This story has been updated.
State and local government officials along with major health providers will announce new guidelines for prescribing opiates at a press conference Tuesday morning in an effort to combat the opiate abuse epidemic in the Portland area.
Along with the announcement Multnomah County is releasing a report on trends in opiate deaths and overdoses (PDF). According to the report, ambulances in Multnomah County responded to opiate overdoses 632 times in 2014.
This number includes overdoses from both heroin and synthetic opiates, such as OxyContin and Vicodin, but is not illustrative of all opiate overdoses because ambulances aren’t always dispatched, and 911 isn’t always called.
The number of responses rose nearly 12 percent from 2013, with 35 percent of ambulances dispatched to private residences, and 38 percent to public spaces and roadways, the report states.
There were 56 heroin related deaths and 56 prescription opiate related deaths in Multnomah County last year.
As Street Roots previously reported, the Healthy Columbia Willamette Collaborative — a work group composed of HealthShare, FamilyCare, health providers, hospitals and officials within Multnomah, Washington, Clackamas and Clark counties’ health departments — has been developing guidelines and standards for prescribing opiates and looking at ways to reduce the risk of overdose since June 2014.
Representatives from this collaborative, including Tri-County Health Officer Dr. Paul Lewis, along with Oregon State Health Officer Dr. Katrina Hedberg, will officially announce the new guidelines that prescribers across the region are expected to follow.
Large health care providers, such as Providence Health and Services, Kaiser Permanente and Legacy Health, signed on with the effort earlier this year. According to the press release, this group is committed to ensuring prescribers within their organizations understand the guidelines and how to treat chronic pain without the use of synthetic opiates.
“Last year, our colleagues at the OHSU Center for Evidence-based Medicine found no studies evaluating the effectiveness of long-term opiate treatment for pain,” Lewis said in a press release. “Instead they found harm which was worse at higher doses.”
The report shows that while opiate-related deaths have dropped each year since 2011, the number of deaths from prescription opiates has remained fairly steady. The decline in the overall number stems from a reduction in heroin-related deaths, which the report credits to the wider distribution and training on the overdose-reversing drug, naloxone.
Both statewide and in Multnomah County, opiates are the most rapidly growing reason for accessing addiction treatment services, with 31 percent of people admitted to treatment in Multnomah County naming opiates as their drug of choice.
During the first nine months of this year, prescribers in Oregon have doled out more than 2.2 million prescriptions for Hydrocodone and Oxycodone alone – making synthetic opiates the most prescribed pills in Oregon, according to Oregon Health Authority’s Prescription Drug Monitoring Year-to-Date Report.
UPDATE 11:50 a.m.:
New prescriber guidelines announced at Tuesday’s press conference include: limiting opioid doses to 120 milligrams per day, monitoring and screening patients for past substance abuse issues, monitoring for opioid risk and maintaining a comprehensive treatment plan that includes non-prescription pain mitigation. The new standards note that naloxone and access to drug treatment should be available to high-risk patients.
“Now the hard work begins,” Dr. Melissa Weimer of Oregon Health and Science University told reporters. “We cannot emphasize enough, the importance of expanding addiction treatment as well. We cannot decrease the access to opioids without having effective treatments available to patients.”
Following 2012 legislation that limited access to prescription opioids in Washington, King County saw a 58 percent increase in heroin-related deaths. Street Roots asked Lewis how Multnomah County would avoid a similar effect.
“That’s what we’re trying to do,” he said, waving toward the panel of local health leaders at the conference. “Starting from the bottom with naloxone, addiction treatment, alternative treatments – and we’re monitoring. We’re going to try and see if there are unintended consequences to the things we’re doing.”
Coinciding with the announcement, Oregon Health Authority launched a page on its website with information about opioid abuse, pain management resources and addiction treatment.