While California as a whole ranks fairly low when it comes to opioid-related deaths, the state’s rural counties are suffering much higher rates.

That’s why Adventist Health/Rideout was chosen as one of 31 health facilities to participate in an 18-month accelerated training program to provide innovative treatment for opioid use disorders. It’s organized by Public Health Institute’s California Bridge Program – which will provide funding, training and technical assistance.

A hospital press release cites some startling figures: 

-- In 2017, there were 90,293 opioid prescriptions written to Sutter County residents, a number equal to about 88 percent of the population.

-- There were 70,300 prescriptions written to Yuba County residents, a number equal to about 100 percent of the population.

-- The rate of emergency room visits for all drug overdoses by Sutter County residents in 2017 was 41 percent higher than the state average, and Yuba County residents’ ER visits for drug overdoses in 2017 was 28 percent higher.

Dr. J Eileen Morley, assistant medical director in Emergency Medicine, who is overseeing the project, said currently if a patient comes to the emergency department in withdrawal from opioids, Adventist Health-Rideout will treat their symptoms but won’t actually treat the withdrawal itself. Now, through this program, personnel will be using buprenorphine, which fully treats the withdrawal. 

“I envision that the (emergency department) will become somewhat of a hub for individuals seeking help and treatment for substance use disorders, and we will have both the medical expertise to give them the best treatment and a navigator to assure that they are actually able to ‘bridge’ into continued outpatient treatment,” Morley wrote in an email Wednesday. “

The model practiced in this program treats emergency rooms and acute care hospitals as a critical window for initiating treatment, according to the press release—a referral to an addiction treatment program has been the most that hospitals have generally been able to provide for patients needing treatment for opioid use disorder.

Morley said two medications are used in medication-assisted treatment: methadone and buprenorphine, the latter chosen for the program for its high safety profile, simplicity in dosage, quick onset and its craving suppression effects in addition to controlling withdrawal symptoms. A common misconception, she said, is that the medication will get people high — she said that’s not the case, and the emergency room will not be overrun with patients “drug-seeking” for the medicine. She said that medication-assisted treatment does not mean people rapidly wean off opioids once starting the medicine.

“Addiction changes your brain chemistry and the best evidence-based practices & clinical trials show that most patients need medication plus counseling/therapy to stick to a recovery plan (not just one or the other),” she wrote.

And while there aren’t any concrete answers as to why rural counties are hit hardest by opioid addiction, Morley said rural counties already have many barriers to healthcare in general— a long drive to get to a doctor’s office, the hospital or treatment clinic; no steady means of transportation or money for fuel; or jobs that make it difficult to take time off.

“But once addicted to opioids, or if one is slipping into an addictive pattern of taking opioids, accessing help is much more difficult in rural counties than urban ones,” she said.

Morley hopes the program will act as a model for how hospitals around the country treat patients with opioid use disorder, and said personnel will work around whatever barrier faces a patient in need. 

“Adventist Health and Rideout Hospital’s strong support of this program shows their commitment to the community and to combatting the stigma surrounding substance use disorders - no small task,” she wrote. “Opioid use disorder can happen to anyone, and we want to create an environment in the ED where everyone can feel safe, not judged, and can receive the help that they need.”

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