ADVOCACY IN FOCUS A Statewide Plan for Opioid Overdose Prevention By Katrina Hedberg, MD, MPH REDUCING OPIOID OVERDOSE is a complex problem that will require a comprehensive set of solutions. In November, the Oregon Health Authority released the “Oregon Prescription Drug Overdose, Misuse, and Dependency Prevention Plan,” which describes in detail a four-year timetable for meeting the state’s goals to combat the opioid overdose epidemic. One key element of this plan is to convene a multidisciplinary stakeholder task force to develop and implement statewide opioid prescribing guidelines that are applicable to a variety of clinical settings and address: patient assessment, including co-morbidities and risk factors; benefits and risks of using opioids to treat various types of pain (e.g. acute, chronic, dental, cancer, end-of-life); possible alternative pain therapies; risks of co-prescribing opioids with other medications (e.g. sedatives); pain treatment agreements and documentation of outcomes; methods for discontinuing opioids; access to medication-assisted treatment (MAT); and Naloxone coprescribing. Plans are to convene this task force early this spring and have the guidelines available by fall 2016. Along with development of prescribing guidelines, the following strategies are intended to reduce prescription opioid overdose, misuse and dependency in Oregon: Œ Reduce problematic prescribing practices. It’s important that we encourage health care providers to use the Prescription Drug Monitoring Program (PDMP) to assist them in providing patients better care in managing their prescriptions and using prescription drugs appropriately. We need to ensure access to non-opioid pain treatment therapies for chronic non-cancer pain, such as physical therapy, massage, acupuncture, cognitive behavioral therapy, nutrition services, and graded exercise. In addition, it’s essential that we implement pharmacy opioid management strategies, including prior authorization for opioids; preferred/non-preferred drug lists; and dispensing limits for daily morphine equivalent doses (MED), quantity of pills, number of refills and early refills. Œ Improve safe drug storage and disposal. We must educate the public about safe storage and disposal of unused medications, and explore expanded drug take-back programs (for example, at health facilities and pharmacies, as well as law enforcement offices). Œ Improve the infrastructure for Naloxone rescue, and Naloxone co-prescribing. Health care providers should consider co-prescribing Naloxone with opioids for at-risk patients. We should explore changes needed to allow Naloxone prescribing and dispensing to third parties of patients, such as a spouse, partner or parent. We need to improve law enforcement’s and Emergency Medical Systems’ training and access to administer Naloxone to patients who have overdosed on opiates; we can promote knowledge to the public of the “Good Samaritan Law,” which, as of Jan. 1, 2016, protects people from arrest who have used illicit drugs if they call 911 to report an overdose; and we can promote access to Naloxone trainings for the public, such as at pharmacies. 18 Medicine in Oregon www.TheOMA.org
OMA Medicine in OR Winter 2015 2016
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