County’s opioid prescription rate highest in state

A supply issue that has rendered the Save Mart pharmacy on Mono Way in Sonora unable to fill prescriptions of controlled substances is due to the high rate of such drugs being prescribed by health care providers in the area, a representative for the Modestobased grocery chain said.

“An audit is underway due to the high volume of controlled substances being prescribed by providers in the area and filled by our pharmacy,” Victoria Castro, a Save Mart spokeswoman, said in an email to The Union Democrat on April 29. “The Save Mart Companies does not have control of the audit timeline but are working diligently toward and hopeful of a rapid turnaround as we continue to serve our patients and the community.”

Castro concluded the email saying she would reach out when the company had an update to provide on the situation, but that had yet to happen as of Wednesday. The Union Democrat has not received a response to an email sent late Monday asking if there was any new information.

The issue appears to have begun sometime in March and shortly before the formerly family owned company announced it had been sold to a private equity firm called Kingswood Capital Management, LP, based in Los Angeles.

Meanwhile, some area residents who used to get their prescriptions for controlled substances filled at the pharmacy have been forced to travel as far as Escalon and Auburn to find other places that will supply their medications, because other pharmacies in Tuolumne County have told them they can’t take on new customers.

Controlled substances can include pain, anti-anxiety and antiseizure drugs.

Opioids are a type of narcotic used for treating pain that have

come under scrutiny in recent years due to an ongoing overdose epidemic, which was blamed for the deaths of record 100,000-plus Americans last year.

Save Mart’s reason for the recent supply issue at its Mono Way store didn’t come as a shock to local health officials, who cited statistics that showed the county has the highest rate of opioid prescriptions in all of California.

According to the latest available data from the California Department of Public Health, the county’s opioid prescription rate in 2020 was 846.47 per 1,000 residents. The average rate for all of California was 374.87.

The county also ranked the highest for milligram morphine equivalents, or MMES, prescribed per person and MMES prescribed to people 90 or older.

“We’re number one in the state,” Dr. Kimberly Freeman, who started her new job as the county’s health officer on April 19, said. “I’m not surprised at all that pharmacies would come under scrutiny, or providers for that matter.”

Freeman said in an April 27 interview there’s nothing the county can do to intervene or influence the situation because the rules and regulations governing pharmacies and suppliers are not set by the local public health department.

She explained that suppliers are limited in the amount of controlled substances they can give to a county based on population, as well as the ratio of prescriptions in the area for controlled substances to non-controlled substances.

“There’s some sort of formula that the suppliers say only X percent of all prescriptions should be controlled substances, and you’re a county with only 54,000 people, so you should not need more than X, either,” she said. “I don’t know what the formulas are, from what I understand that pharmacists don’t either.”

Pharmaceutical suppliers will cut off the flow of medications once the county reaches its threshold, which is why people who got their prescriptions filled at Save Mart have gotten turned away by other local pharmacies.

“Other pharmacies cannot physically take other patients and believe that they can get them the prescriptions they need,” Freeman said. “They’re not trying to limit themselves, from what I understand, the suppliers have limited what they can do.”

Many point to the county also having a higher percentage of people 65 and older as a reason for the higher prescription rate, though Freeman compared the rates of other counties with similar or even older age demographics and Tuolumne County still came out on top.

Freeman said the county having the highest or among the highest opioid prescription rates is an issue that goes back decades, though there has been considerable improvement over the past 10 years.

The county had about 2,500 MMES prescribed per resident in 2010, which Freeman said is equivalent to about 250 10-milligram pills of the pain reliever Norco for every “man, woman, and child in the county.”

While the county was down to about 882 MMES per resident in 2020, that was still higher than the statewide rate in 2010 at about 713. The statewide rate in 2020 was 261.55.

“Our county’s culture was to prescribe a lot, and we’ve had to work on that,” Freeman said.

According to Freeman, the reason health care providers in the area were and still are prescribing more opioids stems largely from the way medical professionals were trained in the past on treating pain.

Freeman said she herself was taught while going through medical school 20 years ago at University of California, San Francisco, that patients suffering from pain could not get addicted, which turned out to not be true.

“It was wrong,” she said. “That created a whole group of patients with legitimate pain who are now on controlled substances, and it’s very, very difficult to wean them off once they’ve gotten used to it.”

Freeman credits the county’s improvement since 2010 largely to the Tuolumne County Opioid Safety Coalition under former county Health Officer Dr. Todd Stolp, which helped to educate local providers about the use of narcotics in treating pain and influencing prescribing practices.

The coalition continued through 2020 before becoming deprioritized following the departure of former county Health Officer Dr. Bob Bernstein and the emergence of the COVID-19 pandemic, Freeman said.

Last year, Freeman helped found the Red Feather Opioid Coalition while working for the Mathiesen Memorial Health Clinic in Jamestown to help fill the void.

Freeman said some common non-narcotic treatments for pain include yoga, acupuncture and changes in diet and lifestyle to reduce chronic inflammation.

Buprenorphine is also a drug Freeman recommends providers try as an alternative for opioids. She said one reason it’s not prescribed as much is because medical professionals are required to go through additional training in order to prescribe it, and many insurance companies — including Medi-cal — don’t cover it despite being safer than opioids.

“As much as providers aren’t really to blame, they are who can help change this, and get patients on safer medicine or reduced doses,” she said. “I encourage looking at the resources and reformulating practices to embrace that.”