April 21 highlighted for many Americans a troubling trend ballooning to tragic proportions: the abuse of opioids.
On that morning rock star Prince — 57, only 112 pounds — was found dead inside his Minnesota home. The “Purple Rain” singer’s shocking death triggered a national conversation, especially given that the star had been known for his clean, drug-free image, shining a spotlight on what has become America’s problem. As the Centers for Disease Control (CDC) website underscores, “The United States is in the midst of an opioid overdose epidemic.”
The term “opioids” includes street heroin but also applies to pharmaceuticals — painkillers and sleeping aids — such as oxycodone, Opana, Vicodin and Dilaudid . In 2014, more than 28,000 people in America died from overdoses of prescription pain relievers and/or heroin. That’s more than any other year on record. Roughly half of those deaths were the result of prescription opioids.
Heroin use cuts across all genders, age categories and income strata, including demographic groups with historically low usage: women, the affluent, the privately insured. Addicts use heroin alone or in combination with other substances (cocaine, prescription painkillers).
As a result, heroin-related overdose deaths in America between 2002 and 2013 nearly quadrupled. In 2013 alone, heroin contributed to the deaths of over 8,200 people, including Glee star Cory Monteith, 31(heroin and alcohol); That ’70s Show actress Lisa Robin Kelly, 43 (multiple drug intoxication); and Kris Kross rapper Chris Kelly, 34 (heroin).
“A disease like addiction doesn’t really know demographics,” said Patrick Zarate, division manager for Alcohol and Drug Programs at Ventura County Behavioral Health (VCBH). “From Prince to [actor] Philip Seymour Hoffman [who, at 46, fatally overdosed from heroin in 2014], they point out that if you have access to medical insurance, you become vulnerable to that. For most of us who don’t have the resources [Prince] has, inexpensive heroin maybe becomes an option.”
What makes opioid addiction especially insidious is that often it starts out innocuously — taking painkillers post-surgery — and ignites from a lit match to a wildfire.
Local opioid abuse
States and counties play a central role in the prevention, treatment and recovery efforts connected to this pandemic. Working in Ventura County’s
trenches, Zarate and VCBH Prevention Services Manager Dan Hicks have witnessed the effects and evolution of heroin and prescription painkiller abuse on the local level. A decade in his current position, Zarate has worked at Behavioral Health since 1979; Hicks since 2005.
“Opioids are the fastest-growing component of accidental deaths, and now exceed motor vehicle collisions as the leading cause,” Zarate said. “Here and across the country, accidental opioid overdose deaths have skyrocketed.”
With just under 1 million residents, Ventura County experienced 93 unintentional overdose deaths in 2013.
“Annually, we lose 70 to 100 residents here to drug overdose,” Zarate said. “Most people overdose with more than one agent.”
Admission data for fiscal year 2014-15 of Ventura County’s treatment centers, including contracted methadone providers and compiled from the nationwide drug treatment system, opioid abuse made up 45 percent of 4,395 admissions. Opioid substance abuse breaks down locally as follows:
Heroin 38.4 percent 1,688
OxyContin/oxycodone 3 percent 130
Other prescription opiates 3.6 percent 159
“Most people who began to misuse pharmaceuticals have access to it through family members and friends,” Zarate explained. “Only 40 percent of [prescription medication] gets utilized; the rest sits in our medical cabinets.”
Statistics for Ventura County neighborhoods ebb and flow depending on the availability of heroin, yet the opiates problem spans across areas as drug procural creates crosstown traffic between the county’s lower- and higher-income areas.
Watching a loved one spiral
Richard Hulse, who lives with wife, Debi, in Oxnard’s Hollywood Beach, knows firsthand the pain and suffering that opioid addiction can visit on a family. His brother fatally overdosed six years ago.
Hulse, a retired Granada Hills Charter High School athletic director, felt deeply and angrily enough about his sibling’s trajectory to pen My Brother Bo: Addicted in Paradise.
According to Hulse’s self-published memoir and characterization of his late brother, Robert “Bo” Hulse was heavily into recreational drugs and alcohol and never quite amounted to much in school or in the military. After many dangerous drunken episodes and a suicide attempt, Bo entered rehabilitation at Impact House in Pasadena while serving weekend jail time for DUIs. After a year at the facility, “He came out of that place as sober as he could be,” Hulse said.
For three decades, the sobriety stuck, as Bo was briefly married, working variously as a Los Angeles Times copy boy, movie extra and Los Angeles Unified School District custodian.
Things took a dire turn after the Hulse brothers’ father died. Gaining an inheritance, Bo moved to Kauai, where, after undergoing a vertical gastric operation and two knee-repair surgeries, Bo began taking a variety of prescription drugs: OxyContin, Wellbutrin, Lyrica, Seroquel and hydromorphine.
“That’s when the doctor shopping began,” Hulse said.
Several overdoses followed during his Kauai residency. Eventually, he ended up on life support. On April 8, 2010, Bo’s relatives made the heart-wrenching decision to pull the plug. Bo was 60.
“I didn’t know a lot of this stuff until after he was dead,” Bo’s brother said. “I didn’t know what OxyContin was. Bo was taking a cocktail of this stuff.”
Complicating matters, Bo refused any help or rehab.
“I tried to help him the best I could,” Hulse said. “If Bo doesn’t want any help, you’re just going to spin your wheels.”
The nightmarish journey left Hulse resentful.
“I’m pissed off at myself,” Hulse said. “I’m pissed off at society. I’m upset with doctors, I’m upset with the system. Something is not right with this procedure of taking the drugs and not overdosing and they’d sign off on it and away they go.”
He finds patient-protecting confidentiality laws hypocritical.
“There are things that doctors don’t share with people until they’re dead,” said Hulse, who only gained access to a litany of Bo’s medical records posthumously.
On the other hand, Hulse recognizes that Bo wrestled unshakable demons.
“My brother was lonely all the time,” Hulse said.
As with others losing someone to opioid abuse, the dominant feeling is more anger than sadness: “I didn’t mourn because I was so pissed off by the way he died and he had debts of $80,000 that I had to take care of. But I wanted to validate Bo’s life in some way, even though it was a terrible situation.”
After Bo died, Hulse wrote his memoir “as sort of a catharsis of getting through him being dead.” Hulse hopes readers can glean two major takeaways: consolation and the motivation to demand changes in laws regarding family access to information. Hulse also resents the casualness with which some pharmaceuticals are marketed on TV. (“They’re advertising opiates like it’s no big deal.”)
One reader moved by Hulse’s book: Irv Berger.
“I had not seen or heard from Robert in over 40 years,” said Berger, moved by Hulse’s book. “Not only was he a classmate of mine, but I have been a pharmacist for 39 years and I have seen prescription drug abuse increase over those years.”
Berger, who works for a major chain pharmacy in Las Vegas, does not blame his employer for the uptick in pharmaceutical abuse, but he has witnessed some shenanigans.
“I can honestly say that we are doing our best to try to help reduce the abuse,” Berger said. “Sometimes we are put in the middle between physician and patient and must use our best judgment whether or not to dispense certain medications.”
In October 2011, Griffen Kramer, a Thousand Oaks High School quarterback (who had a history of battling addiction) and the son of former NFL quarterback Erik Kramer, was found dead of a heroin overdose at a friend’s Agoura Hills home. Four teenagers — Kramer’s former football teammate David Nernberg and Corey Baumann, both 19; and two 17-year-old juveniles — were arrested and charged by sheriff’s investigators with involuntary manslaughter and possession of a controlled substance. Baumann was additionally charged with possession of a controlled substance for sale. A fifth suspect — an Agoura Hills boy, 17 — was also arrested and charged with possession.
In June 2013, Dr. Daryl Westerback, 55, surrendered his Drug Enforcement Administration (DEA) registration to sheriff’s investigators. The Thousand Oaks psychiatrist, who had allegedly treated patients while impaired by pharmaceuticals and overprescribed painkillers such as Vicodin, oxycodone and hydrocodone, can no longer prescribe opiate medications, Undersheriff Gary Pentis told the Ventura County Star.
In April, another local doctor, Adam Sherman of Camarillo, 44, was arrested and charged with three felony counts regarding overprescribing painkillers after Pharmaceutical Crimes Unit searched his Oxnard medical office.
In July, Matthew Volpe, 45, a veteran deputy of the Ventura County Sherriff’s Office, was suspended after he was suspected of taking prescription drugs illegally from drop-off disposal bins at the Thousand Oaks headquarters. He has not been arrested; evidence was turned over to prosecutors at the district attorney’s office.
“Opioid abuse in our country has gotten out of control,” Berger said. “This is why prescriptions — which contain hydrocodone — have been reclassified to Schedule 2, which means they are more highly regulated than when they were in the Schedule 3 classification. Schedule 2 medications are not refillable and the patient must be seeing a physician and obtain a new prescription each time.”
For the past 50 years, methadone has been the most relied-upon opiate agonist medication. According to a May 30 Los Angeles Times article, however, Prince died right before he was to be treated with buprenorphine, a more obscure drug now employed to fight opioid addiction. The National Alliance of Advocates for Buprenorphine Treatment estimated that about 30,000 physicians are qualified to prescribe “bupe” and each is limited to 30 patients in his/her first year, 100 patients thereafter. The Times also reported that the Federal Trade Commission and the Health and Human Services Department are investigating the legality of marketing and market share surrounding buprenorphine manufacturer Indivior.
In Ventura County, both methadone and buprenorphine are used to treat opioid abuse.
Taking either alone, however, is only part of the solution. Methadone or buprenorphine patients must also enroll in medication-assisted treatment (MAT) in order for either drug to be effective, said Mark Hickman, president and CEO of Western Pacific Med Corp., which has 10 clinics throughout Southern California (including one in downtown Ventura).
“We currently use strictly methadone,” Hickman said of Western Pacific’s facility at Thompson and California. “Methadone is still the gold standard of treatment.”
That should change by next summer as the state paves the way for a waiver allowing health insurance coverage of complete, comprehensive buprenorphine treatment.
Hickman has seen a substantial change in opioid addiction over the years.
“When we first opened [in 1987], it was 99 percent heroin addiction,” Hickman said. “Heroin is very inexpensive but much more dangerous. There’s no way to know what they’re getting.”
Many pharmaceutical opiate addicts, however, turn to heroin when they can’t afford the prescription drugs, Hickman continued.
Today, about 25 percent of Western Pacific patients started their addictions with prescription medicines. The facility’s population ranges from ages 18 to 65.
Measures are being taken to curtail opioid addiction and progress is being made. Tougher federal and state laws, tighter regulation of doctors and pharmacies prescribing the drugs, and efforts on the ground to promote awareness and pill disposal are starting to make a dent.
In the wake of Prince’s death, President Barack Obama appeared on a public service announcement to confront the issue. During his White House weekly address in May, the President and rapper Macklemore urged Congress to confront the crisis.
“Deaths from opioid overdoses have tripled since 2000,” Obama said. “A lot of time, they’re from legal drugs prescribed by a doctor, so addiction doesn’t always start in some dark alley. It often starts in a medicine cabinet.”
Obama called on Congress to pass $1.1 billion in new funding to ensure that every American with an opioid-use disorder obtains necessary treatment. On July 8, Rep. Lois Capps, D-Santa Barbara, lauded the passage of S. 524 (Comprehensive Addiction and Recovery Act of 2016), which she co-authored and which is designed to target the opioid epidemic. The bill will provide federal funding to combat prescription opioid abuse and heroin use, and establish an interagency task force to update the best practices for prescribing pain medication.
Locally, Ventura County’s Board of Supervisors also voted in June to allot more monies to Ventura County Behavioral Health toward this area of addiction.
For every person who dies from an overdose, there are about 26 to 28 nonfatal overdoses in emergency rooms, continued Zarate with VCBH.
Addiction statistics have been worse back East than on the West Coast because doctors are tracked better in California, Hickman said.
“There are several safeguards in place that reduce the prevalence of overprescribing [and therefore overdoses] in California,” Hickman continued.
VCBH has also launched a small pilot program employing Vivitrol, an injectable, long-lasting form of naltrexone (one shot lasts 30 days) and expanded an overdose prevention and education project that includes the distribution of overdose reversal agent naloxone.
“The most recent report shows we had almost 400 kits distributed and close to 50 documented OD reversals [locally],” Zarate said.
VCBH also had families identify at-risk relatives, giving them the necessary release of information and allowing them to have those conversations with said addicts. The organization also distributed 274 naloxone kits and more than 40 refills, which Zarate speculates averted 40 potential fatal overdoses in Ventura County. Naloxone blocks or reverses the effects of opioid medication.
Change is in the air
The importance of education and awareness in fighting the abuse can’t be overstated.
“I have also seen a trend for prescriptions for opioids to be written in smaller quantities,” Berger said. “All of this may help decrease abuse but education is the key. A physician or pharmacist cannot solve the problem of drug abuse without any help. It is life stories such as Robert Hulse’s which will [also] help.”
“We’ve been trying to keep up feverishly to get people information,” Zarate said, regarding overdose education and prevention. “We need to start changing the narrative.”
Another positive movement in combating opioid abuse is having an awareness of proper disposal sites for unused medications.
“One of the things we’ve been pushing with law enforcement is to make disposal sites available and visible across the county,” Zarate said.
According to Zarate, 20 percent of 11th graders in Ventura County have used a prescription painkiller to get high.
“Safe disposal of unused and expired medication ensures continuous success in reducing youth access to prescription drugs,” Zarate said.
Such sites are proving effective. Zarate points to a recent survey to convey that 1 in 5 Ventura County residents have used a local drug disposal bin; some 27,722 pounds of prescription drugs have been collected by the Ventura County Sheriff’s Office since 2009.
“It’s a matter of time and will,” Hicks, county prevention services manager, said of seeing a dramatic turnaround. “It’s definitely going to get better, but how many people are we going to lose [until then]?”
Anyone in need of drug treatment can contact Ventura County Alcohol and Drug Programs at 981-9200 to schedule an appointment at a clinic nearby. Visit venturacountylimits.org/en/prevention/prescription-otc.