Services (Marin HHS) should place naloxone, also known by the brand name Narcan, in public spaces, giving bystanders access to the drug to treat people who overdose on opioids. This life-saving medication, which is easily administered, reverses the effects of opioid overdose by restoring breathing.

The report called for Marin HHS to assess whether additional recovery coaches are necessary. Coaches are accredited and have personal experience with substance use. Marin HHS contracts with five coaches for Medi-Cal patients and more are needed, public health officials told members of the grand jury. 

Healthcare providers must possess a waiver to prescribe medication for opioid use disorder and a cap exists on the number of patients they can treat. Marin HHS should expand the prescriber base and provide incentives for prescribers to treat the maximum allowed, the grand jury said.

Marin HHS should also pursue funding and opportunities to increase the number of beds in long-term recovery residences. There is a wait list for adults, and adolescent beds aren’t offered in Marin.

Finally, the grand jury proposed that the Marin Healthcare District, through MarinHealth Medical Center (formerly Marin General Hospital), ascertain whether to hire more substance use navigators, who counsel overdose patients in the emergency room.

The report commended the county for programs already implemented to prevent and reduce opioid misuse, such as participation in statewide monitoring of healthcare providers’ prescribing patterns. This database also allows providers to evaluate a patient’s substance use history.  

The county has also developed the RxSafe Marin agency. Among its many programs is Safe Schools and Prevention, which aims to decrease drug use by school children.

Additional funding for opioid treatment and prevention programs could possibly come from lawsuits the county has filed against the makers and distributors of opioid drugs, the report said.

The Marin County Board of Supervisors and the Marin Healthcare District must respond to the report by March 14, 2021.

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Nikki Silverstein
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