State Standard for Opioid Prescribing will Follow CDC Guideline

06/15/16  Portland, Ore.

Task force recommends new practice for pain management.

A new Oregon standard for prescribing opioids for pain will be modeled after a federal guideline and, public health experts hope, improve patient care and reduce prescription drug overdoses in the state.

The Oregon Opioid Prescribing Guidelines Task Force approved adoption of the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain at its June 3 meeting in Portland. In its motion, the task force also encouraged more discussion at state, regional and organizational levels about how the guideline will be disseminated, communicated to patients and health care providers, and implemented.

“Opioid overdose is a major public health problem in Oregon and nationwide,” said Katrina Hedberg, MD, MPH, state health officer and state epidemiologist at Oregon Health Authority. “This guideline is an important step toward addressing this problem. The task force voted to endorse the CDC guideline as the foundation for opioid prescribing in Oregon.”

The 36-member task force is composed of physicians and other health care industry professionals representing local public health agencies, state and national professional licensing boards, 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, there are more drug overdose deaths than motor vehicle traffic deaths. About 43 percent of those overdose deaths are associated with prescription opioids. Since the 1990s, there has been a dramatic increase in prescription-controlled substance sales, use, misuse, dependency and overdose due to opioids in Oregon.

Data from Oregon’s Prescription Drug Monitoring Program shows that prescribed opioid use is pervasive among Oregonians. In 2015, nearly 25 percent of Oregonians received a prescription for opioid medications, and in a recent national survey, Oregon ranked second among all states in non-medical use of pain relievers (i.e., prescription pain medication).

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

According to the CDC, the federal guideline 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.

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 called for the Oregon Prescription Drug Monitoring Program to assess high-risk behavior, prescribing thresholds, and dangerous co-prescribing—recommending multiple opioid medications—and use of multiple prescribers and pharmacies.

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:

  • 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.
  • Providing education and training of the public, providers, health systems, 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.

Hedberg said next steps for the task force include seeking endorsement for the new guideline from health care provider groups around the state, and getting the word out about them to other stakeholders through the end of the year.

“The hard work now begins with implementing and communicating about this guideline to clinicians, patients and the public,” she said.