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What are we doing in Southern Oregon?
Concerns about opioid prescribing practices
Opioid Consumption in USWe are 4.6% of the world's
population and consume 80% of the world supply of opioids.
Palimed.org
4
Unintentional or undetermined prescription opioid and heroin overdose death rate by year, Oregon, 2000-2012
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
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Herioin rate per 100,000 Prescription opioid per 100,000
Year
Ra
te p
er
10
0,0
00
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
Opioid Overdose Risk (fatal & non-f:atal) by Average
Daily Dose of Medically Prescribed Opioids
Mortality risk compared to Morphine Equivalent Dose (MED)
1.79 %
0.68 %
0.26 %0.16 %
0.04 %
9-fold increasein risk
relativeto low-dose
patients
Dunn et al., Annals Int Med, 2010
**
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** Significant increment in risk p<0.05
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 guidelinesLaura 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 Model2 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 MEDOver 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 EventsA Thoughtful Approach to Pain Management:
May 9th, Smullin Center, Medford.
Best Practices for Opioid Prescribing:
May 8th, Smullin Center, Medford.
