OHA convened workgroups from 2016-2019, all aimed at reducing prescription 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;
- development of prescribing guidelines for healthcare providers and dentists;
- development of implementation strategies for healthcare quality improvement; 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 Risky Prescribing
OHA recommends the following strategies to reduce high-risk opioid prescribing:
- Use opioid prescribing guidelines for pain management and in emergency departments.
- Learn techniques to help patients manage chronic pain by taking the Oregon Pain Management Commission education course for health care professionals.
- Refer patients to the Oregon Pain Guidance patient pain education toolkit to help improve the impact of chronic pain.
- 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 for opioid use disorder (MOUD) services, in conjunction with local substance use treatment programs.
Task Forces for Opioid Prescribing and Tapering Guidelines
The Oregon Health Authority gathered experts from across the state to develop clinical guidelines for opioid prescribing to improve patient safety, spread best practices, and address the need for compassionate care.
In 2016, Oregon’s Opioid Prescribing Guidelines Task Force approved adoption of Oregon-specific prescribing guidelines for chronic pain. Oregon based these guidelines on the CDC Guideline for Prescribing Opioids for Chronic Pain. Through similar collaborations, Oregon developed guidelines to address opioid prescribing for, acute pain, dentists and pregnant women (see below).
OHA convened experts on the 2019 Oregon Opioid Taper Guidelines Task Force. The resulting guidelines from this task force supplement the Opioid Prescribing Guidelines for Chronic Pain to help patients and prescribers approach opioid tapering with best practices in mind.
Medication for Opioid Use Disorder (MOUD)
MOUD combines behavioral therapy with medications (such as buprenorphine, methadone and naltrexone) and can stabilize patients with opioid use disorder and improve social functioning.
MOUD is considered to be the gold standard for the treatment of opioid use disorder. MOUD has been shown to be a cost-effective treatment strategy with benefits to both patients and health care systems. Patients receiving MOUD services have consistently better treatment outcomes, less illicit drug use, lower rates of infectious disease, and overall lower utilization of emergency departments.
MOUD can be delivered in several ways:
OHA is working to:
- Improve access to MOUD services for patients throughout the state;
- Educate partners and stakeholders on the value of increased MOUD 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
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