October 27, 2016THE MILL CASINO | North Bend, Oregon

Sponsored by:

SW OREGON OPIOID SUMMIT

OCT. 27 | SW OREGON OPIOID SUMMIT

Thank you to summit sponsors and recognition of planning team.

The SW Oregon Opioid Summit was funded by Western Oregon Advanced Health, LLC with additional support provided by Curry Community Health, the Oregon Community Foundation,

the Oregon Coalition for the Responsible Use of Meds (OrCRM), AllCare Health Plan, the Oregon Health Authority in partnership with Primary Health of Josephine County.

This event is a joint providership between Lines for Life and Bay Area Hospital

We would like to extend a special thank you to: Planning Input – Laura Heesacker, LSCW, Jackson Care Connect; Tracy Muday, MD, Western Oregon Advanced Health, LLC; Jim Shames, MD, Jackson County Health and Human Services;

Lisa Shields, Oregon Public Health Division; Rachel Stappler, PA, North Bend Medical Center. Summit leadership and support - Ken Dukek, Curry Community Heath; Shannon Durkee, CPS, Curry Community Health; Ashley Trace, Lines for Life;

Alexis Hilliard, Lines for Life; Marie Belsterling, Lines for Life

S P E A K E R SGary Allen, DMD, Advantage Dental

Mark Altenhofen, MS, CEO, Oregon Pain AdvisorsDoug Barrett, CADC I, CPS, Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians

Greg Brigham, PhD, CEO, AdaptCatriona Buist, PsyD, Pain Psychologist, OHSU Comprehensive Pain Center, Chair, Oregon Pain Commission

Tim Edingfield, Youth Chair, For YOUTH by YOUTH coalitionCynthia Edwards, CPS, Health Promotion Coordinator, Coos Health & Wellness

Philip Greenhill, CEO, Western Oregon Advanced HealthDebra Guzman, FNP, Curry County Community Health

Laura Heesacker, LSCW, Behavior Health Innovation Specialist, Jackson Care ConnectDwight Holton, CEO, Lines for Life

Lindsay Jenkins, Research Analyst, STD, HIV, Hepatitis C Program, Multnomah County Health DepartmentJennifer Johnstun, Director of Health Strategy, PrimaryHealth of Josephine County

Rick Jones, Executive Director, Choices Counseling CenterChief Robert F. Kappelman, North Bend Police Department

Chris Laman, PharmD, BCPS, Director of Pharmacy, Columbia Memorial Hospital Representative Caddy McKeown

Lisa Millet, MSH, Manager, Oregon Public Health Division, Injury and Violence Prevention ProgramCaptain Cal Mitts, Director South Coast Interagency Narcotics Team (SCINT)

Laura Porter, ACE Interface LLCSenator Arnie Roblan

Jim Shames, MD, Medical Director, Jackson County Health and Human ServicesRachel Stappler, PA, North Bend Medical Center

Rebecca Wood, OrCRM Project Coordinator, Lines for LifeNancy Yonally-Coleman, Chairperson, Grace Roots

F A C I L I T A T O R S

Morgan Leets, MEd, YouthLine Coordinator, Lines for LifeDonna Libemday, Education Director, Lines for Life

Dennis McCarty, PhD, Professor, OHSU-PSU School of Public Health, Oregon Health & Science UniversityTracy Muday, MD, Medical Director, Western Oregon Advanced Health, LLC

Elizabeth White, MPA, OrCRM Project Manager, Lines for Life

*Financial Disclosure: All speakers, planners and facilitators for this event have disclosed they have no financial relationships with commercial interests.

2 | Special Thanks

SW OREGON OPIOID SUMMIT | OCT. 27

Dear SW Oregon Opioid Summit Participant,

We are so pleased you could join us for this important summit!

Prescription drug abuse and misuse kills more Oregonians than any illegal drug.

Opioids are often being prescribed inappropriately and in excessive quantities with the risks far outweighing the benefits for most people. In 2015, there were over 4 million opioid prescription fills (55% of all prescriptions) in Oregon. That’s over 250,000,000 opioid pills (Oregon Health Authority, 2016).

The goal of the summit is to identify the specific challenges in Coos, Curry, and Josephine counties and develop an Action Plan that will promote a measurable reduction in opioid abuse, misuse and overdose in the region.

The Action Plan is a comprehensive approach to addressing this epidemic and includes strategies to:

1. REDUCE THE NUMBER OF PILLS PRESCRIBED by improving health system practices for pain management

2. EDUCATE PATIENTS AND THE PUBLIC on the dangers, safe use and disposal of Rx

3. BETTER DISPOSAL OF DISUSED PILLS in medicine cabinets that fuel abuse

4. EXPAND ACCESS TO TREATMENT SERVICES for opioid dependence and overdose prevention

The summit provides an opportunity to learn from and connect with state and local leaders. We hope you will learn, share with each other, enjoy your time and help us move discussion into action after the summit.

Welcome | 3

OCT. 27 | SW OREGON OPIOID SUMMIT

7:30 - 8:30am B R E A K F A S T & R E G I S T R A T I O NSalmon East/West Room

8:30 - 8:45am W E L C O M E & O P E N I N G C E R E M O N I E SSalmon East/West Room Senator Arnie Roblan; Dwight Holton, CEO, Lines for Life;

Philip Greenhill, CEO of Western Oregon Advanced Health

4 PLENARY: STATEWIDE AND LOCAL INITIATIVES TO REDUCE OPIOID ABUSE

8:45 - 9:15am Best Practice Prescribing Opioids for Acute & Chronic Pain: How to Keep Salmon East/West Room the Opioid Naïve, Naïve and Provide Compassionate Care for Legacy Patients Jim Shames, MD, Medical Director, Jackson County Health and Human Services

9:15 - 9:45am Ways to Live Well With Chronic Pain Salmon East/West Room Catriona Buist, Psy.D., Pain Psychologist, OHSU Comprehensive Pain Center, Chair,

Oregon Pain Commission; Rachel Stappler, PA, North Bend Medical Center

9:45 - 10:10am Overview: Oregon’s Initiatives to Reduce Opioid Abuse, Misuse and Overdose Salmon East/West Room Lisa Millet, MSH, Manager, Oregon Public Health Division, Injury and Violence Prevention Program

10:10 - 10:45am Answering the Call to Action Through Regional Collaboration Salmon East/West Room Jennifer Johnstun, Director of Health Strategy, PrimaryHealth of Josephine County

10:45 - 11:00am B R E A K2nd Floor Reception Foyer

4 CONCURRENT SESSIONS: MORNING BREAKOUTS

11:00am - 12:30pm SESSION A: REDUCING THE NUMBER OF PILLS PRESCRIBEDSalmon East/West Room 4 Oregon’s Prescription Drug Monitoring Program Presenter: Lisa Millet, MSH, Manager, Oregon Public Health Division, Injury and

Violence Prevention Program 4 Overcoming Barriers to Expanded Use of Non-Opioid Therapies for Persistent Pain Presenter: Mark Altenhofen, MS, CEO, Oregon Pain Advisors 4 The Role of Dentists in Preventing Opioid Abuse Presenter: Gary Allen, DMD, Advantage Dental

Spruce /Cedar Room SESSION B: GETTING PILLS OUT OF CIRCULATION 4 Prescription Drug Abuse and Heroin: Regional and Statewide Impact

on Youth and Young Adults Presenters: Cynthia Edwards, CPS, Health Promotion Coordinator, Coos Health &

Wellness; Tim Edingfield, Youth Chair, For YOUTH by YOUTH coalition

4 Reducing Diversion in SW Oregon Presenters: Captain Cal Mitts, Director South Coast Interagency Narcotics Team (SCINT); Rachel Stappler, PA, North Bend Medical Center

4 Oregon Disposal Initiative: Helping Pharmacies Help Communities Prevent Drug Abuse and Pollution

Speaker: Rebecca Wood, OrCRM Project Coordinator, Lines for Life

4 Pharmacy Run Medication Disposal Programs Presenter: Chris Laman, PharmD, BCPS, Director of Pharmacy, Columbia Memorial Hospital

summit agenda

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4 | summit agenda

SW OREGON OPIOID SUMMIT | OCT. 27

12:30 - 1:15pm L U N C H S E R V E D A N D N E T W O R K I N GSalmon East/West Room

4 GENERAL SESSION

1:15 - 2:15pm L U N C H S E S S I O NSalmon East/West Room OVERDOSE PREVENTION: COMMUNITY, PHARMACY, AND LAW ENFORCEMENT DISTRIBUTION OF NALOXONE

4 Preventing Overdose Deaths By Expanding Naloxone Use Speaker: Lindsay Jenkins, Research Analyst, STD, HIV, Hepatitis C Program, Multnomah County Health Department 4 Naloxone Hydrochloride Program Development and Implementation:

North Bend Police Speaker: Chief Robert F. Kappelman, North Bend Police Department

2:15 - 2:30pm B R E A K2nd Floor Reception Foyer

4 CONCURRENT SESSIONS: AFTERNOON BREAKOUTS

2:30 - 4:15pm SESSION C: EXPANDING ACCESS TO TREATMENT FOR OPIOID USE DISORDERSSalmon East/West Room 4 Medication Assisted Recovery for Opioid Use Disorder Speaker: Greg Brigham, PhD, CEO, Adapt 4 Integrated Care: Opioid Addiction | Physical and Mental Speaker: Debra Guzman, FNP, Curry County Community Health 4 Grace Roots Pathway to Wellness Speakers: Rick Jones, Executive Director, Choices Counseling; Center; Nancy Yonally-Coleman, Chairperson, Grace Roots

Spruce /Cedar Room SESSION D: EDUCATING THE PUBLIC ABOUT THE PROBLEM 4 Canoe Journey: The Sacred Journey Speaker: Doug Barrett, CADC I, CPS, Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians 4 The Magnitude of the Solution: Building Self-Healing Communities Speaker: Laura Porter, ACE Interface LLC Beargrass/Willow/Hazel Room SESSION E: CONVERSATIONS AS MEDICINE: COMPASSION-BASED DIFFICULT CONVERSATIONS Speakers: Jim Shames, MD, Medical Director, Jackson County Health and Human

Services; Laura Heesacker, LSCW, Behavior Health Innovation Specialist, Jackson Care Connect

4:15 – 4:40 p.m. C L O S I N G S E S S I O N Salmon East/West Room Representative Caddy McKeown

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summit agenda | 5

OCT. 27 | SW OREGON OPIOID SUMMIT

Function LocationsThe SW Oregon Opioid Summit sessions are located on two levels of the Mill Casino Hotel. The Salmon East/West Room can be accessed through the main floor of the hotel or casino. Registration, Exhibitor Tables, Plenary, Lunch, General and Closing Sessions are located in the Salmon East/West Room on the main floor. Please note: The Salmon East/West room is accessible through the smoke-free entrance via the hotel (look for signs marking the smoke-free entrance) or through the casino. The morning and afternoon breakout sessions and refreshment breaks are located on the second floor of the hotel which is accessible by stairs or elevator.

BadgesYour name badge is your ticket to the conference. You will receive a conference badge after you check-in at the registration desk located in the Salmon East/West Room. Name badges must be worn at all times. It is especially important for entrance into all meal functions, general sessions and breakouts.

EvaluationsYour feedback is very important to planning future summits and provides information and enhancements that could be made. In your folder is an evaluation form to be returned at the end of the day at the registration table.

ExhibitsWe have a limited number of display tables with free materials in the Salmon East/West Room. Please take time to visit the tables and meet the organization representatives.

Speaker Presentations & HandoutsSpeaker presentations have not been printed as a waste reduction and cost savings measure. Speaker presentations and available on the OrCRM website: www.OrCRM.org.

Continuing Education CreditsA Certification of Attendance will be provided to those attendees requesting certificates and will be available for pick-up at the registration table located in the Salmon East/West Room at 4:30 p.m. To receive continuing education credits, you must fill out number of hours attended on the evaluation form and return it to the registration table. If you are unable to attend the full day, you may request a certificate for partial credit at the registration table.

ACCBO Accreditation: ACCBO has approved this activity for 6.0 continuing education credit hours.

Oregon Board of Pharmacy Accreditation: The Oregon Board of Pharmacy has approved this activity for 6.0 continuing education credit hours.

CME Accreditation: Bay Area Hospital is accredited by the Oregon Medical Association to sponsor Category 1 medical education activities for physicians. As an accredited institution, Bay Area Hospital’s Medical Education Committee designates this live educational activity for a maximum of 6.0 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Bay Area Hospital fully complies with the legal requirements of the ADA and the rules and regulations thereof. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Oregon Medical Association, through the joint providership of Bay Area Hospital and Lines for Life.

If any participant in this educational activity is in need of accommodations, please call 541-266-7855.

general information

6 | general information

SW OREGON OPIOID SUMMIT | OCT. 27

T H U R S D A Y , O C T O B E R 2 7 , 2 0 1 6

8:45 – 10:45 a.m.SALMON EAST/WEST ROOM

4 PLENARY SESSION: Turning the Tide on Opioid Abuse

Presenters: Jim Shames, MD, Medical Director, Jackson County Health and Human Services; Catriona Buist, PsyD, Pain Psychologist, OHSU Comprehensive Pain Center, Chair, Oregon Pain Commission; Rachel Stappler, PA, North Bend Medical Center; Jennifer Johnstun, Director of Health Strategy, Primary Health of Josephine County

The opioid epidemic demands an effective regional approach that reflects the particular challenges and opportunities that providers, health systems and communities face in the Southwestern region of Oregon. The plenary session provides an opportunity to hear from experts in the field on ways to build heath system and community strategies for safe pain management. To shift away from our dependence on opioids, we must help providers be better prepared to treat patients with pain.

Speakers will present information on preventing opioid use and abuse, current best practices concerning the treatment of Chronic Complex Non-Cancer Pain (CCNP), strategies for providing compassionate care and ways to live well using non-opioid pain treatment options and ideas for solving this problem as a community. There will also be an opportunity to learn about the impact of the opioid epidemic in Oregon and how statewide organizations such as the Oregon Coalition for the Responsible Use of Meds (OrCRM) and Oregon Health Authority (OHA) are working together to tackle this crisis through community and prescriber education, encouraging use of CDC prescribing guidelines, promotion of non-opioid pain management strategies, improved access to addictions treatment services and naloxone and strategies for safely discarding unused medication. At the end of the plenary, there will be an overview of collaborative, regional work underway to promote consistent messaging for providers and patients on safe pain prescribing in Coos, Curry and Josephine counties.

11:00 am – 12:30 pm4 CONCURRENT SESSIONS:

Morning Breakout Sessions A & B Breakout Sessions

The complexity of the opioid crisis requires coordinated medical, behavioral, legislative and educational policy changes. All stakeholders need to be engaged and aligned if we are to prevent future opioid dependence and support the recovery of those already dependent. As a way to effectively engage these different actors, the summit includes breakout sessions in the morning and afternoon focused on each core element essential to reducing opioid abuse.

The breakout sessions are divided into two tracks, health systems and community, to give all stakeholders an opportunity to participate in the process of action planning. The sessions provide an overview by subject experts, followed by facilitated discussion and action planning to identify barriers and best practices and help stakeholders form core strategies for an implementation plan to increase the community’s readiness to act. Action planning includes identification of region-specific action steps in Coos, Curry and Josephine counties that are in alignment with the OHA’s Prescription Drug Overdose (PDO) work plan and health system and community initiatives to reduce opioid abuse and overdose. At the end of the day, participants will come back together to report on their findings, develop a comprehensive list of action steps and identify commitments and champions that will drive implementation after the summit.

summit highlights

Summit Highlights | 7

OCT. 27 | SW OREGON OPIOID SUMMIT

4 SESSION A: Reducing the Number of Pills Prescribed SALMON EAST/WEST ROOM

Presenters: Lisa Millet, MSH, Manager, Oregon Public Health Division, Injury and Violence Prevention Program; Mark Altenhofen, MS, CEO, Oregon Pain Advisors; Gary Allen, DMD, Advantage Dental

This session will focus on approaches to reduce the overall number of pills prescribed through improvements to health system practices for pain management. These strategies include expanding enrollment and increasing use of the Prescription Drug Monitoring Program (PDMP), improved opioid prescribing practices for dentists and other providers, and expanded access to non-opioid therapies for pain. Systematic use of PDMP by providers and their delegates in conjunction with opioid prescribing guidelines and improved access to non-opioid pain treatment options are essential to better pain management. Lastly, to prevent opioid overdose, health systems need to incorporate strategies that eliminate barriers to co-prescribing naloxone by providers recommending opioid treatment.

4 SESSION B: Getting Pills out of Circulation SPRUCE/CEDAR ROOM

Presenters: Cynthia Edwards, CPS, Health Promotion Coordinator, Coos Health & Wellness; Tim Edingfield, Youth Chair, For YOUTH by YOUTH coalition; Captain Cal Mitts, Director South Coast Interagency Narcotics Team (SCINT); Rachel Stappler, PA, North Bend Medical Center; Chris Laman, PharmD, BCPS, Director of Pharmacy, Columbia Memorial Hospital; Rebecca Wood, OrCRM Project Coordinator, Lines for Life

Disused pills in our medicine cabinets create a significant risk for abuse and dependence -- most people who become dependent on opioids report that they first started with pills that they got from a friend or family member (NSDUH 2014). In fact, more than four in ten teens who have misused or abused a prescription drug took it from their parent’s medicine cabinet (Partnership for a Drug Free America, Partnership Attitude Tracking Study, 2012). We can stem the flow of future dependency by establishing systems to properly dispose of leftover prescription medications and public education. This session will focus a three-pronged approach to opioid abuse prevention:

1) reducing diversion and increasing collection of disused medications through law enforcement, 2) encouraging more pharmacies to amend their DEA license and become collectors of these medications, and 3) expanding community-based outreach efforts to increase public education and awareness on the need for safe and responsible disposal and changing social norms about the dangers of these medications.

1:15 – 2:15 pmSALMON EAST/WEST ROOM

GENERAL SESSION Speakers: Lindsay Jenkins, Research Analyst, STD, HIV, Hepatitis C Program, Multnomah County Health Department; Chief Robert F. Kappelman, North Bend PD; others TBN

LUNCH SESSIONThis session will explore successes in using peer support for people in recovery or living with persistent pain.

Overdose Prevention: Community, Pharmacy and Law Enforcement Distribution of Naloxone

For people who regularly take opioids, having naloxone on hand can mean the difference between life and death. The effectiveness of community and law enforcement distribution of the life-saving drug naloxone in reducing opioid overdose deaths is a proven approach. In Multnomah County, naloxone distribution through needle-exchange programs has led to a measurable decline in the number of opioid related deaths. Law enforcement and first responders have also been using naloxone in Oregon to save lives. Recently, Oregon passed new legislation that expands access by allowing a pharmacist to prescribe naloxone to individuals. This session will provide information and data supporting the impact of expanded naloxone distribution through community, law enforcement ---and now pharmacies to save lives.

Summit Highlights | 8

SW OREGON OPIOID SUMMIT | OCT. 27

2:30 – 4:15 pm4 CONCURRENT SESSIONS: Afternoon Breakout

Sessions C, D, & E

Anyone can become addicted to opioids. Mother, father, friend, student, daughter, son, coworker … anyone. Removing the stigma around receiving assistance for opioid use disorder (OUD) and approaching addiction as a treatable chronic health condition are important strategies to expanding access to effective treatment options. The aim of all three afternoon sessions is to create a positive shift in pain and addiction treatment by incorporating elements of compassion, community and hope.

4 SESSION C: Expanding Access to Treatment for Opioid Use Disorders

SALMON EAST/WEST ROOM Speakers: Greg Brigham, PhD, CEO, Adapt; Debra Guzman, FNP, Curry County Community Health; Rick Jones, Executive Director, Choices Counseling; Center; Nancy Yonally-Coleman, Chairperson, Grace Roots

Levers for expanded treatment access include offering a full range of effective and coordinated OUD treatment options, including medication and evidence-based behavioral treatment programs, coordinated medication assisted OUD treatment with other support strategies that focus on recovery and improving cognitive, and social functioning and increasing the number of training and education opportunities to increase the number of qualified providers. During this session, speakers will provide an overview of medicated assisted recovery for OUD including dependence verses addiction, local data on treatment admissions, types of medications for OUD treatment, and Adapt and Grace Roots’ approach to delivering medicated assisted treatment. Speakers will also discuss the role of integrated, quality behavioral health services in improving coordinated care.

4 SESSION D: Educating the Public About the Problem SPRUCE/CEDAR ROOM Speakers: Doug Barrett, CADC I, CPS, Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians; Laura Porter, ACE Interface LLC

Educating the public on the dangers of opioids is important, but how can we help make a difference if there is no hope for change or recovery? Breaking the cycle of addiction and hopelessness includes incorporating culturally specific practices and teachings and changing generational patterns that lead to risky decision making and addiction. This session will include an overview of a Tribal Best Practice for substance abuse prevention, the Canoe Journey, and will illustrate how culture is prevention. A training on developing trauma informed communities to prevent and heal substance abuse follows this discussion. This training will give an overview of Adverse Childhood Experiences (ACEs) research and include information on how experience shapes development both biologic and epigenetic, vulnerabilities that can lead to dependency, ways to use self-regulation strategies to manage pain, a basic framework for building resilience in children and adults, and the importance of two-generation strategies to reduce transmission across generations.

4 SESSION E: Conversations as Medicine: Compassion-Based Difficult Conversations

BEARGRASS/WILLOW/HAZEL ROOM

Speakers: Jim Shames, MD, Medical Director, Jackson County Health and Human Services, Laura Heesacker, LSCW, Behavior Health Innovation Specialist, Jackson Care Connect

Learn and practice effective communication strategies for compassionate refusal, tapering and other emotionally laden clinical situations. These practical tools for approaching tapering or opioid removal are based on a risk-benefit and shared decision making framework. Participants will watch patient case examples role-played by facilitators, followed by opportunities to practice skills in a safe and supportive environment. Participants will walk away with enhanced skills leading to safer and more effective health outcomes as well as improved patient and provider satisfaction.

Summit Highlights | 9

OCT. 27 | SW OREGON OPIOID SUMMIT

notes

note page | 10

SW OREGON OPIOID SUMMIT | OCT. 27 note page | 11

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