More San Diegans with chronic pain are managing that pain, without powerful and addictive prescription drugs, according to a data analysis completed by NBC 7 Investigates.
Orville Dalager of Carlsbad is one of them.
He experienced chronic -- and at times -- excruciating pain in his fingers, hands, and wrists, caused by chemotherapy treatment for prostate cancer. Dalager said he couldn’t even open a car door without pain, so he turned to the prescription opioids tramadol, hydrocodone, and oxycodone for help; the tramadol gave him quick and significant pain relief.
“It’s like they went in with WD 40, and lubed the joints,” Dalager told NBC 7 Investigates. "Made it so I could do what I usually do, which is work with my hands."
But that pain relief came with some serious side effects.
“I felt groggier, a lot more forgetful,” Dalager explained. “Just no energy. And I got constipated. Yeah, that was no fun.”
Those side effects and concerns about addiction led Dalager to work with his doctor to find alternative solutions for his constant pain.
He began walking several miles a day, two or three times a week, on the beach in Carlsbad. On days when the tide is high, Dalager said he walks on the rocks at the top of the beach, which he said helps with his balance. He’s also doing yoga, a practice he said he once dismissed as “a bunch of creepy crap”, but now acknowledges it “stretches me out, helps with my balance, and helps with my attitude.”
Perhaps most importantly, Orville changed his diet.
“I lived on junk food,” he admits. "Fat, fried, and greasy food. Red fatty meat. White bread. Candy bars every day."
Now, Orville said he fills his plate with fresh fruit and vegetables. He drinks acai shakes and carrot juice and eats tomatoes and kale.
“I've got so that I really like kale, which is something I thought I'd never say in my life."
Orville said those lifestyle changes -- especially his diet revolution -- improved his physical and mental health and reduced his pain, allowing him to cut back on tramadol, and use it sparingly, for only the worst pain.
Data reviewed by NBC 7 Investigates shows thousands of other San Diegans are also kicking the opioid habit.
According to DEA statistics:
- Oxycodone sales in San Diego have declined every year, since their peak in 2012.
- Hydrocodone use has trended down slowly since 2011, with a significant drop in 2016.
Dr. Roneet Lev, an emergency room physician and pain medication expert at Scripps Mercy hospital, said those stats represent a significant improvement.
“Hydrocodone was the number one prescribed medication in the entire United States,” she said. “More than blood pressure medicines, cholesterol medications, diabetes medications. More than anything by far was hydrocodone."
According to Dr. Lev, prescription opioid use spiked ten years ago, in response to well-funded campaigns by pharmaceutical companies, a lack of knowledge about the potential for abuse, and misguided medical education. She said medical students were taught if “somebody cut their thumb and they had a little boo-boo, (aspiring doctors) are not there to judge their pain. If they say they're in pain, they deserve prescriptions."
Data from the San Diego County Medical Examiner shows from 2006 to 2011, overdose deaths from prescription opiates climbed steadily in San Diego, from 180 deaths in 2006 to 273 deaths in 2011.
Details about those deaths are available on the state of California’s Opioid Overdose Surveillance Dashboard.
According to the interactive website, in San Diego County:
- Whites and Native Americans have the highest rates of deadly overdoses, while Asians are consistently the least impacted.
- Prescription opioid users ages 55 to 59 are the most likely to overdose.
- Women get more opiate prescriptions than men, but men are much more likely to die of opiate abuse.
“What turned it around was the huge number of people that were dying,” Dr. Lev said of the impetus to reduce the use of prescription opioids.
That effort includes educating doctors and dentists about the importance of limiting the number of pills they give patients, and the use of a statewide database, called “C.U.R.E.S”., to help stop patients from “doctor shopping”.
The DEA also requires doctors to write opioid prescriptions on forgery-resistant forms. In addition, no refills are allowed for the most powerful opioids, so patients must visit their doctor every time they want more pills and doctors’ offices can not phone in prescriptions to pharmacies like they do for other prescription medications.
“If you work in a doctor’s office, maybe at the front desk, you might know what to say to a pharmacy to call in a prescription,” said DEA agent Amy Roderick. “And this will stop that kind of fraud."
Despite these attempts to reduce prescription opioid abuse, Dr. Lev said some patients push back, and even threaten to get their drugs somewhere else.
“They’ll say, ‘I need these medications. I need them to survive, and if you do not give me my pain prescriptions and my medications, then I'll go on to be a heroin addict, and it will be your fault!'"
Data reviewed by NBC 7 Investigates shows as opioids have become harder to get, heroin overdose deaths have increased. Dr. Lev and the county medical examiner's both said the increase in heroin deaths is due more to the cost, potency, and supply of that illegal and powerful narcotic, than to the crackdown on opioid prescribing.
This series of line charts shows the overall overdoses as well as breaks it down by types of drugs.
Sales of hydrocodone, the opioid in Vicodin, have fallen sharply in much of the Northeast, the upper Midwest and Texas in the past five years – a result, perhaps, of the concerted effort by health care workers and regulators to prevent addiction and overdoses. At the same time, however, sales of the drug have risen in broad V stretching from Michigan to Louisiana back north to the Dakota oil fields. Parts of the West are also seeing a spike in sales.
Retail sales of oxycodone, the opioid in OxyContin and Percocet, rose in the past five years in the Plains and much of the South and Rocky Mountain West while declining elsewhere in the U.S. Public health authorities have tried to discourage use of the drug to prevent fatal overdoses. After rising rapidly for a decade, the death toll for natural and semisynthetic opioids such as oxycodone and hydrocodone has stabilized in the past five years while deaths from heroin and synthetic opioids such as fentanyl have soared.