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experienced a 50 percent abstinence rate after one year. Without MAT, recovering opioid addicts were 3.5 to 10 times more likely to die of an overdose. Orange County currently offers MAT, but we could improve. “Five percent of U.S. doctors have a licence to prescribe [Suboxone], and of those, only a fraction actually prescribe it because insurance payments are very poor, and many doctors simply give up,” Deyhimy says. Switzerland’s MAT program, which provided free injections of clean heroin for patients, effectively eliminated that country’s heroin crisis during the 1990s. Since 1991, there has been a 50 percent reduction of overdose death, an 80 percent reduction of incidence of starting heroin use and a 65 percent reduction of HIV infections, according to Ambros Uchtenhagen of the Research Institute for Public Health and Addiction. The medical journal Lancet concluded, “The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people.” Such an effort in Orange County would rely on a commitment from policy makers, police and the community to address opioid addiction medically. Otherwise, senseless deaths and crime will increase. Unfortunately, this might not be enough. In the Feb. 23 issue of The Economist, a trio of Stanford public-health experts say that increasing naloxone distribution and MAT will decrease deaths by 4.1 percent and 2.4 percent respectively, over the next six years. Restricting opioid prescriptions, however, would result in a sharp increase in deaths, as people switch from pills to street opiates. The experts expect to record 500,000 overdose deaths between 2016 and 2025. According to the Economist article, “Even if America introduced all the policies likely to save lives, deaths over the next decade will drop by just 12.2 percent.” Dr. Deyhimy introduced this bleak future at a town hall meeting in January. “We’re going to continue seeing lots of deaths each year in increasing number, and it’s going to be due to the fact that fentanyl is basically available on the internet,” he said. “Anyone can buy it.” ma rc h 08 -14, 2 0 19
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MAT Clinic, 90 percent to 95 percent of recovering opioid addicts in abstinencebased treatment relapse within a year. And two: It’s easy to access fentanylcontaminated heroin. In an article for Justice Quarterly, published Jan. 21, Christopher Contreras, a UC Irvine Ph.D. student in criminology, notes that rising drug use in a community correlates with rising violence. “Residential stability and high socioeconomic status do not necessarily buffer blocks with drug trafficking against rising robbery and burglary rates,” Contreras writes. “Instead, blocks with narcotics activity bring in serious, high-rate offenders, such as drug users, who may commit robberies and burglaries for drug money.” Additionally, because drug markets aren’t static, they can quickly shift from city to city. In other words, OC’s affluence won’t protect its residents from drug-related crimes if the spread of drugs continues. Since police alone can’t be expected to solve the problem, harm reduction may be the best solution. In 2017, when Dunkle had a central location to distribute naloxone, overdose rates decreased. However, when the OC Needle Exchange Program was shut down in January 2018, rates began rising. “In 2016, we had 336 deaths. [In] 2017, we had 304 [255 were opioid related]. I literally bought all the naloxone that was distributed,” Dunkle says. In that time, overdose-death rates in San Diego, Los Angeles and Oakland were higher than the year before. “Orange County was the only one that was down,” she says. “That in itself is an indicator of what happens when you have a centralized location for harm reduction.” Dunkle believes that three centralized naloxone distribution locations—one each in North, South and Central OC—would greatly reduce the county’s death rate. Medication assisted treatment (MAT) has also proven effective. It combines the use of drugs such as Suboxone, a lowaddiction-risk opioid, and methadone with behavioral therapy. According to Deyhimy, “When you stabilize with buprenorphine, all drug use decreases by 50 percent. These folks are getting the behavioral treatment they need, plus MAT.” Deyhimy added that patients undergoing MAT
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