The North Coast Opioid Strategy
In Columbia, Clatsop, and Tillamook counties, the Columbia Pacific Coordinated Care Organization (CPCCO) been working on a community response to the opioid crisis for several years. In 2014, the CPCCO Clinical Advisory Panel (CAP) recommended creating non-prescribing, behavior-based pain clinics as an alternative to treat patients’ pain. In early 2016, the North Coast Opioid summit brought together over 200 community members consisting of providers, pharmacists, behavioral health specialists, law enforcement, general public, and public health professionals to discuss the epidemic and develop an action plan. The North Coast Substance Use Steering Committee was subsequently formed to help move this work forward. The steering committee in partnership with the CAP is advising on regional action plans addressing: improving clinical prescribing, decreasing pills in circulation, increasing naloxone access, increasing access to medication assisted treatment, and developing community education campaigns.
CPCCO has continued to adjust our recommendations as information concerning safe practice evolves. We now advocate prescribing less than 50 mg/day MED (morphine equivalent dose) rather than the 120 mg/day MED mentioned in our previous guidelines. Likewise, we do not recommend methadone for the treatment of chronic pain, reflecting the increase in overdose deaths associated with methadone use for pain treatment. To achieve genuine and lasting practice change, our entire community must be educated regarding the current understanding of the appropriate management of pain. We need to understand the science that underlies best-practice recommendations; and our patients and families need to hear the same message. We feel the best approach is to promote a coordinated, community-based effort where providers share a common understanding, patients hear a consistent message, and the community at large supports and guides these efforts.