State task force OKs new opioid prescribing guidelines

A group of Oregon health care leaders has approved a new standard for prescribing opioids for pain. The Oregon-specific guidelines aim to improve patient care and pain management, and reduce prescription drug overdoses in the state.

The Oregon Opioid Prescribing Guidelines Task Force approved the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain as the basis for Oregon guidelines in June.

Since then, the task force has worked on Oregon-specific additions to the guidelines. The additions include recommendations for evaluation, consultation and documentation for patients who are on higher doses of prescribed opioids —- and who use prescribed opioids in combination with other medications, including marijuana.

The approval also encouraged continued discussion at state and local levels about how the state guideline will be implemented and communicated to patients and health care providers.

“Opioid overdose is a major public health problem in Oregon and nationwide,” said Katrina Hedberg, MD, MPH, state health officer and state epidemiologist at the Oregon Health Authority. “These guidelines provide Oregon a blueprint for decreasing opioid-related deaths in Oregon through the prescription process. Approval of these guidelines represents agreement and commitment from health care leaders in the effort to address addiction and misuse.”

The 36-member task force was composed of physicians and other health care industry professionals representing local public health agencies, state medical licensing boards, professional associations and other nonprofit organizations. Hedberg and OHA Chief Medical Officer Jim Rickards, MD, are the task force’s executive sponsors.

Each year in Oregon, drug overdose deaths exceed motor vehicle traffic deaths, and more overdose deaths involve prescription opioids than any other type of drug. It’s reported that three prescription opioid-related deaths occur every week, and many more Oregonians develop opioid use disorder. Since the 1990s, Oregon has seen a dramatic increase in sales, use, misuse, dependency and overdoses involving prescription controlled substances, particularly opioids.

Data from Oregon’s Prescription Drug Monitoring Program shows that prescribed opioid use is pervasive among Oregonians. In 2014, enough opioids were prescribed in Oregon for nearly every person in the state to have a bottle, despite insufficient evidence that long-term opioid treatment is effective for chronic non-cancer pain. In a recent national survey, Oregon ranked second among all states in non-medical use of pain relievers (i.e., prescription pain medication).

According to the CDC, the federal guideline—-approved by Oregon—-is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain; improve the safety and effectiveness of pain treatment; and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose.

“The hard work now begins with implementing and communicating about this guideline to clinicians, patients and the public,” Hedberg said. “Looking ahead, success will continue to require a shared commitment by our health care and community partners. We all serve a critical role, and approving this final set of guidelines continues momentum toward reducing opioid overdose and misuse in Oregon.”

Developing and implementing an opioid prescribing guideline for pain management was a goal of the OHA’s “Oregon Prescription Drug Overdose, Misuse, and Dependency Prevention Plan” published in November 2015. The plan also encourages reimbursement for non-opioid treatment for chronic pain, and implementation of pharmacy opioid management strategies.

In addition, OHA’s prevention plan supports:
— Increasing access to non-opioid treatments for chronic non-cancer pain.
— Improving the infrastructure for naloxone rescue medication, such as passing laws–as Oregon has–that allow lay people to carry and administer naloxone to people suffering from an opioid overdose.
— Providing medication-assisted treatment (MAT) for opioid use disorder.
— Implementing routine collection, analysis and reporting of opioid overdose, misuse and dependency data.
— Maintaining and improving the Oregon Prescription Drug Monitoring Program.
— Providing education and training of the public, providers, health systems and policymakers on the issues related to opioid overdose, misuse and dependency.
— Collaborating with federal and state entities to support the work of the initiative to reduce prescription drug overdoses.
— Improved safe drug disposal at pharmacies.

Reducing harms associated with alcohol and substance use is one of seven priority areas from Oregon’s State Health Improvement Plan.

For more information:
— OHA website: Reducing Opioid Overdose and Misuse https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/index.aspx
— CDC Prescribing guideline information for patients http://www.cdc.gov/drugoverdose/prescribing/patients.html
— CDC Prescribing FAQ http://www.cdc.gov/drugoverdose/prescribing/faq.html
— CDC Guideline for Prescribing Opioids for Chronic Pain http://www.cdc.gov/drugoverdose/prescribing/guideline.html
— Oregon’s State Health Improvement Plan https://public.health.oregon.gov/About/Pages/HealthImprovement.aspx