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Is Prescription Drug Abuse in CA at Its Peak? (2018)

Treatment Options in California


Prescription drug abuse is a serious problem in the United States. California, as one of the most populous states in the country, struggles with high rates of opioid, benzodiazepine, and stimulant abuse. Thousands of people in California are impacted by addiction, overdose, and death involving prescription drugs every year.

Fortunately, California has put several treatment programs into place, from prevention and education to detox, rehabilitation, and aftercare. Here are a few avenues to find help:

assortment of pills

The Landscape of Prescription Drug Abuse in California


Between 1999 and 2015, the large state of California had one of the highest rates of drug-related deaths in the United States, increasing 30 percent over that time. Because that period overlaps with the rising opioid abuse epidemic across the U.S., a 30 percent jump in overdose deaths in 20 years was not very high compared to many other states. Instead, California started at a high rate of substance abuse problems and related deaths, experienced a slight bump, and still reports high rates of drug abuse, including prescription drug abuse, primarily because the state has a large population.

Further Reading

The Behavioral Health Barometer for California in 2014 reports that, between 2009 and 2013, 3.1 percent of adolescents in the state initiated nonmedical abuse of psychotherapeutics, like benzodiazepines or antidepressants. This may be due to how many young people in California between the ages of 12 and 17 have access to these drugs.

In the 2012–2013 survey year, California reported that 10.5 percent of adolescents had at least one major depressive episode (MDE) in the past year compared to 9.9 percent around the nation. While rates of MDEs rose steadily since 2009 for both the state and the U.S. overall, California’s reported rate was always higher than the rest of the country.

More young people may receive prescriptions for psychotherapeutics due to higher reported rates of depression and other mental health concerns. Among this age group, about 5 percent abused painkillers nonmedically in 2013, which was the same as the national average that year.

Interestingly, rates of serious mental illness (SMI) among adults were slightly lower than national averages between 2009 and 2013. California reported a rate of 3.4 percent of all adults, which represents about 958,000 people, with SMI in that four-year span. In 2012–2013, 3.9 percent of California’s adults reported SMI compared to national reports at 4.1 percent.

heroin needle and drugs

Opioid Abuse in California


In California, opioid drugs from codeine to heroin continue to be a serious problem, but the rate of overdose deaths is beginning to decline. The peak rates of opioid overdoses appeared to occur from 2006 to 2013. In 2009, there were 1,616 deaths involving prescription opioid drugs in the state, which represented 82 percent of total opioid overdose deaths. By 2013, 3.1 opioid overdoses out of 100,000 residents involved prescription painkillers, but this accounted for 73 percent of opioid overdose deaths, highlighting the rise of illicit opioids.

The pattern is similar among opioid-involved emergency room admissions. In 2014, there were 11,683 total emergency room admissions involving opioids, and 9,085 of those cases (about 78 percent) involved pharmaceutical opioids while 2,651 cases involved heroin. While there was an overall increase of 103 percent in opioid-involved emergency room admissions between 2006 and 2014, the rate at which prescription narcotics were involved rose slower than the rate of heroin admissions.

The National Institute on Drug Abuse (NIDA) reports that in 2013, California’s prescribers wrote 54.9 opioid prescriptions for every 100 people living there on average, which represents about 21 million prescriptions. However, this is lower than the U.S. average that year, which was 79.3 for every 100 people.

Thanks to concerns over the opioid abuse epidemic and knowing that this problem stemmed from prescription narcotic painkillers, opioid prescriptions have declined across the U.S. There was a 12.8 percent decline in California specifically between 2013 and 2015. As of 2015, there were 47.9 opioid prescriptions for every 100 residents, and by 2017, that rate was 39.5 for every 100 residents.

Between 2009 and 2013, tens of thousands of people across California enrolled in methadone treatment for opioid addiction. While there was a slight dip in 2010, the rate of people seeking medication-assisted treatment in the state has risen each year. In 2013, there were 30,872 people enrolled in opioid treatment programs using methadone to detox. The rate of people detoxing with buprenorphine also rose. In 2009, there were only 1,392 people receiving buprenorphine to end their addiction to opioids,
and that number rose to 2,154 people by 2013.

Fortunately, as of 2017, 95 percent of California’s residents live in a part of the state where their elected leaders have joined a coalition to stop prescription drug abuse. Thanks to the ability to gather more data and implement more prevention, education, and treatment programs, there was a drop of about 12 percent in the number of opioids prescribed across the state as well as the rate of people taking high-dose opioid drugs.

While heroin and illicit fentanyl are severe problems in California, prescription opioids will be less of a gateway drug for people who are at risk of opioid addiction and overdose. The California Department of Public Health reports that, statewide, opioid abuse and overdose specifically peaked in 2010 and has declined on average ever since.

Benzodiazepine Abuse


This class of sedative medications are the second most-abused prescription substances in the United States. Although it is rare for benzodiazepines like Valium or Xanax to be abused on their own, many people combine them with opioids, alcohol, cocaine, and other drugs, which can quickly cause an overdose. In San Diego County in 2013, for example, there were 13.6 benzodiazepine pills per resident in the county, so the drugs are widely prescribed and available.

Stimulant Abuse & Young People


Typically prescribed for attention deficit hyperactivity disorder (ADHD), stimulants like Adderall and Ritalin are also widely abused by young people. In San Diego County in 2013, there were reportedly 4.9 stimulant pills per county resident.

While these drugs are not as widely available as opioids or benzodiazepines, they can be abused. Since they are often prescribed starting at a young age, friends of children who have ADHD may ask to take the drugs. In comparison, adolescents typically do not abuse prescription sedatives as often.

Polysubstance Abuse


Prescription drug abuse rates are high across the country, but it is rare, including in California, for only one drug to be abused at a time, especially among people struggling with chronic addiction. One doctor reported that 80 percent of people who died from a prescription drug overdose had multiple substances in their system, with a mix of opioid painkillers and benzodiazepines being the most common combination. About 70 percent of people who overdosed on multiple drugs were chronic users.

In Sacramento County between 2008 and 2010, for example, overlapping benzodiazepine and opioid painkiller prescription rates, which overlapped for at least 30 days, increased 215.3 percent. This puts people at risk because they could accidentally combine these drugs without realizing that the mixture increases the risk of overdose.

In addition, many people also intentionally mix these drugs to get high, a dangerous form of substance abuse. In the following years, about 9,200 people in the county had overlapping prescriptions until 2015 when the rate finally decreased by 42.3 percent.

California’s Most Affected Areas

barn in rural california

California Taking Steps to Address Prescription Drug Abuse in the State


The whole state expanded access to naloxone when the opioid abuse epidemic hit its peak, but California also aims to expand treatment programs to help anyone who struggles with addiction, especially those who are low income and may not otherwise have access to medically supervised, evidence-based services.

Medi-Cal is California’s implementation of Medicaid funding from the federal government, and in 2015, the state reported that it would use Medicaid funding and expand California detox and rehabilitation options for those who qualify for Medi-Cal. The changes stemmed, in part, from ongoing implementation of the Affordable Care Act (ACA). According to the National Institute on Drug Abuse (NIDA), 14 percent of Medicaid recipients nationally struggle with substance abuse. Many people who struggle with addiction do not even have medical insurance, although the ACA expands treatment options covered by insurance plans.

Further legislation, including clean needle exchanges and access to naloxone, is helping many people in the state. Although the landscape of addiction in California is changing — moving from prescription drug abuse to illicit substances and marijuana — treatment programs are available for more people than ever.

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References

Prescription Drug Overdose Prevention Initiative. California Department of Public Health, Safe and Active Communities (SAC) Branch.

Statewide Standing Order for Naloxone. California Department of Public Health, Safe and Active Communities (SAC) Branch.

State of California Narcotic Treatment Program Directory. The California Department of Health Care Services (DHCS).

Behavioral Health Services Locator. Substance Abuse and Mental Health Services Administration (SAMHSA).

California’s Opioid Death Rate Is Among the Nation’s Lowest. Experts Aren’t Sure Why. (October 27, 2017). Los Angeles Times.

Behavioral Health Barometer, California, 2014. (2014). Substance Abuse and Mental Health Services Administration (SAMHSA).

California Adolescent Substance Abuse Facts. (January 27, 2017). Department of Health and Human Services (HHS).

State of California Strategies to Address Prescription Drug (Opioid) Misuse, Abuse, and Overdose Epidemic in California. (June 2016). California Department of Public Health.

California Opioid Summary: Opioid-Related Overdose Deaths. (March 2018). National Institute on Drug Abuse (NIDA).

Opioid Overdose: U.S. State Prescribing Rates, 2017. (July 31, 2017). Centers for Disease Control and Prevention (CDC).

See Where California’s Heroin, Opioid Problems Are the Worst. (August 18, 2015). The Sacramento Bee.

Benzodiazepine Overdose Deaths Soared in Recent Years, Study Finds. (February 18, 2016). CNN.

Prescription Drug Abuse and Prescribing Patterns in a Large Regional Area. (2017). Department of Emergency Medicine, University of California, San Diego.

As Opioid Death Toll Worsens, California Doctors Will Soon Be Required to Check Patient Prescription Drug History. (September 16, 2018). The San Diego Union-Tribune.

Opioid Prescription Drug Monitoring Surveillance Report. (2015). Sacramento County, Department of Health and Human Services, Division of Public Health.

Needle by Needle, a Heroin Crisis Grips California’s Rural North. (May 8, 2018). The New York Times.

California Expands Substance Abuse Treatment for Low-Income Residents. (December 11, 2015). NPR.