Price of Addiction: New prescribing standards aim to reduce opioid dependence

Portland Business Journal, Dec. 1, 2015

PainKillers2A group of more than a dozen hospitals, clinics and Coordinated Care Organizations announced Tuesday they will adopt a community-wide standard for the safe prescribing of opioids in order to combat an epidemic of abuse and addiction.

The guidelines, developed over the course of the past year, are designed to rein in prescriptions of addictive opioid-based painkillers, including Oxycontin and Vicodin. The hope is to reduce the number of pills in circulation, estimated at 100 million in 2012 in Oregon. The state has one of the highest rates of nonprescription use of painkillers in the nation.

The new standards outline what sorts of evaluations and monitoring should be performed for patients with chronic, non-cancer pain. It also specifies a daily dosing limit of 120 “morphine equivalent units,” a standard already adopted in the state of Washington and in Jackson County, Oregon.“We’re in the midst of one of the worst public health crises the U.S. has ever seen,” said Dr. Melissa Weimer, medical director at CODA, a Portland addictions treatment center and an assistant professor at Oregon Health & Science University.

“Twenty years of liberal opioid prescribing has shown us the current path,” she said. “Each day, as a primary care and addiction medicine provider, I hear stories from patients and families about the effects opioids have had on their lives. Better, safer and more effective chronic pain treatment is available.”

Weimer said there was “collective consensus among health systems” about the standards and little dissent. Already, OHSU and Providence Health & Services have developed new policies and procedures to promote safe opioid prescribing.

One mom shared her family’s addiction story. Michele Chisholm said between 2008 and 2011, her “life turned upside down,” when two teenage sons migrated from pain pills to heroin and one fatally overdosed.

“It’s like a slow, sad movie spiraling downward to rock bottom,” Chisholm said. “Sharing my story helps me with my grieving and out of grief comes hope … hope that today’s events will bring more awareness of the epidemic.”

The new standards call for:

  • Developing a comprehensive treatment plan with agreed upon goals prior to beginning chronic pain treatment with daily opioids.
  • Recommending behavioral health evaluation for patents with current or prior mental health conditions.
  • Avoiding the use of high-risk medications or substances with opioids.
  • Referral to an addiction specialist for patients who develop an opioid use disorder during treatment.
  • Considering a prescription for a Naloxone rescue kit for high-risk individuals.

“There’s no single magic bullet,” said Dr. Paul Lewis, Multnomah and Tri-County Health Officer.

A report out today on opioid trends in Multnomah County found drug overdoses claimed 109 lives, or more than two per week, in the county last year.

The death toll decreased from a peak of 156 overdose deaths in 2011, mainly because of fewer heroin-related deaths. That’s thanks in part to the expanded availability of naloxone, which reverses overdoses. Prescription opioid deaths haven’t decreased and accounted for half of all fatal overdoses in 2014.

Beginning in 2014, the Healthy Columbia Willamette Collaborative worked to develop safe prescribing standards for chronic pain not caused by cancer or other terminal conditions.

Here are the participants in the safe prescribing workgroup.

  • Central City Concern
  • Clackamas Health Centers
  • NARA
  • OHSU Richmond
  • Oregon College of Oriental Medicine
  • Outside In
  • Virginia Garcia
  • University of Western States
  • FamilyCare Health
  • Health Share of Oregon
  • Adventist Health
  • Kaiser Permanente
  • Legacy Health
  • Oregon Health & Science University
  • Peace Health Southwest
  • Providence Health & Services
  • Tuality Healthcare
  • Public health departments from Clackamas, Clark, Multnomah and Washington counties
  • Oregon Academy of Family Physicians
  • Oregon College of Emergency Physicians
  • Oregon Section of the American College of Obstetrics and Gynecology.