From Overprescription to Overdose

Declaration of emergency rings hollow in Santa Cruz

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The opioid epidemic is nothing new, rooted in a legacy of the War on Drugs, the pharmaceutical industry and mental health disparities, but in October 2017 President Donald Trump declared it a public health emergency. Now the nation, small counties such as Santa Cruz and institutions such as UC Santa Cruz face the impossible task of solving a decades-old problem with little federal support.

UCSC student Jack* sat in a health center appointment room, waiting to explain to the doctor that his back hurt and he needed painkillers — opioid-derived painkillers. Over the last 10 years of opioid use, Jack was successful in sustaining his addiction in every emergency room or doctor’s visit.

This was the first doctor, including previous UCSC Student Health Center visits, to say no.

Illustration by Lizzy Choi

“I weighed 120 pounds, I had staph infections all over my body,” Jack said. “I had run out of my pills, and [the doctor] was like, ‘You are going to die in six months if you don’t stop using drugs.’”

The Centers for Disease Control (CDC) estimates that 91 Americans die from opioid overdose every day, reflecting death rates that quadrupled since 1999. In total, 53,332 Americans died from opioid-related overdoses in 2016, and 64,070 in 2017, according to the CDC.

This epidemic hit Santa Cruz hard in recent years. Of the 33 drug-related deaths between January and October 2017 in Santa Cruz County, 12 were from opioid overdoses, according to the County Coroner’s Office.

UCSC students have also been increasingly using opioids in the last five years, said UCSC Counseling and Psychological Services (CAPS) psychologist Dr. Blair Davis.

The opioid epidemic, which took the lives of over half a million Americans from 2000-2015, was declared a public health emergency by President Donald Trump on Oct. 26, 2017. Yet, individual counties such as Santa Cruz won’t feel the effects of the declaration.

“When there is legislative change on such a macro level without significant dollars behind it, it frankly doesn’t shift our opportunities very much,” said Shaina Zura, Santa Cruz County chief of Substance Use Disorder Services (SUDS).

The 90-day public health emergency, expiring on Jan. 24, only allows states to redirect existing federal funding for opioid addiction resources, not allot new funds. Zura said the declaration won’t help in solving Santa Cruz’s opioid crisis.

Trump promised to declare a national emergency, which differs from public health emergency in that it would legally open up additional federal funding to addiction resources. It is unclear if the president will eventually declare a national emergency.

In 2016, 1,925 Californians died from opioid-related overdoses, and there were 23,684,377 opioid prescriptions written in the state. Prior to the declaration, California established a Statewide Opioid Safety (SOS) Workgroup and Prescription Drug Overdose Prevention Program (PDOP) in 2014. The state has not announced any further initiatives.

“[Because] there isn’t significant [federal] financing […] we are continuing to utilize the resources we have to collaborate with our community to get the message out [about opioids] and provide a spectrum of opportunities from dialogue and prevention all the way through to intervention,” Zura said.

Disproportionately Affected, but Improving

In 2014, Santa Cruz County had the sixth highest opioid death rate per 100,000 residents in the state. In the same year, Los Angeles County was ranked 48th.

“Santa Cruz has been disproportionately impacted. Our stats are higher for opioid use and opioid overdoses than other parts of the state and the country,” said Shaina Zura, Santa Cruz County chief of Substance Use Disorder (SUD) Services.

However, the overdose death rates are declining in Santa Cruz County. Between January and October 2015 there were 27 opioid-related deaths, according to Santa Cruz County coroner Dr. Stephany Fiore. Only 12 deaths were reported during the corresponding time period in 2017.

Part of the reason why these rates are declining, Fiore said, is due to the county’s naloxone campaign. Naloxone is an anti-opioid overdose medication. Additionally, the county is attempting to address addiction rates by launching the Drug Medi-Cal Organized Delivery System (DMC-ODS) on Jan. 1, which other counties in California have been using since 2015. DMC-ODS is a model that gives individual counties more local control of fund allocation and standardizes care.

Zura said this system will allow Santa Cruz SUD Services to increase care from 1,500 to 3,000 people. More services, including inpatient, outpatient and youth programs will be available to anyone who qualifies for Medi-Cal.

While prescription opioids are a national problem, locally, heroin overdose rates have become a more urgent problem. Heroin, which is often cheaper and more accessible than prescription opioids, caused 10 of the 12 opioid-related deaths in Santa Cruz in 2017.

Since November 2017, at least two more houseless people have died from heroin overdose, a population already disproportionately represented in opioid overdoses, according to the Santa Cruz County coroner.

The only county-approved opioid-specific recovery treatment is a medication-assisted treatment (MAT) program, specifically a methadone clinic, run by Janus of Santa Cruz. Methadone is a drug used to mitigate opioid withdrawal symptoms.

The Janus of Santa Cruz Methadone Clinic serves around 600 residents, most of whom are Medi-Cal qualified. Almost no private insurance companies cover methadone MAT programs.

Houseless people have difficulty meeting the methadone clinic’s daily attendance requirement due to lack of reliable transportation, said houseless advocate Brent Adams.

“What I am hearing […] is [for] a person on the street who wants to get clean, there is virtually nothing offered for them other than methadone,” Adams said.

Specifically for any MAT programs, daily attendance is mandatory for 30 days, said Robin Oakey, project coordinator at Central Coast Recovery and counselor at Janus of Santa Cruz. Methadone mitigates the risk of excruciating mental and physical pain during opioid detoxification, which is potentially fatal under conjunctive health conditions.

“The daily attendance is probably a […] barrier to treatment,” Oakey said. “I’ve definitely heard people say that they shy away from methadone because of the very strict attendance requirements.”

UCSC Students Impacted by Epidemic

Jack, a UCSC student in recovery, thinks UCSC has a much larger drug problem than the campus wants to admit. He’s been able to obtain heroin at UCSC in fewer than 15 minutes. He, and other students, provided false symptoms to doctors at hospitals, including the UCSC Student Health Center, to obtain opioids. And during finals week, he found tin foil that had been used for freebasing heroin on the ground at Jack Baskin Engineering.

“I think that alcohol has kind of lost its status in a way, and that’s being replaced with Xanax, molly and opiates,” Jack said.

The UCSC Student Health Center’s policy regarding opioid prescription states no opioid prescription will be written for chronic pain but could be written for short-term, non-refillable circumstances, said nurse practitioner and patient care coordinator Beth Hyde.

All narcotic prescriptions from the UCSC Student Health Center are entered into a California state database, the Controlled Substance Utilization Review and Evaluation System (CURES). This allows the health center to monitor narcotic prescriptions by patient and total prescriptions written.

“I know that I have no providers who provide large quantities or repetitive prescriptions, but you are going to have people in the universe who come in and make a good case that they have a condition for which it would be appropriate to use a narcotic pain medication,” Hyde said.

“You can’t simply say that, ‘Oh, everyone who asks for the use of a narcotic is an addict.’”

When asked about the issue of drug use on campus, news and media relations director Scott Hernandez-Jason said the university regularly sends messages regarding the consequences of drug use and resources for campus affiliates.

Currently, resources such as the COVE provide safe spaces for students recovery and allies. Aleen Voskanian, chancellor’s undergraduate intern for the COVE, said it can be difficult to connect students to resources.

“There is stigma around specifically alcohol and other drug recovery that makes it harder for people to want to get help for their addiction,” Voskanian said. “People have a certain image of what it looks like to be an addict.”

Roots of the Problem

Understanding how both Santa Cruz and the nation reached this peak of opioid abuse requires understanding the War on Drugs, pharmaceutical misbranding and mental health disparities.

UCSC student and activist Michael** was caught with drugs at the age of 12. Instead of receiving care, Michael was criminalized. Years of juvenile hall, solitary confinement, and drug abuse followed. His story is common in low-income communities and communities of color impacted by systemic trauma and oppression.

While opioid-related deaths are decreasing in Santa Cruz County, they are peaking nationwide. Many factors led to this point, beginning with drug criminalization legislation known as the War on Drugs. This legislation is also referred to as the War on People by activists including Michael and Ismail Ali, policy and advocacy counsel at the Multidisciplinary Association for Psychedelic Studies and vice chair of the board of directors for Students for Sensible Drug Policy (SSDP).

“That framework was used to criminalize people who used the drugs. People of color, Black people, hippies,” Ali said. “[…] Over the last 40 years, that’s really concentrated primarily on brown and Black populations, not only in the United States but around the world.”

The Nixon administration’s crackdown on using and selling drugs in the 1970s created a multinational law enforcement agency to criminalize specific types of drugs such as heroin and marijuana, Ali said.

Michael, like hundreds of thousands of Black and brown people, experienced the frontlines of the War on People.

Currently, 57 percent of people incarcerated for a drug offense are Black or Latinx, despite white people using and selling drugs at similar rates. Heroin has disproportionately affected Black communities and communities of color since the 1980s. Yet, the opioid epidemic gained media attention as the demographics of prescription drug overdose emerged in middle class, white Americans in the last decade, said Dr. Blair Davis, psychologist for UCSC Counseling and Psychological Services (CAPS).

The prescription drug boom that shifted the demographics of overdoses to white communities began with the pharmaceutical company, Purdue Pharma, misrepresenting OxyContin in the 1990s. The company advertised the long-acting drug as being less addictive and more effective than short-term pain relievers, misinforming medical practitioners.

Opioid prescription drug sales quadrupled from 1999 to 2016, yet Americans did not report any increased amounts of chronic pain in that time period.

Inaccessible mental health care also plays a large role in why drug abuse is so common, said Jack, UCSC student in recovery.

“If people had told me these things at 20, ‘Hey, you could go see a physical therapist to work out your [chronic pain] or a psychologist,’” Jack said, “things would be very different for me than the belief in my mind that I was sick and that I needed [medicinal] treatment.”

This country’s long history of drug criminalization policy will take more than a national emergency declaration to fix 40 years of damage, Ismail Ali said.

“The types of interventions that we need are much more systemic, much more radical,” Ali said.  “[We need] more awareness of how drug users and drug economies and drug communities actually function, which just doesn’t exist right now.”

*Last name omitted to protect anonymity

**Name changed to protect anonymity