Can data explain the opioid crisis in California’s rural, underserved San Joaquin Valley?

Over the past few years, the number of Californians dying from opioid overdoses has appeared to level off. While national overdose deaths rose by 10 percent from 2016 to 2017, California’s fatal overdose rate fell to the lowest it has been since 2012, when the opioid epidemic first rose to national attention.

But don’t be fooled: Within California, many regions have bucked that encouraging trend — including Kern County, which reported a 30 percent rise in overdose deaths from 2016 to 2017. Only a portion of that increase can be attributed to growing use of the street drug fentanyl.

What’s more, fatal overdoses are not the only indicator of the opioid problem. According to data from the state Department of Public Health and the nonprofit Urban Institute, the whole southern San Joaquin Valley reports higher-than-average per capita rates of opioid prescribing and abuse. Two of the three ZIP codes with the highest prescription rates in the state are located in the valley.

This rural region of the state, where the majority of residents are eligible for Medicaid, also suffers a disproportionate lack of access to critical treatment. Fresno contains the only needle exchange program in the Central Valley between Sacramento and Los Angeles, leaving Bakersfield as California’s biggest city not served by a needle exchange somewhere within its surrounding county. At the same time, the San Joaquin Valley contains far fewer prescribers who are able to provide medically assisted treatment to opioid users than the state average.

Who is using opioids in this area? Why? And how can they be better served? These are the questions I hope to answer with the help of a 2018 Data Fellowship.

For instance, is the city of Bakersfield doing all it can for its opioid users? The answer varies depending on whether you’re examining its share of prescribers waivered to provide buprenorphine, or its tally of medical services like needle exchanges and narcotic treatment programs. Health advocates, meanwhile, argue that it’s a vacuum for opioid treatment. How can data help answer this question, and address how the opioid treatment landscape has changed over time?

In North Bakersfield, the neighborhood of Oildale has a reputation as the illicit substance epicenter of the city. That’s bolstered by the fact that in 2010, it reported the highest rate of overdose deaths of any Kern County ZIP code. But by 2017, its mortality rate had fallen by half, to a rate just barely above the county average. What changed? Community outreach, law enforcement, or luck? And are the mortality numbers even big enough to be statistically significant. 

Meanwhile, between north and south valley, there appears to be a tale of two ZIP codes. Two of the three ZIP codes with the state’s highest opioid prescribing rates are located in the San Joaquin Valley, and on the face of it, they don’t have a lot in common. ZIP code 93626, in Madera and Fresno Counties, is made up of 1,700 residents living in the Sierra foothills at the rural-suburban interface. They’re solidly middle class, and according to state data, in 2016 they were prescribed the equivalent of six opioid prescriptions per person. ZIP code 93276, in Kern County, comprises a poor, rural, unincorporated community of 150, originally settled to serve nearby oilfields. Residents there possess the equivalent of four opioid prescriptions per person. Both communities, however, are majority white. What else unites them, and what drives them toward so much pain medication?

By chipping away at these and other questions with the help of data, I hope to better educate valley residents on the opioid crisis and its solutions, and deliver information to the hands that need it.