1. What are we doing in Southern Oregon? Concerns about opioid prescribing practices

2. Opioid Consumption in US We are 4.6% of the world's population and consume 80% of the world supply of opioids.

3. Palimed.org

4. Unintentional or undetermined prescription opioid and heroin overdose death rate by year, Oregon, 2000-2012 4

5. Jackson County (population 206,000) Overdose data 8 years (2004 through 2011): 246 total 141 deaths were determined Accidental Averaging 31 overdoses per year Averaging 18 accidental deaths per year Averaging 7-8 drug suicides per year 44 are undetermined

6. We’re Number One! Oregon leads the nation in inappropriate use of prescription pain killers for adults.

7. Consider non-opioid treatments

8. Opioid Overdose Risk (fatal & non-f:atal) by Average Daily Dose of Medically Prescribed Opioids Mortality risk compared to Morphine Equivalent Dose (MED) 1.79 % 0.68 % 0.26 % 0.16 % 0.04 % 9-fold increase in risk relative to low-dose patients Dunn et al., Annals Int Med, 2010 ** ** Significant increment in risk p<0.05

9. We do need to provide compassionate care to those with certain painful conditions We don’t want to throw the baby out with the bathwater Opioids have a role to play In the treatment of acute and post surgical pain In cancer and other deteriorating painful conditions In some chronic conditions, when utilized at safe doses

10. The prescription drug crisis is the result of prescriptions!

11. Opioid Prescribers Group Attendees: Physicians, Mid-level providers, Nurses, Substance Abuse Counselors, CCOs, Therapists, Pharmacists, Medical specialty (Pain Medicine, ED), Dental

12. OPG Meeting monthly for 3 years. Josephine and Jackson counties Opportunity to collaborate with peers + CME Take ownership of a difficult problem Evolving process: Brainstorming >Creation of local best practice > Achieve practice change

13. OPG Steering Committee Both local CCOs Paid staff Public Health Committed local thought leaders

14. We need to re-invent the wheel By adopting the best practices created by others we create a sense of “ownership”

16. www.opioidprescribersgroup.com

17. Pilot project 2013-2014 Initial Proposal: Bring resources to selected medical groups to help them adopt the guidelines Laura Heesacker LCSW, Alicia Mangiaracina MSW intern, Michele Schaefer Project Coordinator, myself and others Criteria: provider champion, administration support, provide us with time to work with staff One clinic completed, second clinic in progress

18. The Current Model 2 hour all clinic meeting (Jim and Laura) Hour long provider and MA meetings (Laura) Behavioral health support (Laura) Provide resources to clinic leadership (All) Identify high risk groups: Over 120 MED Over 40 Mg methadone Benzos + Opioids Aberrant Behavior Conversations as Medicine Peer to Peer: Group now offered every Wednesday at the Medford YMCA – Free.

19. Next Step: Behavioral Support Clinic “Back to Balance” Referrals from local prescribers who need support evaluating or tapering their patients Close collaboration with CCMH No prescribing on site. Free standing clinic with the following resources on site: Education, Counseling, Peer to Peer, OT, and more

20. Upcoming Events A Thoughtful Approach to Pain Management: May 9 th, Smullin Center, Medford. Best Practices for Opioid Prescribing: May 8 th, Smullin Center, Medford.

21. Thank You shamesjg@jacksoncounty.org