From Mono County Heath Officer Dr. Tom Boo
Opioids: Reducing Harm in Mono County
Today’s Monogram focuses on local efforts to address the opioid epidemic, which has been declared a national emergency. Tens of thousands of Americans will die this year from opioid overdose. There are people at risk in every community, including ours.
As County Public Health Officer, I am today issuing two orders intended to further our collaborative efforts to save lives. One order mandates healthcare workers to report opioid overdoses to us at the County Health Department. The other authorizes a wide range of people to administer and to distribute naloxone, the fastacting and easily administered antidote for opioid overdose.
There is a compelling rationale for making opioid overdoses, fatal and non-fatal, reportable. First, the reporting will help us track the epidemic locally, to identify trends over time, and I hope allow us to identify the presence of risky batches of street drugs, such as those containing fentanyl, in a timely fashion. Second, when we receive reports of non-fatal overdoses we intend to contact survivors to offer them assistance.
People who survive an overdose are at the highest risk of fatal OD in the near future, yet in the period right after an overdose they may be particularly willing to accept help.
Survivors will be offered intranasal naloxone to reverse overdoses and addiction treatment, including buprenorphine-based medication-assisted treatment
(MAT). I believe that Mono County is the first jurisdiction in California to make opioid overdoses reportable.
The second order permits anyone who receives training in the use of naloxone as an emergency treatment for opioid overdose to distribute naloxone to other people, accompanied by brief education.
The objective is community distribution of this potentially life-saving drug, and a recent state law makes it possible for us to distribute naloxone without prescription, by health officer order. Mono County has applied for an in-kind grant of naloxone from the California Department of Public Health (our state health department) and we will
commence training and distribution of the medication as soon as we receive it from Sacramento.
The ideal outcome would be to make naloxone available in any household where someone is worried about overdose, their own or a loved one’s. By supplying it to police, fire and other first responders we hope also to facilitate more rapid first responder treatment.
Mono County is working to make medication-assisted treatment for opioid use disorder more available.
Currently the only MAT provider that I am aware of is Bright Heart Health, a telemedicine practice offering treatment for all kinds of addiction and accepting virtually all insurance plans (844 844-4474; brighthearthealth.com), but we anticipate soon that one or more Mono County clinicians will offer MAT.
Buprenorphine-based MAT is also currently available in Bishop at the No. Inyo Hospital Rural Health Clinic and in Lone Pine at Toiyabe Indian Health Project.
In public health, the value of syringe exchanges is well-established as a means of decreasing bloodborne infections among people who inject drugs, promoting safe disposal of used needles, and establishing relationships with people who may benefit from health services.
Mono County Health and Behavioral Health Departments are applying to the state health department (California Department of Public Health) for syringe certification.
Whenever we interact with people who may be at risk we will encourage testing for hepatitis and HIV, which is offered at the Health Department as well as through any clinic or medical practice. Hepatitis C is now curable with safe drugs taken for 8-12 weeks and there is effective long-term treatment for HIV and hepatitis B.
Efforts to reduce the harms from opioids and other addictive substances at the community level require official support and I appreciate the commitment of the Mono County Board of Supervisors and Sheriff Ingrid Braun to evidence-based public health strategies.
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