While opioid use in San Mateo County is currently not as big a problem as that of many other communities, it’s important that everyone understand the risks and benefits related to prescription pain medications (opioids).

Download our factsheet here.

What are opioids?

Opioid pain relievers are prescription pain medications that can be dangerous and highly addictive, even for people who have no history of substance use disorders.

Opioids are frequently prescribed for management of short-term (acute) pain.  They have also been prescribed to people who suffer from long-term, chronic pain. Unlike treatment for acute pain, research has shown opioids are not an optimal treatment for chronic pain. Long-term use of opioids increases the risk of dependence leading to substance misuse or substance use disorders.

Opioid dependency can start in as little as one week.  Ask your prescriber about alternative pain treatments for long-term or chronic pain. 

It’s up to all of us to prevent prescription pain medication dependency and deaths.

Across the United States in the last two decades, opioid prescriptions, drug overdose deaths, and emergency department visits have risen dramatically, and place a strain on our families, hospitals, and entire community.

Research estimates that for every one drug overdose death, there are approximately 130 other people dependent on opioids.

If you or someone you know are taking opioids and think you may be dependent, talk to your doctor or call San Mateo County Behavioral Health and Recovery Services at 1-800-686-0101.

Commonly prescribed opioids include hydrocodone (Norco, Vicodin®), oxycodone (OxyContin®, Percocet®), fentanyl (Duragesic®, Fentora®), and codeine.

What are the risks associated with opioid dependence and addiction?

Opioids can be highly addictive and starting a prescription could lead to misuse or substance use disorders even if you do not have a history of misusing drugs. In the past two decades across the US, the number of filled opioid prescriptions and overdose deaths has been increasing. When someone takes increasingly higher doses of opioids over an extended period of time – the risk of dependence increases. Research has shown that more teens are using opioids and taking medicines prescribed to relatives. Prescription opioids can be a gateway to heroin use, and injection drug use can lead to the spread of Hepatitis C and HIV.

Why should I talk with my doctor before accepting an opioid prescription?

There is no medical research that shows that opioids work for chronic pain. Continual use of opioids can increase your risk of dependence, overdose, and even death.  Research shows misuse of prescription opioids increases the risk of transitioning to heroin use.

Why is substance misuse and overdose common for opioids?

Prescription painkillers bind to receptors in the brain and decrease the perception of pain, which creates a feeling of euphoria. When someone feels the need to take higher doses of opioids to achieve the euphoric effect, or to reduce withdrawal symptoms, it can cause breathing to reduce to a much slower rate or stop, resulting in a fatal overdose.

Who is more likely to be prescribed opioids?

When opioids are used for acute pain after a surgery, injury, cancer treatment, or end of life care, opioids may be the best option for you for short-term pain management – but know the risks. Opioids have been prescribed for ongoing, chronic pain but have been found to create a long-term high-risk cycle where misuse and possible substance use disorders become more likely.

Why are prescription pain medications a concern right now?

Between 1990 and 2010, prescription opioid painkillers sales have quadrupled in the U.S, with emergency department visits for prescription drug overdoses doubling between 2004 and 2011.

In just one year, over 24 million opioid pills were prescribed and filled by San Mateo County residents. That’s 43 pills for every resident over 18. Nationally, drug overdoses now cause more deaths than traffic accidents.

How does San Mateo County opioid use compare to other communities?

In San Mateo County, we are seeing opioid use and prescriptions rising and we want to ensure that everyone is aware of the benefits and the risks of taking these medications and avoid the suffering many communities are facing. While opioid use in San Mateo County is not currently as big of a problem as many other communities, it’s important that patients and prescribers discuss the risks and benefits of all pain management alternatives.

What is San Mateo County Health doing to prevent opioid misuse?

We are performing county-wide drug surveillance for opioids, marijuana, and illicit drugs. This includes tracking and reporting:

• Emergency Medical Services alert when a patient requires two or more doses of Naloxone
• Poison control calls for opioids, marijuana, and illicit drugs
• Alert from San Mateo County Coroner’s Office for cases of fentanyl and heroin
• Review of emergency department drug overdose visits
• Review of deaths related to opioids, marijuana, and illicit drugs
• Collaboration with San Mateo County Narcotics taskforce

The Health System also issued a Health Alert to all physicians in San Mateo County on February 7, 2017, and launched a public awareness campaign shortly thereafter.

What prescription pain medications should you be careful in taking?

There are many types of prescription medication you should be cautious about taking and can create potential for abuse:

• Opioid painkillers: Derived from the opium poppy (or synthetic versions of it) and used for pain relief. Examples include hydrocodone (Norco, Vicodin®), oxycodone (OxyContin®, Percocet®), fentanyl (Duragesic®, Fentora®), methadone, and codeine.

• Benzodiazepines: Central nervous system depressants used as sedatives, to prevent seizures, and relieve anxiety. Examples include Zolpidem (Ambien), alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®).

• Hypnotic: Sleeping tablets effective in initiating sleep, including zolpidem (Ambien, Sonata, Lunesta)

• Stimulants: Central nervous system stimulants used to treat attention deficit hyperactivity disorder (ADHD). Examples include dextroamphetamine/amphetamine (Adderall®, Adderall XR®), and methylphenidate (Ritalin®, Concerta®).
   
• Alcohol

What you can do

• Download our factsheet  for more on what you can do today. Know the risks. Don’t start taking opioids unless you have a plan to stop. Dependency can start in as little as one week. Just because your doctor gives you a prescription does not mean you are safe. Ask your prescriber (doctors, dentists, etc.) about alternative pain treatments. 
• Tell your doctor if you have any history of substance misuse or substance use disorders before being prescribed pain medication.
• Do not share medication with others. Research shows that more than half of people who used prescription pills for nonmedical reasons reported using pills that were prescribed to a friend or family member. It’s important to safely store and dispose of medications. In San Mateo County, teens misusing opioids are using medicine prescribed to relatives.
• Dispose of unused medication at Drug Take Back locations where you can turn in unused and unneeded medication for safe disposal.
• Naloxone can prevent a deadly overdose. Ask your doctor or pharmacist about Naloxone/Narcan to help prevent accidental overdose.
• If you or someone you know are taking opioids and think you may be dependent, talk to your doctor or call San Mateo County Behavioral Health and Recovery Services at 1-800-686-0101.
• Follow medication directions carefully and do not mix opioids with other drugs or alcohol. 

Resources

• Drug & Pain Medication Facts
• Prescription Opioid Misuse and Overdose Workgroup (CDPH)
• California Health Care Foundation – Opioid Safety