In March of 2016, the CDC released the Guidelines for Prescribing Opioids for Chronic Pain. The summary of evidence demonstrates that the risk of opiate use greatly outweighs the benefit for the majority of patients. Population studies of death rates and prescribing practices demonstrate a close relationship between the amount of opiates prescribed and deaths related to their use. In short, there is inadequate evidence to support long-term opiate use for chronic, non-cancer pain.
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.
The likelihood of chronic opioid use increases with each additional day of medication supplied starting with the third day, with the sharpest increases in chronic opioid use observed after the fifth and thirty-first day on therapy, a second prescription or refill, 700 morphine milligram equivalents cumulative dose, and an initial 10- or 30-day supply.
Since 1999, opioid prescriptions have quadrupled, and over 183,000 people have died from prescription opioids.
In Oregon in 2013, drug poisoning deaths involved prescription opioids more than any other type of drug, including methamphetamines, heroin, cocaine, and alcohol.* The United States is in the midst of an opioid overdose epidemic. Opioids (including prescription opioids and heroin) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid.
THA realizes that treating chronic opioid patients for non-cancer pain of the back and spine can be difficult and that the intent of the guidelines can and will be difficult to apply in certain cases. By using these guidelines as a standard for reducing and eventually stopping opioid use for chronic non-cancer pain of the back and spine, the patient will not be dependent on a drug that is harmful to themselves and indirectly to others.
If a Provider believes the patient has developed a dependence and/or addiction to opioids and cannot be tapered off before or by January 1, 2018, the patient should be evaluated for a substance abuse disorder which is covered on Line 4 of the prioritized list. Please contact the Washington County Mental Health Member Service at 503-291-1155 for information on substance abuse referrals.
Addictions Care Coordination Program
Our mission is to partner with agencies in order to provide additional assistance for individuals who display high risk substance use disorder (SUD) patterns.
The primary duties of the Addictions Care Coordinator (ACC) are to identify with the individual the next steps needed to obtain an increased level of stability, assist in seeking access to substance use treatment, and/or to provide information and connection to local resources.
Intake Criteria for a High Risk Individual
Any Washington County resident who is willing to meet with the ACC and has one or more of the high risk patterns listed below:
- Repeated detox or ED episodes for SUD within 6 months.
- Hospital admit for SUD within 6 months.
- Currently pregnant with substance use during pregnancy and is not connected with a SUD provider.
- History of unsuccessful SUD treatment engagements and/or completions.
- Significant lack of community supports and wants to learn about SUD resources and treatment options.
- Complete and forward the Referral form to the Addictions Program by secure email to: Addictions Programs or by fax to: 503-846-4560.
- Send ROI (42 CFR, part 2).
The ACC will:
- Communicate that the referral and ROI have been received.
- Create a brief plan, which may include in-person or phone contact with the individual.
- Conduct an intake assessment.
- Identify treatment engagement goals and action steps with the individual.
Care Coordination is complete when the action steps determined during the Intake are met by the individual and the ACC. Goals are expected to be specific and short-term. They will relate to facilitating placement into a treatment program and linking the individual to SUD resources. The ACC will provide applicable SUD resource education and advocacy.
Please send referrals to the Washington County Addictions Program
E-mail: Addictions Programs or Fax: 503-846-4560
Juli Pearson, Addictions Care Coordinator | Desk: 503-846-6294
Nancy Griffith, Addictions Program Coordinator | Desk: 503-846-3280
Kathy Prenevost, Addictions Program Supervisor | Desk: 503-846-4432
Download the Washington County Addictions Care Coordination Packet (PDF) »