How Oregon Steadily Decreased Opioid-Related Deaths

By Paul Fuhr 04/10/18

Oregon health officials tout an aggressive approach to CDC guidelines as one of the main reasons behind the decline.

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team of doctors

With national death rates continuing to climb in the opioid crisis, one state has managed to beat the trend.

According to Oregon Public Broadcasting, Oregon’s opioid death rate hasn’t simply decreased over the last few years; the state’s numbers have fallen by up to 25% since their peak.

Oregon has taken an aggressive approach when it comes to opioid prescribing, by focusing on better educating physicians on how to treat their patients.

In 2017, the Centers for Disease Control and Prevention (CDC) updated its opioid prescribing guidelines, outlining how to best prescribe pain medication for patients 18 and older.

The new guidelines recommended lower opioid dosages in addition to the use of technologies such as state prescription drug monitoring programs, among other approaches, though the OPB indicated that change takes time.

“There’s this report that says that the average time that it takes guidelines to turn into clinical practice is 17 years. That’s from the Institutes of Medicine,” Dr. Cat Livingston, a family physician, told OPB.

For Oregon, that was simply too long to wait.

The state’s medical community quickly put the guidelines into effect, outpacing the rest of the country. The key to making it all happen, Livingston said, was to implement a task force around the new prescription guidelines.

“Changing clinic policies is an incredibly powerful way to [accelerate the process], so making sure that the whole clinic or health system is aware of what those guidelines are, [then] providing data and feedback to providers,” Livingston observed.

OPB reported that this data and feedback is available through the prescription drug monitoring database, which gives doctors the ability to see if their patients are shopping around for opioids.

Additionally, the database allows physicians to see how many opioids they’re prescribing in comparison to their peers. (One recent study, for example, revealed that 65% of surveyed physicians had no idea they were overprescribing.) 

Oregon remains determined to not lose any ground in their fight against the crisis, but is keenly  aware of how the opioid problem began. “We didn’t know that [opioids] had such a potential for addiction and such a potential to cause disarray in people’s lives,” Livingston insisted, noting that in the mid-1990s, pharmaceutical companies hadn’t yet disclosed just how habit-forming opioids were.

She also pointed to a 2001 lawsuit where a doctor was found “liable for not providing patients with enough pain relief.”

To make matters worse, the American Pain Society and Joint Commission argued that pain was “the fifth vital sign,” alongside temperature, respiration rate, blood pressure, and heart rate.

“Pain being the fifth vital sign really brought the need to treat subjective pain as a critical issue that physicians were supposed to address,” Livingston said. “They believed that they had this very effective tool of opioids to treat that chronic pain.” In other words, it became physicians’ jobs to bring their patients’ pain (like other vital signs) back to normal. (The American Medical Association no longer sees pain as a vital sign.)

Regardless, with millions of Americans living with chronic pain, many have come to depend upon opioid medications. Dr. Catriona Buist, the Oregon Pain Commission’s chair, advocates for alternative treatments like sleep, acupuncture and physical therapy instead of resorting to opioid prescriptions.

“These therapies are extremely effective, especially if the person really is taking a self-management approach and putting into work what they’re learning,” Buist told OPB.

She admitted that these therapies take more effort than simply taking a pill.

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Paul Fuhr lives in Columbus, Ohio with his family and two cats, Vesper and Dr. No. He's written for AfterParty MagazineThe Literary Review and The Live Oak Review, among others. He's also the host of "Drop the Needle," a podcast about music and addiction recovery. More at paulfuhr.com. You can also find Paul on Linkedin and Twitter.

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