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Sonoma Medicine

The magazine of the Sonoma County Medical Association

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Reducing Opioid Prescriptions

Mary Maddux-González, MD

Seventy-eight Americans die every day from an opioid overdose, and more than half of these overdoses involve an opioid prescribed by a physician. Since 1999, both opioid prescriptions and opioid overdose deaths have quadrupled. Meanwhile, evidence is mounting that opioid pain medications are less efficacious than initially thought for chronic pain management. Indeed, we now know that opioids can worsen pain at higher doses and are associated with an increasing number of serious adverse health effects.

How are we doing in Sonoma County in terms of physician prescriptions for opioids? Unfortunately, our local rates of opioid prescriptions, of residents on high daily doses, and of opioid/benzodiazepine prescriptions exceed statewide rates. On the positive side, many local efforts are underway to reduce what has become an unsafe community standard of practice for opioid prescribing. The articles in this edition of Sonoma Medicine highlight some of these efforts.

Epidemiologist Sarah Katz and her colleagues at the Sonoma County public health department provide a detailed review of county data on opioid use, as well as an overview of the department’s efforts and collaborative initiatives to address the opioid epidemic. Dr. Marshall Kubota, regional medical director for Partnership HealthPlan of California, presents the significant progress that PHC has made in reducing the number of opioid prescriptions and the number of patients on high doses of opioids in Sonoma County.

Dr. Gary Pace, chief medical officer of Alexander Valley Healthcare, discusses medication-assisted treatment for opioid addiction, including current research on addiction and brain chemistry. He challenges our biases as a medical community regarding addiction and recovery, particularly when that addiction is iatrogenic. Dr. Erin Lund describes the New Beginnings Clinic at Santa Rosa Community Health Center, which cares for the increasing number of pregnant women with opioid use disorder. The clinic serves as an excellent model of integrated medical and behavioral health care that promotes regular prenatal care, medication-assisted treatment, favorable pregnancy outcomes and reduced rates of neonatal abstinence syndrome.

As we move together as a medical community to reverse the overprescribing of opioid medications, we need to ensure that we don’t restrict access to appropriate use of these medications. Dr. Bo Greaves addresses this topic in a thoughtful and compassionate manner.

The Sonoma County Medical Association has joined forces with other local health care leaders to address the opioid epidemic. SCMA is a member of the Opioid Prescribing Work Group chaired by Sonoma County Health Officer Dr. Karen Milman and Dr. Lisa Ward, chief medical officer of Santa Rosa Community Health Centers. Physician leaders from SCMA, Annadel, NCMA, Sutter, TPMG, community health centers, PHC and the public health department are working together to develop guidelines that support consistent and safe primary care opioid prescribing practices across our community. On a parallel track, physicians and other leadership from St. Joseph’s, Kaiser, Sutter and district hospitals are developing community-wide emergency department guidelines for safe opioid use. A consistent community standard of practice across primary care and emergency departments, supported by evidence-based prescribing guidelines, will increase patient safety while reducing “doctor shopping,” “ER shopping” and other drug-seeking behaviors.

Unfortunately, physicians have played a central role in what is largely an iatrogenic epidemic of opioid addiction and overdose deaths. This fact weighs heavily on physicians who have prescribed these medications in a genuine effort to do right by providing their patients with relief from pain. In recent years, physician decisions to increase their prescribing of opioids were heavily influenced by the active promotion of opioids, not only by pharmaceutical companies, but also by state medical boards, national health care agencies and professional medical associations. These well-intentioned but poorly informed policies and practices have led to the dramatic increase in the availability of prescription opioids in Sonoma County and elsewhere, with the accompanying negative consequences of addiction, diversion and overdose deaths.

To protect the health and safety of patients, physicians need to play a central role in reversing ill-informed and unsafe opioid policies and prescribing practices. SCMA is pleased to offer this special issue of Sonoma Medicine on the opioid epidemic, and we will continue to work collectively with the medical community in Sonoma County to address this important issue. ::

Dr. Maddux-González, chief medical officer for the Redwood Community Healthcare Coalition, is the immediate past president of SCMA.
Email: mmgonzalez@rchc.net

SONOMA MEDICINE  |  Summer 2016  |  Sonoma County Medical Association

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