Roc “Oregon has been, like other states, The Oregon Health Authority issued a report, “Reducing Opioid Overdose, Misuse and Dependency: A Guide for CCOs,” in October. It suggest numerous strategies for these goals, and notes, “Use of opioids for long-term management of chronic non-cancer pain lacks evidence of benefits, and may lead to poor results and negative side effects”: www.oregon.gov/ oha/Transformation-Center/ Documents/Reducing-Opioid- Overdose-Toolkit.pdf. Portland Metro Regional Safe Opioid Prescribing Standards: https://multco.us/ file/47545/download. Standard for New Opioid Prescriptions for Patients with Chronic Non-Cancer/Non- Terminal Pain. Oregon Medical Board Statement of Philosophy of Pain Management, and additional resources such as various prescribing guidelines and CME programs, many of which are free: www. oregon.gov/omb/board/ philosophy/Pages/Pain- Management.aspx. grappling with this issue,” she said. The board’s current first approach is education and remediation rather than punishment, she said. The Statement of Philosophy emphasizes and describes the care and treatment for different types of pain, including acute pain, chronic pain and terminal illnesses. Haley said the board recognizes prescription opiates represent a multifaceted problem requiring “a multifaceted approach. Our education efforts need to continue. That’s why we redoubled our continuing-education opportunities.” Task Force members weigh in Andris Antoniskis, MD, co-chair of the OMA’s Opioid Task Force and a longtime addictions specialist, said that too often, “Acute and chronic (pain) are seen the same way. They’re entirely two different animals.” He said he would like to see more emphasis in medical schools about responsible pain management and using treatment modalities in an appropriate way. Antoniskis said most physicians don’t know what the alternatives are and could benefit from learning what is available and which patients would be most suitable for options such as cognitive behavioral therapy, physical therapy and mental health treatment. Laura Scobie, PA-C, who practices with Columbia Pain Management in Hood River, agrees. But she added that a concern is the lack of reimbursement for alternatives to opioids. “Who’s going to pay for all of that?” she asks. “It is a big challenge for certain populations.” Most pain diagnoses fall below the line on the Oregon Health Plan’s priority list and are not covered. Private health insurance may not cover approaches such as mental health care, physical therapy or acupuncture, but may pay for morphine or methadone, treatments less expensive but more fraught with risks, such as of overdose, she said. One initiative by the Oregon Coalition for Responsible Use of Meds is to make disposal of unwanted opioid pills as easy as dropping them off at a pharmacy. The coalition is sponsoring a work group intending to help pharmacies become licensed disposal locations. This idea originated in 2010, with the Drug Take- Back program led by Leanna Lindquist, a former OMA Alliance president, in collaboration with the organization now known as Lines for Life. Since that successful program, drug take-back efforts have spread far and wide nationally, said OMA Opioid Task Force co-chair Irish. Such collection efforts now are led by law-enforcement agencies, which regularly sponsor drug take-back days for the public. Scobie said the OMA’s establishment of its Opioid Task Force is important because providers need a go-to place for their questions about what constitutes appropriate prescribing. In addition, the task force can provide education to clinicians and the public not just about the potential dangers of opioids, but also about the alternative treatments and modalities that can offer effective treatment, she said. OMA Annual Meeting to focus on epidemic In addition to the Opioid Task Force, the OMA’s Annual Meeting, scheduled for April 23, “will center on what OMA can do to make a positive impact” on the prescription opiate epidemic, said task force member Xiao-Yue Han, a second-year medical student at OHSU and a member of the OMA’s Board of Trustees’ Student Section. (See page 17 for details.) “It’s a multipronged approach the OMA is supporting, to educate physicians and patients to look for alternatives to opiates,” he said. “The last thing I want to do is harm (my) future patients. That’s what drove me to the task force: What are the specific problems? What needs to change so we take better care of patients and do no harm, while caring and treating them for real pain. This is the struggle and I want to be part of the solution, not the problem,” he said. w ww.TheOMA.org Winter 2016 15
OMA Medicine in OR Winter 2015 2016
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