Opioids

Oregon has enough problems with opioids without people becoming addicted from a doctor’s prescription. It is how some people get hooked.

It might be anywhere from 3% to 19% of people who take prescription pain medications become addicted, according to the American Medical Association.

State Rep. Emerson Levy, D-Bend, told us after the legislative session she wanted to look into the issue. That got us interested.

Attitudes about prescribing opioids have changed profoundly over the last 20 years. Pain for a while became known as the fifth vital sign. Patients were not supposed to feel any pain.

“I was drinking the Kool-Aid too,” Michael Powell, the chief pharmacy officer at St. Charles, told us. “Patients should have no pain ever.”

That attitude was usurped by deep concern. He remembered when his father had major surgery for a hip replacement some 15 years ago. There was already a lot being published about the hazards of prescribing too many opioids or for too long a period.

He went to pick up his father at a hospital in the Willamette Valley. Powell was told he needed to go to the pharmacy to pick up prescriptions his father would need.

“When I went there, there was a bottle of 120 Oxycodone prescribed for him and a bottle of 120 Tramadol and some other meds,” he said. “And I was furious.”

His father wouldn’t have taken them. He wasn’t that type of person. He was also from a generation that wouldn’t throw anything away. They would have been in the medicine cabinet. Powell worried his children or someone else would stumble upon them.

Today St. Charles follows strict standards for treatment of pain — those recommended by The Joint Commission in 2017. Health care providers can find out easily what other painkillers patients are receiving through a state database. Powell told us the hospital’s electronic health records dictate very low starting doses and then there is quick follow up to ensure that is the right amount. The hospital makes available data to its emergency room physicians on how they are doing against best practice guidelines.

Dr. Jessica LeBlanc, a family practice physician at Mosaic Community Health who helped write Mosaic’s new policy on prescribing, isn’t necessarily a typical doctor. Different doctors have a different practice. She focuses on prevention and lifestyle changes to improve people’s pain. Sleep, diet, exercise, ice packs, a warm bath are things among others that she considers first for her patients, rather than writing a prescription. She said it is very rare, though, she does have a few older patients who are on long-term, very low doses of opioids for pain.

“It is pretty difficult for them to stop doing that,” LeBlanc said. “They are taking them consistently. They are following up. They are doing other therapies.”

They have other medical complications that prevent them from having surgery or other forms of medical intervention to improve their pain.

“One of the hardest things in medicine is that we are here to help people to reduce or possibly eliminate suffering and people are coming to us with suffering,” she said. “And some of them don’t want to take any medicine. Others feel very strongly that they should be prescribed these things. And so how do you have a really therapeutic conversation with patients who are in that group?”

The approach of Powell and LeBlanc are, of course, a tiny small sample of prescribers in Oregon. Still, it is clear that a change in state and national strategies have had an impact. Overdoses from prescription drugs in Oregon have been falling since 2010. There is more access to medication assisted treatment for opioid addiction. It is now mandatory that all prescribers licensed by the Drug Enforcement Administration register with the state’s prescription drug monitoring program. It’s also easier for prescribers through that program to find out if how they are prescribing is risky.

An Oregon committee actually sends out letters four times a year to prescribers that may be engaging in risky prescribing practices. There were 501 of those letters sent out for the first quarter of 2024, the Oregon Health Authority told us. That is out of some 19,000 providers prescribing controlled substances. The practice of sending out those letters has not been evaluated for how effective it is. We hope it works.

A state audit did recommend a host of changes in the way the state prescription drug monitoring program works a few years ago. Many were made. Notably two were not:

“State laws that prevent PDMP information to be shared proactively with stakeholders to help monitor and address questionable prescription activity have not changed” and “Oregon still does not require prescribers or pharmacists to use the PDMP database before certain prescriptions are written or dispensed.”

If Levy or other policymakers are looking for areas that might need change, perhaps a good place to start is with those unfulfilled audit recommendations.