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Local hospital scaling back opiate prescriptions while public health officials work on classes to prevent overuse, abuse

CENTRAL OREGONIAN - St. Charles Prineville is trying to prescribe fewer opiates.

State and federal lawmakers have not been shy about declaring an opioid crisis in Oregon and throughout the U.S.

Lawmakers have pushed to pass new laws in the past couple years to curb abuse of opiates, which medical professionals agree are highly addictive and can cause health problems with prolonged use as well as dangerous overdoses.

Meanwhile, local efforts have emerged of late to get in front of the problem and find ways to not only prevent abuse, but to seek alternatives to opiate prescriptions and manage pain other ways whenever possible.

In 2016, St. Charles Prineville handled six opioid overdose cases. In 2017 that number rose to seven, and another seven cases were reported in 2018.

"It actually looks like our rates have been pretty stable, but we have such small numbers it doesn't take much to make a pretty big difference percentage-wise," said Dr. Torree McGowan, M.D., site lead for St. Charles Prineville and Madras.

Whether that will prove true in 2019 remains to be seen, but in just two months, the Prineville hospital is seemingly on pace to eclipse that total with four overdoses reported in just the past two months.

McGowan is approaching the data with a measure of caution.

"That certainly looks like it would be on track to be higher than the previous years," she acknowledges, "but it is so early in the year that it is kind of hard to tell that."

But what isn't in dispute is that Prineville is in the same boat as the rest of the state and country, facing a problem that health experts and legislators agree needs addressed. Data provided by Oregon Health Authority's Opioid Publications website reveals that opioid drug overdoses statewide have risen steadily for non-heroin opioids since 2000. The number of overdose hospitalizations per 100,000 people climbed from single digits in 2000 to nearly 25 by 2016. Accidental deaths from opioid overdoses climbed from less than four for every 100,000 people in 2000 to as high as eight earlier this decade before declining to around six in more recent years. Historically, pharmaceutical opioids have been the culprit twice as often as heroin, but since 2015, a rise in heroin overdose deaths and decline in overdoses on pharmaceuticals has resulted in the numbers for each being about the same in 2017.

To combat the problem, health leaders have begun to more closely scrutinize when they prescribe opiates, who they provide them to, and for how long.

"At St. Charles, as well as emergency physicians in general, we try to be very cautious to balance the risk and benefit of a medication, an opiates are obviously a very risky medication," McGowan said. "So, if patients are on medications for long term and certainly if they are using them for chronic pain, we usually encourage them to go back to their primary doctors. Generally, we don't refill medications if they have been lost or stolen — we encourage them to go back to their primary doctors."

McGowan added that physicians will often have conversations with patients who seem to be addicted to or abusing opiates and tell them they are concerned that they may have a problem and steer them toward treatment resources in the community.

In addition, emergency department personnel are now required to query the Oregon Prescription Drug Monitoring Database, which tells physicians who else is prescribing medication to a patient, how many refills they have received, and how many prescriptions for pain medication they have received in the past year. McGowan notes that the database has limitations, namely that it does not provide information for patients who may have been seen in neighboring states.

Another safeguard is physicians can produce a printout for frequent users of the emergency department, which opiate-dependent people often are, to review how often they have come in and for what medical conditions.

Oregon Health Authority data shows that prescription rates are in steady decline since peaking locally at more than 300 prescription fills per thousand residents in 2014 and nearly 250 statewide toward the end of 2012. Crook County numbers have since dropped to a bit more than 200 and statewide about 150. Deschutes and Jefferson counties have followed the same trend, and both counties have slightly lower prescription rates than Crook County.

The downward trend opioid prescriptions comes at a time when St. Charles put greater emphasis on other methods of pain management. McGowan said that other medications and treatments can absolutely be effective.

"Medicine is something that is continually evolving, and we are continuing to learn and trying to do things better," she said. "Fifteen years ago, when I started practicing medicine, we were told opiates are not addictive, you can give them to everybody and they will be just fine. We have unfortunately learned that is absolutely not the case. Now we are trying to figure out what the right balance of that is."

McGowan said that the prevailing belief is opiates are not a good option for treating people with chronic pain. She points out that such medications are typically a good option to treat major injuries or other medical situations like passing a kidney stone where pain is intense but temporary.

"That is going to be a time-limited thing," she says of the opiate prescription, adding that patients are given enough to last a few days.

However, opiates are no longer considered a good medication option for people who are dealing with chronic pain, fibromyalgia or other long-term conditions.

"There are much better alternatives for this type of pain," McGowan said. "There are actually physicians who specialize in pain management, and we have several with St. Charles who are able to take patients with Chronic Complex Pain Syndrome and help them find ways to wean off those opiates and find other medications and ways to address their pain that are safer."

In addition to connecting opiate users with pain management physicians, people can turn to treatment facilities in the Crook County community, McGowan said.

"There are some really successful ways to treat this and get patients off of opiates and back to a place where their pain is well controlled," she said.

While hospital leaders institute changes to slow opioid abuse, the Crook County Health Department has been taking their own steps to combat the crisis. Heather Stuart, the department's prevention coordinator, said CCHD is pursuing a grant that would focus on preventing the onset and reducing the progression of opioid use in people ages 9 to 20. The health department is also trying to add a staff member dedicated solely to opioid overuse and abuse, although those efforts have not yet been fruitful.

In addition, the health department's AmeriCorps VISTA Katie Walsh has been working on an opioid assessment for Crook County.

"She has been meeting with stakeholders around the community," Stuart said of the effort, noting that she has talked to the Prineville Police Department, District Attorney Wade Whiting and others.

The information will be used in part to develop a chronic pain class, Stuart said, which would require them to know first how many people experience chronic pain and then determine how many people use opioids — legal or illegal — to deal with that pain.

"The Central Oregon Health Council has a regional workshop called the Pain Standards Task Force," Stuart added. "Right now, they are getting ready to release information around acute pain guidelines."

Another continual issue driving the opioid crisis is medication getting into the wrong hands. McGowan points out that about 80 percent of overdose patients got the medication from someone else. She notes that some people will have surgery or get injured, receive opiates and then fail to use them all and either lose them or have them stolen.

"So if you are not using that medication anymore, take it to a pharmacy or to any local law enforcement (agency)," she said. "They are happy to help us dispose of those medication properly."

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