Pubdate: Sat, 07 Nov 2015
Source: Press Democrat, The (Santa Rosa, CA)
Copyright: 2015 The Press Democrat
Contact:  http://www.pressdemocrat.com/
Details: http://www.mapinc.org/media/348
Author: Gary Pace
Column: Close to Home
Note: Gary Pace has been a primary care doctor serving Mendocino and 
Sonoma counties since 1998 and is currently medical director at 
Alexander Valley Healthcare in Cloverdale. He lives in Sebastopol.

IN RESPONSE TO OPIOID USE IN NORTH COUNTY

The most commonly abused prescription drugs include painkillers, 
stimulants, and medications used for anxiety and sleep.

I read with particular interest the article in Wednesday's Press 
Democrat that analyzed local opioid prescribing patterns based on 
information from a new Medicare website ("Cloverdale area rates high 
in prescriptions of addictive painkillers"). With the headline, my 
attention was guaranteed since I am the medical director of 
Cloverdale's only medical facility.

Opioid abuse and over-prescribing are definitely pressing concerns, 
in Sonoma County and across the United States. Opioid use has 
skyrocketed over the past decade or so, and the medical profession 
has played a significant role in this development. Approximately 57 
people die annually in our county of drug overdoses, and nationwide 
overdoses have surpassed automobile accidents as a leading cause of death.

Treating pain with high doses of opioids was considered the standard 
of medical care until just a few years ago. Now, due to better 
understanding of the biology of pain management, a clearer sense of 
side effects and the recognition of the devastating impact on our 
communities from ready availability of these powerful medicines, good 
medical practice has shifted to limiting their use to the equivalent 
of 120 mg of morphine per day or less.

Many patients reached much higher doses due to the earlier 
prescribing trends, but now most medical providers are in the process 
of slowly weaning them to this safer threshold.

I appreciate the timeliness of raising these issues, and the 
article's implied questions are very important: "Are there areas in 
the county where an inordinate amount of medication is being 
prescribed? Are certain medical providers giving out medication 
either at too high a dose or inappropriately?" Unfortunately, the 
information presented in the article does not really answer these questions.

The data appear to come from 2013, which was right about when these 
new strategies to decrease prescriptions came into practice. 
Reporting that certain providers have a higher percentage of Medicare 
prescriptions for opioids implies that they are over-prescribing. It 
would take more in-depth analysis to determine if that is due to 
their patient population (potentially a more chronic pain practice 
thus leading to a higher ratio of pain meds) or if other variables are at play.

Also, only Medicare patients were looked at, which may not provide a 
full picture of the situation. Many people who live in Cloverdale go 
to Healdsburg and Santa Rosa for their care, so determining from the 
online tool just who is doing the prescribing is difficult. My main 
point here is not to defend my health center but to point out that a 
deeper look at the data would be helpful, and this is something we 
intend to do.

In Sonoma County, our medical leadership has instituted many active 
programs to try to bring this problem under control. The Health 
Department recently started a consortium that includes primary care 
physicians, ER doctors, pain specialists and public health experts 
geared toward achieving adherence to agreed-upon prescribing 
guidelines. Partnership Health Plan, the local Medi-Cal provider, 
started an aggressive program within the past year to bring down the 
prescribing throughout the region, and it has noticed a reduction in 
opioid prescriptions for Partnership patients of 50 percent over the 
past 18 months. There is also a push to increase the number of local 
providers of Suboxone, an alternative to high-dose opioids that helps 
with addiction.

The problems suggested in the article are real, and the medical 
providers in this county are actively involved in decreasing opioid 
use and in developing alternatives for people in pain.

Hopefully, a future headline can declare, "Sonoma County accomplishes 
a significant reduction in opioid prescribing and abuse."
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MAP posted-by: Jay Bergstrom