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Opioids: Resources for Health Care Professionals and CCOs

Responsible Prescribing Saves Lives

In Oregon in 2013:

  • Almost 1 in 4 Oregonians received a prescription for opioid medications.
  • More drug poisoning deaths involved prescription opioids than any other type of drug, including methamphetamines, heroin, cocaine and alcohol.

Update from OHA

The OHA Opioid Initiative - Information for the Health Care Community, February 2017

Prescribing Guidelines and Resources  Data Dashboard


Primary Goals of the Oregon Opioid Initiative

The Oregon Health Authority Opioid Initiative brings statewide partners and communities together to reduce deaths, non-fatal overdoses, and harms to Oregonians from prescription opioids, while expanding use of non-opioid pain care.
1. Reduce risks to patients by making pain treatment safer and more effective, emphasizing non-opioid and non-pharmacological treatment
2. Reduce harms to people taking opioids and support recovery from substance use disorders by making naloxone rescue and medication-assisted treatment (MAT) more accessible and affordable
3. Protect the community by reducing the number of pills in circulation through implementation of safe opioid prescribing, storage, and disposal practices
4. Optimize outcomes by making state and local data available for monitoring, evaluating, and informing policies and targeted interventions

Work groups have convened and projects are underway, all aimed at reducing opioid misuse and overdose. These significant steps forward include:

  • approval of statewide prescribing guidelines by a work group of statewide providers;
  • chronic-use opioid reduction strategies with the CCO statewide performance improvement project;
  • naloxone availability;
  • increase in medication-assisted treatment;
  • coverage of non-opioid therapies for pain and prescribing limitation policies;
  • community interventions in high-burden regions;
  • and ongoing surveillance of controlled substance prescribing and drug overdose outcomes (calculated by hospitalizations and deaths).

A data dashboard is available with state and county statistics for opioid-related health outcomes and prescribing metrics.


Strategies to Reduce Problematic Prescribing

  • Use opioid prescribing guidelines for pain management and in emergency departments.
  • Use the Oregon Prescription Drug Monitoring Program to assess and manage patient prescriptions.
  • Provide coverage for non-opioid chronic non-cancer pain treatment therapies.
  • Increase the number of providers who are certified to provide medication-assisted treatment (MAT) services, in conjunction with local substance use treatment programs.

Prescribing Guidelines Task Force

Adopting opioid prescribing guidelines for pain management and in emergency departments is a key strategy for reducing harms associated with opioid overdose and misuse.

In 2016, Oregon convened a stakeholder Task Force to develop statewide opioid prescribing guidelines. On November 18, 2016, the Task Force approved adoption of Oregon-specific prescribing guidelines, based on the CDC Guideline for Prescribing Opioids for Chronic Pain.


Medication-assisted Treatment (MAT)

MAT combines behavioral therapy with medications (such as buprenorphine, methadone and naltrexone) and can stabilize patients with opioid use disorder and improve social functioning.

MAT is considered to be the gold standard for the treatment of opioid use disorder. MAT has been shown to be a cost-effective treatment strategy with benefits to both patients and health care systems. Patients receiving MAT services have consistently better treatment outcomes, less illicit drug use, lower rates of infectious disease, and overall lower utilization of emergency departments.

MAT can be delivered in several ways:

OHA is working to:

  • Improve access to MAT services for patients throughout the state;
  • Educate partners and stakeholders on the value of increased MAT utilization, and partnering on innovative ways to serve Oregon's opioid dependent population; and
  • Increase the number of buprenorphine waivered physicians in practice in Oregon.

Prescribing Guidelines and Resources

TOPIC

SOURCE

Prescribing Guidelines: Healthcare Providers

Oregon Opioid Prescribing Guidelines (pdf) Oregon Opioid Prescribing Guidelines Task Force
Oregon Emergency Department Opioid Prescribing Guidelines (pdf) Oregon ACEP

CDC Guideline for Prescribing Opioids for Chronic Pain and Guideline Resources

CDC
Prescribing Guidelines: Dentists

Recommended Opioid Guidelines for Dentists (pdf)

Oregon Opioid Prescribing Guidelines Task Force
Brochure: Prescribing Opioids Safety as a Dentist (pdf) Oregon Opioid Prescribing Guidelines Task Force

Oregon Plans and Reports

Reducing Opioid Overdose, Misuse and Dependency: Guide for CCOs (pdf) OHA
CD Summary: Prescribing Opioids for Chronic Pain, Guidelines are one piece of the puzzle (pdf) OHA

Oregon Health Plan (OHP) Resources

OHP Fee-for service coverage of back and spine pain diagnosis and treatment (Word) OHA
Resources for tapering OHP members with chronic pain off prescription opioids (pdf) OHA

Medication-Assisted Treatment (MAT)

SAMHSA's MAT website SAMHSA
Your Doctor Understands Your Addiction ATTC

NW Addiction Technology Transfer Center's website

NW-ATTC
Providers' Clinical Support System for MAT PCSS
Providers' Clinical Support System for Opioid Therapies PCSS
American Association for the Treatment of Opioid Dependence AATOD

Naloxone / Opioid Overdose

Naloxone Training Protocol OHA
Naloxone Rescue for Opioid Overdose OHA
SAMHSA Opioid Overdose Prevention Toolkit (pdf) SAMHSA

Neonatal Abstinence Syndrome (NAS)

Neonatal Abstinence Syndrome PubMed Health
Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy ACOG
MMWR: Opioid Prescription Claims Among Women of Reproductive Age, U.S. 2008-2012 CDC
Clinical Report: Neonatal Drug Withdrawal (pdf) AAP
Webinar - Perinatal Quality Collaborative: Neonatal Abstinence Syndrome, 2013 CDC

National Reports and Data

Vital Signs: Prescription Painkiller Overdoses in the U.S. (pdf) CDC
Opioid Overdose: Data Overview CDC
The Prescription Opioid Epidemic: An Evidence-Based Approach (pdf) Johns Hopkins Bloomberg School of Public Health

Related Websites

Oregon Pain Guidance website Oregon Pain Guidance Group
American Medical Association: Reversing the Opioid Epidemic AMA
Surgeon General's "Turn the Tide Rx" campaign website Surgeon General of the United States

Acronyms

AATOD: American Association for the Treatment of Opioid Dependence

ACEP: American College of Emergency Physicians

ACOG: American College of Obstetricians and Gynecologists

AMA: American Medical Association

ATTC: Addiction Technology Transfer Center

CDC: Centers for Disease Control and Prevention

OHA: Oregon Health Authority

PCSS: Providers' Clinical Support System

SAMHSA: Substance Abuse and Mental Health Services Administration


Hear from an Oregon Physician

U.S. Surgeon General's Turn the Tide campaign

Having a difficult conversation
by Safina Koreishi, MD, MPH
Medical Director, Columbia Pacific CCO
Columbia, Tillamook & Clatsop counties

Featured on the Surgeon General's Turn the Tide Rx website

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