Close to Home: In response to opioid use in north county
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.'
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.