prescribing more safely: targeting opioid abuse, misuse€¦ · most addictive or abused...
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Dr. Reb Close, Dr. Casey Grover, and their colleagues in the Emergency department at Community Hospital of the Monterey Peninsula were seeing an alarming increase in patients returning again and again for pain medications or, worse, arriving after an overdose.
Though clearly wrestling with addiction, many didn’t fit the stereotype of an addict. There was the construction worker who became dependent on pain pills while recovering from a back injury. An honors student who got started at a “pill party,” where everyone dumps pills from the family medicine cabinet into a bowl and then swallows a random sample. A
teacher who got steadily stronger prescriptions for migraines until it seemed like it was never enough.
“We had a big problem,” says Grover. “About one person every week was dying in Monterey County from a prescription overdose. We were seeing, routinely, 15-year-olds and 16-year-olds addicted to prescription medications. We were seeing families just torn apart by addiction. It was awful.”
Awful, but not unique. Similar scenes play out in hospitals around the country as addictions to powerful painkilling opioids have multiplied into a national crisis. In Monterey County, like many places, prescription drugs cause more deaths than car accidents.
A teenager approached me at the hospital and asked if she could give me a hug. I thanked her and asked her why. With tears in her eyes she said, ‘I’m meeting my real mom for the first time she’s not high. Thank you for bringing her back to me.’ I get goosebumps just thinking about it.Dr. Casey Grover Emergency department Community Hospital of the Monterey Peninsula
25,000
20,000
15,000
10,000
5,000
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
19,354
National overdose deathsNumber of deaths involving opioid pain relievers (excluding non-methadone synthetics)
Source: National Center for Health Statistics, CDC Wonder male female
Prescribing more safely: Targeting opioid abuse, misuse
From left: Dr. Reb Close and Dr. Casey Grover Photo courtesy of Nic Coury, Monterey County Weekly
California deaths — all opioid overdoseTotal population: age-adjusted rate per 100,000 residents
2012 2017
0 10 20 30 40 0 5 10 15 20
ModocPlumas
LakeHumboldtCalaveras
SiskiyouTuolumne
AmadorShastaLassen
MaderaVentura
Santa CruzButte
MariposaSan Diego
OrangeSan Luis Obispo
ColusaSan FranciscoMONTEREYSan Joaquin
MarinRiverside
KernSonoma
SutterFresno
San BenitoDel Norte
NevadaCalifornia
SacaramentoTehama
YoloContra Costa
KingsTrinity
El DoradoSanta Barbara
MercedImperial
MendocinoSan Bernardino
StanislausPlacer
Santa ClaraLos AngelesSan Mateo
TulareAlameda
SolanoNapaYuba
SierraMono
InyoGlennAlpine
ModocHumboldt
MendocinoLake
ShastaLassen
YubaDel Norte
SiskiyouVentura
San FranciscoSan BenitoTuolumne
San JoaquinKern
San DiegoSan Luis Obispo
ButteOrange
Santa BarbaraSanta Cruz
MarinSonoma
RiversideMariposa
NevadaCalifornia
PlacerSan Mateo
MercedFresno
ImperialKings
Contra CostaTrinity
Los AngelesSacramento
MaderaStanislaus
Santa CalraInyoYolo
NapaAmador
San BernardinoTulare
SolanoEl Dorado
SutterAlameda
PlumasMONTEREY
CalaverasTehama
SierraMonoGlenn
ColusaAlpine
The statistics, and the stories behind them, were the impetus for Prescribe Safe Monterey County, a collaboration of nearly 20 agencies and organizations to reduce the misuse, abuse, and diversion of controlled addictive medications. Working together, they’ve achieved measurable successes in Prescribe Safe’s first three years:
❚ A 32-percent reduction in opioid deaths in Monterey County
❚ A 54-percent reduction in opioid medications prescribed in participating physician offices, and greater than 50-percent reduction in county health clinics
❚ At Community Hospital, a 59-percent decrease in recurrent Emergency department visits by people seeking opioid painkillers, and nearly $1 million in savings treating those patients
“I am most proud of the collaboration,” Dr. Close says. “We all care so much. We all
come together with one common goal, and it’s the safety of our community.”
Close’s intent from the start was to find ways to help those suffering from pain-medication dependence and to prevent the addiction from happening in the first place. She found pockets of good practices around the nation, including a San Diego program, and met with Dr. Anthony Chavis, chief medical officer for Montage Health, Community Hospital’s parent company, to plot a road map for moving forward.
The county’s other three hospitals, many doctors, the Monterey County District Attorney’s Office, pharmacies, law enforcement agencies, substance abuse treatment centers, and others signed on and began going at the problem from their respective angles:
❚ Doctors are prescribing fewer addictive pain medicines, directing patients as much as possible to alternative pain relief and, when needed, to recovery programs.
Prescribe Safe partners
Community Hospital
of the Monterey Peninsula
Mee Memorial Hospital
Natividad Medical Center
Salinas Valley Memorial
Healthcare System
Doctors on Duty
Urgent Care
Monterey Bay Urgent Care
Montage Medical Group
Monterey County
Community Health Centers
Community Health
Innovations
Monterey County Office
of the District Attorney
Monterey County
Sheriff’s Department
Monterey County
Coroner’s Office
Monterey County Public
Health Department
Monterey County Mental
Health Department
Monterey County Fire
Chiefs Association
Hospital Council
of Northern and
Central California
Monterey County
Medical Society
Central California
Alliance for Health
Community Human Services
Hospital Council of
Northern
and Central California
Sun Street Centers
Central Avenue Pharmacy
All opioid overdose deaths: Monterey vs. CaliforniaTotal population — age-adjusted rate per 100k residents
MontereyCalifornia
6
4
2
2008 2010 2012 2014 2016 2018
❚ A database now enables prescribers to look up patients’ prescription medication histories statewide, so they can be alerted to recurrent visitors shopping for pills from multiple sources.
❚ Law enforcement is being flagged to potential abuse and misuse.
❚ Public awareness is being raised to encourage people to seek alternatives to addictive pain relief, to keep their prescription medicines out of the hands of others, and to dispose of them properly when no longer needed.
❚ Drug take-back bins, for safe disposal of medications, have been added around Monterey County, including at Community Hospital.
Key to the effort is redirecting people to effective but non-addictive relief, not simply cutting them off. Opioid medications have a place in helping patients get through the initial traumatic pain of an injury, illness, or surgery, Grover says, but they do not address problems long-term. The goal is that if opioids are necessary, they be closely monitored; the plan from the start is to help patients taper off the addictive medication by addressing the root cause of the pain through physical therapy, surgical and non-surgical interventions, non-addictive medications, and complementary therapies.
With its broad approach and successful outcomes, Prescribe Safe was a finalist for a national hospital quality award and has become a model for other communities.
“The whole idea of Prescribe Safe is novel,” says Amy Patterson, a Monterey County deputy district attorney. “We’re one of the top mentor counties doing this in California. I go out and speak to local law enforcement agencies and other counties’ district attorney’s offices and explain Prescribe Safe, and it’s amazing how excited they are about starting something in their own county and following our lead.”
The problem ❚ Prescription drug abuse is the nation’s fastest-growing drug problem.
❚ Prescription drugs are the second-most-abused category of drugs after marijuana.
❚ Prescription drug-related deaths now outnumber those from heroin and cocaine combined.
❚ Prescription-drug overdose deaths exceed motor vehicle-related deaths in 29 states and in Monterey County.
❚ Misuse and abuse of prescription drugs cost the country an estimated $53.4 billion a year in lost productivity, medical costs, and criminal justice costs.
Most addictive or abused prescription drugs ❚ Hydrocodone (brand names: Norco®, Vicodin®)
❚ Carisoprodol (brand name: Soma®)
❚ Oxycodone (brand names: OxyContin®, Percocet®)
❚ Meperidine (brand name: Demerol®)
❚ Fentanyl (brand names: Actiq®, Duragesic®)
❚ Alprazolam (brand name: Xanax®)
❚ Clonazepam (brand name: Klonopin®)
❚ Methylphenidate Hcl (brand name: Ritalin®)
❚ Amphetamines (brand names: Adderall®, Benzedrine®)
Disposing of medication
Community Hospital now
has drug disposal bins where
the public can safely dispose
of medications that are no
longer needed or are out of
date. Bins are also available
throughout Monterey
County. Find locations at
chomp.org/prescribesafe.
Resources Learn more about Monterey
County Prescribe Safe
and find resources at
chomp.org/prescribesafe.
❙ Alcohol and drug
counseling and treatment
❙ Pain-management options
❙ Safe medication-disposal sites
❙ Complementary
medicine options
❙ Teen or young adult
prescription drug guide
Narcotic pill prescriptionUrgent care clinic in Monterey County
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
60,740
29,441 27,948
1/1/14 - 6/11/14 1/1/15 - 6/11/15 1/1/16 - 6/11/16
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