San Diego Union-Tribune (Sunday)
WE NEED OPEN DIALOGUE ABOUT DRUG USE, ABUSE
Since the start of the opioid epidemic in 1999, opioids have claimed more than 650,000 lives in the United States, about twothirds of all the drug overdose deaths. The crisis continues and is worsening. We have been seeing a precipitous rise in fentanylrelated deaths as we begin another crucial year to combat the problem.
As an emergency physician and medical toxicologist in San Diego, I see the impact of the opioid epidemic and substance use disorders daily. In my 10-plus years practicing medicine, I have watched firsthand as the number of fentanyl-related emergency department visits and deaths have increased exponentially.
Fentanyl has been used to treat pain in hospitals for more
Lasoff, M.D., is assistant clinical professor of emergency medicine and director of the Medical Toxicology Fellowship Program at UC San Diego, and lives in San Diego. than 50 years. It is a powerful medication that is safe and effective when used appropriately and managed by a medical provider.
However, people who use the drug, either recreationally or unintentionally, have no idea how much they are using, which results in people ingesting doses that are dozens to hundreds of times higher than what would be safely used in a hospital.
When an opioid is used in higher doses, it leads to the suppression of normal breathing. Without appropriate care, repositioning or naloxone, a medication that can reduce or reverse the effects of opioids, people eventually suffocate and die.
According to the San Diego Prescription Drug Task Force, in just five years, San Diego went from 84 fentanyl-related deaths in 2017 to 814 in 2021, a trend that seems likely to continue. In 2020, fentanyl killed nearly three San Diego residents per day and accounted for more than 9,500 emergency department visits that year, or nearly 25 emergency department visits per day.
On a typical day, I will see between five and 10 non-fatal fentanyl overdoses, adding to the already-incredible strain placed on our overstressed health care infrastructure.
I have watched as colleagues broke the news that a loved one and friend died from an overdose during a party, inadvertently using cocaine adulterated with fentanyl, a fatal combination.
I have sat with a young patient and his family and explained how the patient’s sister saved his life using naloxone when the patient overdosed on fentanyl after using it for the first time.
I meet with patients regularly who overdose on fentanyl and didn’t even realize they were using it, a phenomenon that has further complicated the opioid epidemic in recent years. The opioid is so potent that a single exposure, intentional or accidental, can kill.
The question remains: How do we combat this crisis?
Naloxone can be rapidly administered through injection or nasal spray. Any organization or entity in California can provide naloxone to those at risk of overdose and those in a position to intervene during an opioidrelated overdose. California pharmacists can dispense naloxone without a prescription from a health care provider. The medication should be easily accessible to anyone in need should a crisis arise.
UC San Diego Health is one of 52 health facilities participating in the California Bridge Program, which increases access to treatment for substance use disorders, enhances initiation of long-term medication and processes referrals to outpatient clinics.
The Bridge model treats emergency departments and acute care hospitals as the frontline for initiating treatment. The key component is to create a means to access comprehensive care for this patient population.
Recent legislation in California has provided all 52 participating hospitals with a counselor in the emergency department setting. This professional meets patients with substance use disorders and connects them to treatment resources and longterm care.
Expanding these policies in the state and at the national level is a critical step in preventing abuse and mortality. Legislation that leads to policies that reduce the harm associated with drug use, increases access to care and helps link patients to treatment in locations where patients frequent will all help reduce drugrelated deaths.
We need to have a continuing, open and frank dialogue about drug use and addiction to further remove the stigma, provide lifesaving treatments for the disease of substance use and effectively begin to remedy the fentanyl crisis.