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Eastern Oregon health departments to target opioid abuse

Prevention, risk reduction big parts of program

By Jayati Ramakrishnan

East Oregonian

Published on December 25, 2017 3:17PM

Last changed on December 25, 2017 6:17PM


Though opioid abuse is an epidemic across the nation, locals may have reason to take heart: four Eastern Oregon counties are receiving federal funds to fight opioid abuse, in a partnership with the Oregon Health Authority.

Umatilla, Union, Baker and Malheur counties will receive $200,000 over two years, which health departments in those counties will use to target prescription drug abuse in the area.

“I’m sorry to say, our four counties are a priority,” said Jim Setzer, Umatilla County’s Public Health Director.

According to the Centers for Disease Control and Prevention, deaths from opioid overdoses have quadrupled nationally since 1999. They also reported that rural areas are now seeing higher rates of death due to drug overdose than urban areas. But often, treatment is more difficult to access than in cities.

Along with Mike Stensrud, the new prescription drug overdose prevention coordinator for the four counties, Setzer is aiming to target several areas of opioid addiction: prevention, treatment and risk reduction.

In addition to community forums and education, the program will aim to increase local participation in Oregon’s Prescription Drug Monitoring Program, a database that lets pharmacies and physicians document and monitor patient prescriptions, and potentially spot and stop opioid abuse.

Stensrud, whose position is funded through the grant, said Umatilla and Malheur counties are two of about 10 in the state that are “high-intensity drug trafficking areas,” which he attributed to their location — close to major transportation corridors, like I-84 and I-82. The others in the state, Setzer said, are along I-5.

Stensrud noted that around the holidays, people can be at an even greater risk of opioid overdose.

“It’s a time of high relapse risk that can arise from not having family to spend the holidays with, or experiencing a ‘trigger,’ such as seeing an old friend or family member you used to get high with,” he said.

Stensrud said it’s even more important during the holidays to keep prescription opioids locked up, to prevent guests from taking medications, either accidentally or on purpose.

He said there are a few hotlines substance abusers can use for immediate assistance — they can call Lines for Life at 800-923-4357, or text RecoveryNow to 839863.

Treatment options

Stensrud and Setzer said one of the program’s goals is to see more medical providers prescribing Suboxone. The medication for medically-assisted therapy is a combination of Buprenorphine and Naloxone. According to American Addiction Centers, Buprenorphine is a “partial opioid agonist” that produces a milder form of the effects that opioids have. It gives the user the same effect as an opioid without the same high, which makes it more difficult to abuse. Naloxone blocks the effect of opioids.

“There’s no risk of overdose as with a straight opioid,” Setzer said.

He said that unlike other treatments, such as methadone, Suboxone can be prescribed by a doctor and administered at home.

While it’s an effective treatment option, Setzer said there’s a lack of providers that prescribe Suboxone.

Chuck Hofmann, a doctor at New Directions Northwest, an integrated mental health and substance abuse facility in Baker County, said many providers don’t prescribe Suboxone because of the time involved to get certified.

“To get ‘X Waiver’ certified, physicians are required at least eight hours of training,” he said. “For physician’s assistants and nurse practitioners, it’s an additional 24 hours.”

He added that there’s a shortage of primary care practitioners to take care of other health issues, let alone opioid addiction.

He said the training includes the pharmacology of opioids, how to administer Suboxone, and the pitfalls of the treatment.

He said while there have always been lots of options for treatment, such as behavioral therapy and substance abuse counseling, data shows that addicts tend to have lower rates of recidivism if they’re using a medically assisted therapy.

“When you use opioids for a long time, some brain-rewiring occurs,” he said. “Patients don’t do well without those receptors satisfied.”

But he said one of the challenges with Suboxone, or other medically assisted therapies, is that you’re still replacing one opioid with another — even though the risk of abuse may be lower.

Hofmann said it’s also important for people to understand the psychosocial aspects of addiction.

“The more everyone can understand what’s going on in the epidemic, the better we’ll be able to address it,” he said.

Setzer said one of the biggest problems with opioid addiction is that most of the substances are legal.

“People are addicted, but they have a prescription,” he said.

Hofmann said while it’s hard to paint with a broad brush, most of his patients are between the ages of 25 and 40, and would have started using prescription drugs in their teens. Some ended up on heroin.

But he said most initially started out using them for pain management.

“People think, you smoke a little dope, get into heroin. Yeah, that happens, but currently more than half of the people suffering from addiction suffer because they got started in pain medication,” Hofmann said.

A key part of the project, Setzer said, is to make people aware of existing resources — making it easier for people to dispose of old or unused medications, making sure Narcan, a brand of Naloxone that can be administered nasally, is widely available.

“A longer-range sort of activity we discussed is looking for ways to expand alternative pain therapy — acupuncture, movement therapy. Not everything works for everyone.”

He added that some of those options are now covered by local insurance.

Setzer said the main idea behind the program is to use local resources to combat opioid abuse. That includes training and equipping people — healthcare providers, law enforcement officials and citizens.

“Like so much of public health, we need to make people aware, and then make it easy for them to do the right thing,” he said.



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