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What are we doing in Southern Oregon?

What are we doing in Southern Oregon?. Concerns about opioid prescribing practices. Opioid C onsumption in US. We are 4.6 % of the world's population and consume 80% of the world supply of opioids. . Palimed.org.

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What are we doing in Southern Oregon?

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  1. What are we doing in Southern Oregon? Concerns about opioid prescribing practices

  2. OpioidConsumption in US • We are 4.6% of the world's populationand consume 80% of the world supply of opioids.

  3. Palimed.org

  4. Unintentional or undetermined prescription opioid and heroin overdose death rate by year, Oregon, 2000-2012

  5. 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

  6. We’re Number One! Oregon leads the nation in inappropriate use of prescription pain killers for adults.

  7. Consider non-opioid treatments

  8. Mortality risk compared to Morphine Equivalent Dose (MED) Opioid Overdose Risk (fatal & non-f:atal) by Average Daily Dose of Medically Prescribed Opioids 9-fold increasein risk relativeto low-dose patients ** 1.79 % ** ** Significant increment in risk p<0.05 0.68 % 0.04 % 0.26 % 0.16 % Dunn et al., Annals Int Med, 2010

  9. 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

  10. The prescription drug crisis is the result of prescriptions!

  11. Opioid Prescribers Group Attendees: Physicians, Mid-level providers, Nurses, Substance Abuse Counselors, CCOs, Therapists, Pharmacists, Medical specialty (Pain Medicine, ED), Dental

  12. 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

  13. OPG Steering Committee • Both local CCOs • Paid staff • Public Health • Committed local thought leaders

  14. We need to re-invent the wheel By adopting the best practices created by others we create a sense of “ownership”

  15. www.opioidprescribersgroup.com

  16. 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

  17. 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.

  18. 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

  19. Upcoming Events • A Thoughtful Approach to Pain Management: May 9th, Smullin Center, Medford. • Best Practices for Opioid Prescribing: May 8th, Smullin Center, Medford.

  20. Thank You shamesjg@jacksoncounty.org

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