Coroners in San Diego County have taken a bold new approach to persuade doctors to curb opioid prescribing. The San Diego County’s chief deputy medical examiner, Dr. Jonathan Lucas, sent letters to physicians about their possible role in the escalating opioid abuse epidemic.
The doctors received a letter stating: “This is a courtesy communication to inform you that your patient (name, date of birth inserted here) died on (date inserted here). Prescription drug overdose was either the primary cause of death or contributed to the death.”
The letter continued by stating how many medication deaths the coroner sees each year in San Diego County (between 250 and 270) and offered five prescribing tips proven to decrease overdose death rates. The letter also suggested an online program designed to help doctors who are “dedicated to avoiding prescribing controlled substances when they are likely to do more harm than good.” This experiment, initiated in San Diego County to notify doctors when an overdose of certain drugs has claimed the life of a patient, is also being explored in Los Angeles County.
It’s hard to change doctors’ prescribing habits and patients’ consumption overnight. It will involve long and difficult conversations with patients who will certainly push back. Doctors will also have to put aside years of reassurances by the makers of opioid narcotics that certain medications are safe and effective to relieve pain. Dr. Sean Michael, a University of Colorado ER doctor says, “The intention when people wrote these prescriptions was to try to help someone, not to accidentally kill them. But that’s the problem: The edge is so narrow and the risk is so high with these medications.”
This is a unique approach to the national drug crisis, which has claimed 72,000 lives this past year, up from 65,000 the year before (according to the CDC). The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths. Experts point to two causes: a growing number of Americans are using opioids and the fact that drugs are becoming more deadly.
The introduction of fentanyl, a synthetic drug, in the heroin markets in the Midwest may explain recent increases in overdose deaths. Those who had used heroin before the recent changes to the drug supply might be unprepared for the strength of the new mixtures.
On the West coast the heroin supply is processed into a form known as black tar that is difficult to mix with synthetic drugs like fentanyl. So overdose deaths are fewer than those in the Midwest. Overdose deaths increased sharply in Ohio, Indiana, and West Virginia by more than 17 percent in each state and in New Jersey by 27 percent. Overdose deaths in the Northeast have leveled off because those states have developed public health and addiction treatment programs.
However, more than 70 people overdosed in New Haven during a 24-hour period this past week. Authorities suspect a virulent batch of synthetic marijuana, known as K2 or Spice, was possibly laced with an opioid.
Let’s hope that more cities try San Diego’s innovative approach to curb the drug overdose crisis.