Public Health Topics
Opioids & Prescription Drugs

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain. Opioids can also make people feel very relaxed and "high" – which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin is one of the world's most dangerous opioids and is never used as a medicine in the United States. (1)

Key Indicators & Quick Facts

In the South Bay:

  • Data from the 2018-19 California Healthy Kids Survey show that 37% of Beach Cities 11th graders have used drugs or alcohol in the past 30 days, on average (2)
  • Nearly 29% of adults in the South Bay report that they were under 18 years of age when they first misused a prescription drug. (3)
  • In the South Bay, there were 430 opioid prescriptions per 1,000 residents in 2018. (4)
  • In Service Planning Area (SPA) 8, 18.7% respondents perceive that misusing prescription medication is a major problem in their neighborhood. (8)
  • In 2018, there were around 4 opioid overdose-related deaths per 100,000 in SPA 8. (6)

SPA 8 includes the communities of Athens, Avalon, Carson, Catalina Island, El Segundo, Gardena, Harbor City, Hawthorne, Inglewood, Lawndale, Lennox, Long Beach, Hermosa Beach, Manhattan Beach, Palos Verdes Estates, Rancho Dominguez, Rancho Palos Verdes, Redondo Beach, Rolling Hills, Rolling Hills Estates, San Pedro, Torrance, Wilmington, and others.

In Los Angeles County:

  • In Los Angeles County, there was an average of 464 accidental opioid-related deaths per year from 2011-2017. (5)
  • In 2018, there were 587 opioid-related deaths in Los Angeles County. (6)
  • There was an 82% increase in the fentanyl-involved mortality rate in from 2019 to 2020. (7)

In California:

  • Starting in 2016 in California, all licensed prescribers authorized to prescribe scheduled drugs and all licensed pharmacists authorized to dispense scheduled drugs are required to register for access to the Controlled Substance Utilization Review and Evaluation System (CURES), California's Prescription Drug Monitoring Program (PDMP).

Overview of Benzodiazepines and Opioids

What are benzodiazepines?
Benzodiazepines (sometimes called "benzos") work to calm or sedate a person. Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others.

What are opioids?
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Side effects of opioid use include:

  • Drowsiness
  • Mental fog
  • Nausea
  • Constipation

What is fentanyl?
Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a Schedule II prescription drug; drugs in this classification have a high potential for abuse, which may cause severe psychological or physical dependence. Fentanyl is typically used to treat patients with severe pain or to manage pain after surgery.

What are the signs of an overdose?
Sometimes it can be difficult to tell if a person is heavily under the influence or experiencing an overdose. If you’re having a hard time telling the difference, it is best to treat the situation like an overdose – it could save someone’s life.

The following are some symptoms of being under the influence of opioids or benzodiazepines:

  • Pupils will contract and appear small
  • Muscles are slack and droopy
  • Speech may be slurred
  • They appear to be falling asleep but will respond to outside stimuli like loud noise or a light shake

The following are signs of an overdose:

  • Loss of consciousness
  • Unresponsive to outside stimulus
  • Awake, but unable to talk
  • Breathing is very slow and shallow, erratic or has stopped
  • Vomiting
  • Body is very limp
  • Face is very pale, clammy
  • Fingernails and lips turn blue or purplish black
  • Pulse (heartbeat) is slow, erratic or not there at all

What should you do if you suspect someone is overdosing?

  • Shout loudly, “Are you okay? Can you hear me?” to make sure the person is conscious. Apply painful stimuli like rubbing the knuckles against the sternum or applying a fingernail to the nail bed.
  • If there is no immediate change in their condition, call 911 immediately. Tell the 911 operator, “I believe this person is overdosing.”
  • California’s 911 Good Samaritan Law provides protections for any person experiencing a drug-related overdose, or a person who seeks medical assistance for a person experiencing a drug-related overdose. For more details, read AB 472 here.

Naloxone
Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

Types of Naloxone:

  • Injectable: Liquid form, injectable naloxone is commonly used by paramedics, emergency room doctors and other specially trained first responders.
  • Auto-injectable: EVZIO® is a prefilled auto-injection device that makes it easy for families or emergency personnel to inject naloxone quickly into the outer thigh. Once activated, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators.
  • Intranasal: NARCAN® Nasal Spray is a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while patients lay on their back. Anyone can be trained to use NARCAN®.

How to get help if you or someone you know is dealing with substance use disorder:

  • Substance Abuse Service Helpline (SASH) 1-844-804-7500
    • By calling SASH, residents of Los Angeles County can find out about free treatment that is available with Medi-Cal, My Health LA, and other county-funded programs.
    • The helpline is toll-free and available 24 hours a day, seven days a week. Translation services are available.
    • Available substance use treatment services include:
      • Outpatient Services
      • Intensive Outpatient Treatment
      • Detox and Withdrawal Management
      • Medication-Assisted Treatment and Opioid Program
      • Residential Services
      • Recovery Support Services
  • The Service and Bed Availability Tool (SBAT) is a web-based dashboard of available substance use services throughout Los Angeles County, including a provider directory. To locate Substance Abuse Disorder Treatment, use the LA County Service & Bed Availability Tool.

What is Medication-Assisted Treatment or MAT?

  • Buprenorephrine (Suboxone ® or Subutex ®):
    • A medicine for people who have chronic pain or addiction to heroin or other opioids. Many know it by the brand names, Suboxone or Subutex.
    • Buprenorephine reduces the risk of overdose and helps rid the body of cravings and withdrawal, without the effect of feeling high.
    • You can be prescribed MAT by an emergency department physician, an addiction specialist or your primary care doctor.

Resources:

Citations:

  1. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
  2. Manhattan Beach Unified School District, Redondo Beach Unified School District. California Healthy Kids Survey, 2018-19: Main Report. San Francisco: WestEd Health and Justice Program for the California Department of Education. Secondary
  3. Prescription Medication Misuse and Public Perceptions in Los Angeles County: Findings from the 2017 Community Needs Assessment. Health Outcomes and Data Analytics, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health, March 2019.
  4. California Department of Public Health (CDPH). Controlled Substance Utilization Review and Evaluation System (CURES). https://pdop.shinyapps.io/ODdash_v1/ 
  5. Prescription Opioid Abuse in Los Angeles County Dashboard, SafeMed LA https://insight.livestories.com/s/v2/prescriptions-opioid-abuse-in-la-county/c153ae4e-020d-4833-ace7-b8ceb7775467
  6. Los Angeles County Department of Medical Examine-Coroner. Los Angeles County Coroner Data
  7. Steep increases in fentanyl-related mortality west of the Mississippi River: synthesizing recent evidence from county and state surveillance
    Chelsea L Shover, Titilola O. Falasinnu, Candice L Dwyer, Nayelie Benitez Santos, Nicole J Cunningham, Noel A Vest, Keith Humphreys
  8. Prescription Medication Misuse and Public Perceptions in Los Angeles County: Findings from the 2017 Community Needs Assessment. Health Outcomes and Data Analytics, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health, March 2019.