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

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:

• Directly by a physician (in the case of naltrexone);
• Through state and federally licensed opioid treatment programs (where both methadone and buprenorphine can be dispensed); and
• Through office-based treatment by physicians who have received a waiver from SAMHSA to prescribe buprenorphine.

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

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

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