Transcript Opioids and Pain Management in Southern Oregon

What are we doing in Southern
Oregon?
Concerns about opioid prescribing practices
Opioid Consumption in US
 We are 4.6% of the world's
population and consume 80% of the
world supply of opioids.
Palimed.org
Unintentional or undetermined prescription
opioid and heroin overdose death rate by year,
Oregon, 2000-2012
9
8
Rate per 100,000
7
6
5
4
3
2
1
0
2000
2001
2002
2003
2004
2005
Herioin rate per 100,000
2006
Year
2007
2008
2009
2010
Prescription opioid per 100,000
2011
2012
4
Jackson County (population
206,000) Overdose data
 8 years (2004 through 2011): 246 total
 141 deaths were determined Accidental
 Averaging 31 overdoses per year
 Averaging 18 accidental deaths per year
 Averaging 7-8 drug suicides per year
 44 are undetermined
We’re Number One!
 Oregon leads the
nation in
inappropriate use
of prescription
pain killers for
adults.
Consider non-opioid treatments
Mortality risk compared to Morphine
Opioid Overdose
Risk (fatal
& non-f:atal)
by
Equivalent
Dose
(MED)
10
9
8
7
6
5
4
3
2
1
0
Average
Daily Dose of Medically Prescribed
**
Opioids
1.79 %
9-fold
increase
in risk
relative
to low-dose
patients
**
** Significant
0.68 %
0.04 %
0.16 %
increment in
risk p<0.05
0.26 %
Non-user 1-19 mg. 20-49 mg. 50-99 mg. 100+ mg.
Dunn et al., Annals Int Med, 2010
We do need to provide compassionate care to
those with certain painful conditions
We don’t want to throw the baby
out with the bathwater
Opioids have a role to play
 In the treatment of acute and
post surgical pain
 In cancer and other
deteriorating painful
conditions
 In some chronic conditions,
when utilized at safe doses
The prescription drug crisis is
the result of prescriptions!
Opioid Prescribers Group
Attendees: Physicians, Mid-level providers, Nurses, Substance Abuse
Counselors, CCOs, Therapists, Pharmacists, Medical specialty (Pain
Medicine, ED), Dental
OPG
 Meeting monthly for 3 years. Josephine
and Jackson counties
 Opportunity to collaborate with peers +
CME
 Take ownership of a difficult problem
 Evolving process: Brainstorming
>Creation of local best practice > Achieve
practice change
OPG Steering Committee
 Both local CCOs
 Paid staff
 Public Health
 Committed local thought leaders
We need to re-invent the wheel
By adopting the best practices created by others we create a sense of
“ownership”
www.opioidprescribersgroup.com
Pilot project 2013-2014
 Initial Proposal: Bring resources to selected
medical groups to help them adopt the guidelines
 Laura Heesacker LCSW, Alicia Mangiaracina MSW intern,
Michele Schaefer Project Coordinator, myself and others
 Criteria: provider champion, administration support, provide
us with time to work with staff
 One clinic completed, second clinic in progress
The Current Model
 2 hour all clinic meeting (Jim and Laura)
 Hour long provider and MA meetings (Laura)
 Behavioral health support (Laura)
 Provide resources to clinic leadership (All)
 Identify high risk groups:
 Over 120 MED
 Over 40 Mg methadone
 Benzos + Opioids
 Aberrant Behavior
 Conversations as Medicine
 Peer to Peer: Group now offered every Wednesday at the
Medford YMCA – Free.
Next Step: Behavioral Support
Clinic
 “Back to Balance”
 Referrals from local prescribers who need support
evaluating or tapering their patients
 Close collaboration with CCMH
 No prescribing on site.
 Free standing clinic with the following resources on
site: Education, Counseling, Peer to Peer, OT, and
more
Upcoming Events
 A Thoughtful Approach to Pain Management:
May 9th, Smullin Center, Medford.
 Best Practices for Opioid Prescribing:
May 8th, Smullin Center, Medford.
Thank You
[email protected]