Drug Abuse in the Inland Empire

In October 2017, the U.S Department of Health and Human Services declared the misuse of prescription opioids as a country wide epidemic. It’s a term that you may have heard when watching news of COVID-19 in its early stages, or when watching your favorite post-apocalyptic T.V show. So why is a category of pain-killers being coined with the same term that was used in 2015 Zika Virus outbreak and the 2014-2016 ebola virus epidemic that ravaged West Africa?

According to the Center of Disease Control (CDC), an epidemic is “An unexpected increase in the number of disease cases in a specific geographical area.” This includes pathogens such as viruses and bacteria, but also encompasses specific health-related behavior, which brings us to the primary topic of today’s discussion: Opioid Abuse.

In 2012, the total number of deaths due to a drug overdose was 41,502. Out of this, an approximate 22,000 of them were victims of an opioid related overdose, making up a little over 50% of the drug overdose related deaths that year. In 2021, the total number of drug overdose fatalities rose to 106,699, of which roughly 81,000 were due to an overdose of opioids. In other words, this represents 76% of the drug-related deaths in 2021. From 2012 to 2021, the United States witnessed a 66% increase in drug overdose related deaths. Even more alarming, was the increasing use and availability of opioids, more specifically fentanyl. With its cheap production and a 100x increase in potency compared to morphine, this synthetic opioid began to take the United States by storm.

It’s clear that the United States is suffering from the abuse of opioids that have only seen an increase in related fatalities and drug potency. Now let’s take a closer look at our own backyard, the Inland Empire. 

Encompassing Riverside and San Bernardino county, the Inland Empire is unfortunately no stranger to the devastating impact of drug abuse. According to the Inland Empire Opioid Crisis Coalition (IEOCC), there were 688 opioid related deaths in the Inland Empire, with 479 opioid related hospitalizations, and close to 1900 ER visits in relation to opioid abuse. Alarming data provided by the Riverside County EMS Agency for the months of January and February show that there have already been 557 drug overdoses, with 419 of them being opioids.

When looking back at 2021 and 2022, roughly 800 people died of a drug overdose in Riverside County, with deadly opioids like Fentanyl and Heroin representing roughly 50 percent of these deaths each year. When looking at fatalities from a demographic point of view, the most affected age groups are 15-24 and 25-44, having 77 and 311 deaths related to drug overdose respectively within Riverside County in 2021.

In just two months into 2023, nearly 420 people have suffered from opioid abuse. This information also serves to address another issue that the IE faces: The same report states that of the 419 overdoses, 126 of them are recorded as being homeless. There exists a correlation between homelessness and drug usage and this data serves as a tragic but important example of it happening right here.

With the information just provided, it’s known now that substance abuse, specifically opioids, has and continues to claim the lives of people across the nation. With the use of fentanyl as a cheap to produce and much more potent drug in comparison to heroin, there doesn’t seem to be a clear end in sight to the use of opioids. We’ve spent a significant amount of time discussing statistics and numbers regarding opioid abuse, but what exactly are they?

Opioids refers to a class of drugs that interact with your body’s opioid receptors that are located on cell surfaces. Upon this interaction with the receptors, the opioids elucidate a biochemical pathway that serves to block pain signals between the brain and the body. There are 3 kinds of opioid receptors: mu, delta, and kappa opioid receptors, but the one that’s important in our case is the mu receptor. This receptor is responsible for feelings of  analgesia, respiratory depression, and euphoria to name a few. It also plays a role in causing digestive issues, which increases the risk of gastrointestinal infection (GI).

The mu opioid receptor is known as a G-Coupled Protein Receptor (GPCR), a receptor that when activated causes a signal amplification within the cell. It’s important to note that these receptors are found all over the body, but its concentration varies from each part. Within the brain, these GPCRs that opioids act on are found in the Ventral Tegmental Area (VTA) of the brain, which produces complex behavioral responses such as reward processing, stress modulation, learning, and drug addiction to name a few. In addition, they can also be found in the brainstem, which contains delicate structures such as the medulla and pons, both which are vital to autonomic bodily function such as breathing, sleep regulation, heartbeat, and a sense of balance. Surprisingly, they are also found in the stomach, which helps to explain the statement regarding GI in the previous paragraph.

Opioids bind onto these receptors which causes intracellular inhibition of GABA release from the presynaptic cell. Since GABA cannot be released from the cell, the GABA receptors on the same presynaptic cell are now unbound and its downstream effects are inhibited. This prevents presynaptic hyperpolarization, where the cell’s membrane gets more negative to delay another action potential.

Now that the science behind opioids has been summarized, we can move forward to talk more about the recent surge of fentanyl in the United States. This synthetic opioid is widely thought to be among the most potent and deadly opioids currently being used. It’s reported that it’s 50 times more potent than heroin and 100 times more than morphine, both of which are also commonly used opioids. Looking at it from a biochemical perspective, this makes sense. When looking at these molecules binding affinities to the mu receptor, fentanyl is reported to have a (Km ) value of 1.6 M, whereas morphine is 5.7 M. A lower Km means the substrate has a higher binding affinity towards its receptor protein. This makes a drug more potent as a lower concentration is needed to saturate the receptors.

In addition to the drug’s potency, fentanyl is also much cheaper to produce in comparison to other natural and synthetic opioids that are being used on the streets. According to an article talking about the domination of fentanyl in the US illicit drug market, fentanyl manufacturers are able to obtain precursor chemicals for fentanyl for just around $200, whereas to make the equivalent amount for heroin, it can stretch up to $6,000 dollars. With its high potency also comes less amounts to transport in order to yield high profits. A report on opioid trafficking states that around 3-5 metric tons of fentanyl is needed to meet the annual demand for illicit opioid abuse in the United States, compared to heroin’s 45-50 metric tons to meet the same demand.

With high potency, low manufacturing and transportation costs, and only a small amount needed to achieve a high, it makes sense as to why opioids are a problem across the Inland Empire and across the nation. Here at Vega Medical Collective, we are not only here to just spread awareness regarding important healthcare topics and disparities in the IE, but also to actively engage in providing resources and help in order to combat such problems. Below you will find organizations and clinics that provide additional information regarding drug abuse and services for treatment and rehabilitation.

The National Institute on Drug Abuse (NIDA) www.drugabuse.gov is a government-run website that offers resources, research, and educational materials that focus on drug overdose prevention, treatment, and recovery. 

• The Inland Empire Health Plan (IEHP) www.iehp.org is a local health plan for those living in Riverside and San Bernardino counties. They offer resources and support for substance abuse services.

• https://www.ieocc.org/ Inland Empire Opioid Crisis Coalition: Founded in 2015, the IEOCC is dedicated to ending opioid abuse and overdose related deaths in the Inland Empire, integrating community leaders that conduct meetings to locals and providing evidence backed information on the latest information in the greater Riverside and San Bernardino area as a part of their cohesive action plan.

https://www.rcdmh.org/substance-use-programs Website that provides a multitude of substance abuse prevention and treatment locations in Riverside County.