1. Medical Director Jackson County Health and Human Services
Jim Shames MD
Medical Director Jackson County
Health and Human Services
Jackson County Oregon
Population 206,412
(Jackson County averages over 250,000 opioid prescriptions per year)

2. As the dose increases, so does mortality Mortality risk compared to Morphine Equivalent Dose (MED)
Opioid Overdose Risk (fatal & non-f:atal) by Average
Daily Dose of Medically Prescribed Opioids
9-fold increase in risk relative to low-dose
patients ** **
** Significant
increment in risk p<0.05
Dunn et al., Annals Int Med, 2010

3. Overdose deaths in US compared to motor vehicle accidents

4. The 3 legged stool for community engagement: The 3 Ps
Prescribers (Health Professionals): Need to learn about current best practices concerning the treatment of Chronic Complex Non-Cancer Pain (CCNP)
Patients: Need behavioral and other supports to learn to manage their chronic pain without reliance on opioids
Public: Need to understand the changes in scientific understanding of pain management so they can support their loved ones. Need to learn about naloxone.

5. The abundance of prescription opioids is the result of prescriptions!
Prescribers
The abundance of prescription opioids is the result of prescriptions!

6. If we don’t solve this problem as a community, we are only passing it on to the next provider.

7. Oregon Pain Guidance (formerly Opioid Prescribers Group)
Attendees: Physicians, Mid-level providers, Nurses, Substance Abuse Counselors, CCOs, Therapists, Pharmacists, Medical specialty (Pain Medicine, ED), Dental, Community Justice Partners

8. Oregon Pain Guidance (OPG)
Public Health initiative to reduce opioid overdoses by addressing the problem at its core: medical providers
CME and dinner provided
OPG evolution:
Brainstormed >
Created guidelines >
guideline acceptance
Topics for discussion:
Trauma Informed Care
Benzodiazepines
Challenging conversations
Oregon Medical Board
120 MED policy
Best practices
OPG Steering Committee:
Meet every 2 weeks
Handle the work of the OPG

9. Summary of guidelines:
Assess prior to prescribing!
Encourage non opioid treatments
(They really work).
Measure functional improvement.
Compassionately say “No.”
Keep MED below 120
and methadone below 40 mg.
Assess for aberrant behaviors
(UDS, PDMP, pill counts, call backs)
Don’t combine benzodiazepines and opioids
Collaborate with community partners

10. (analysis of 112 JaCo and JoCo prescribers: OPG survey)
Disagree 6%
Neutral 12%
Completely Agree 58%
Agree 24%

11. We do need to provide compassionate care to those with certain painful conditions
Opioids have a role to play
We don’t want to throw the baby out with the bathwater
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

12. www.oregonpainguidance.org Provider resources Patient resources
Public resources
Supported by Medicaid insurance plans and Public Health
Please link us to your websites.

14. The Dissemination concept
Critical mass: If enough providers understand the guidelines, word of mouth and peer pressure will lead to adoption.
Information is transmitted via the pilot’s providers, OPG, KOBI messaging, website, consults, conferences,

15. Educating the Public through TV spots

16. Patients

17. Help from the CCOs They help support the OPG
Pay for behavioral health consultants to assist primary care providers
Support the Website, the Pain Conference, the Guidelines
They both have a 120 MED policy for their members
Are thought leaders at the Steering Committee meetings

18. Providing local alternatives to opioids
Pain Resiliency Program
By referral from Primary Care
Support by CCOs
Curriculum:
Evaluation, orientation
“Pain School”
Peer to Peer support
Movement therapy
Behavioral support
Feedback to Medical Home

19. Help from others Jefferson Regional Health Alliance
Federal Harold Rogers Grant (see next slide)
Jackson County Health and Human Services
In kind contributions from many local non profits

20. Interdisciplinary Action Committee: IDAC
Problem focused monthly meetings
Participants:
District Attorney
Sheriff, Police
Drug Court
Public Health
Substance Abuse treatment
Southern Oregon University
Parole and probation

21. Naloxone Oregon allows bystander use
Medford Police were one of the first in the State to initiate naloxone use by their officers.
Plans for broader community use

22. Jackson County accidental overdose data for the past 3 years:

23. Thank You