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Confronting opioid use in Orange County

March 30, 2017 | Bharath Chakravarthy, MD
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The amount of opioid painkillers such as oxycodone, hydrocodone and fentanyl prescribed in the U.S. has quadrupled since 1999 — as have the number of deaths attributed to them.

Orange County is no stranger to these harsh statistics, and as an emergency specialist at UCI Health, I’ve dealt with these cases first-hand.

In response, UCI Health helped launch in 2015 the Orange County Collaborative on Prescription Drug Abuse, also known as SafeRx OC. It’s a coalition of 19 organizations including health professionals, educators, health insurers and law enforcement officials.

In my current role as SafeRx OC leader, I seek to prevent abuse, avert deadly overdoses and create more treatment opportunities for people with addiction.

What is driving prescription opioid abuse?

In the past, physicians had under-addressed pain. Now the pendulum has swung in the opposite direction, and we’re overprescribing opioids.

Also, culturally, when we seek medical attention we want a pill. That’s not always the best answer. Another factor is the pharmaceutical industry. They’re an amazing partner in our healthcare system, but they have their own interests.

What do opioid-prescribed patients need to know?

Patients need to understand the proper usage and side effects of prescribed opioids and how to properly dispose of them.

Also, certain patients — including the elderly and those prescribed sleep aids and other mood altering drugs — are at a higher risk for overdose.

Why do we need a local opioid coalition?

There are countywide nuances in different parts of California. Each county needs its own network of key stakeholders to share ideas and work together like a well-oiled machine so it can get things done. We really can’t tackle this beast by ourselves.

How does UCI Health provide leadership?

As an academic institution at the forefront of medicine, we have the expertise to help curtail this epidemic.

Our goals center on three pillars:

  • The first pillar is prescribing guidelines and practices.
  • The second is harm reduction, or preventing deaths from overdose.
  • And our third pillar is medication-assisted treatment.

What is SafeRx OC doing to make opioid use safer?

  • We’re educating physicians and nurse practitioners who prescribe opioid medications, making sure they have the right information to prescribe the right pain meds for their patients.
  • We’ve developed Emergency Department Safer Prescribing Guidelines, which have been adopted throughout the county in all emergency departments.
  • Similarly, we’re refining outpatient guidelines based on national recommendations. Also, at UCI Health and CalOptima, we’re piloting a program that identifies and sends an educational letter to the top 10 percent of opioid prescribers in the county.

What is SafeRx OC doing to prevent opioid overdose deaths?

We’re working to educate more doctors about identifying high-risk patients and co-prescribing Naloxone. This is an extremely safe drug, like an EpiPen, that can either be injected or sprayed into the nose in case of an unintentional overdose.

Suppose your mother was prescribed opioid pain medications after her hip replacement. And she is normally taking a muscle relaxant or sleep aid. The two — muscle relaxant and opioid pain medications — can have serious consequences. You suddenly notice Mom’s not breathing properly, a sign of opioid overdose.

After you call 911, you’d give your mother the Naloxone — and save her life. Naloxone is available over the counter for about $60, but patients and caregivers can ask for a prescription if they prefer.

What is SafeRx OC doing about opioid treatment?

Addiction can happen to anyone taking opioids, no matter one’s social status.

We want to find patients with opioid use disorder who are ready to get help and refer them to treatment. We’re also hoping to increase the number of providers treating these patients, in particular those with a special license to prescribe buprenorphine — an effective medicine to help patients stop the cravings and taper off.

To that end, we’re sending out a survey to all the medicine-assisted treatment programs to determine their barriers to effectively treating new patients. We’re asking questions like, “Do you need more referrals, or are you treating patients at your capacity and need more facilities to accommodate them?” We hope this data will help us see what barriers are out there so we can come up with solutions.

Learn more about SafeRx OC and join the fight ›

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