The Oregon Health Authority has approved guidelines to help reduce opioid use that include testing patients for drugs and monitoring marijuana use.
The recommendations call on providers to test patients they suspect of sharing, misusing or selling opioids. They encourage them to consult peers when prescribing high doses of opiates and to document and discuss marijuana use, including asking patients what they use, how much and why.
“It’s really about a discussion that needs to happen between the patients and their physician,” Dr. Katrina Hedberg, Oregon’s health officer, said about cannabis. “There’s a difference between an occasional Friday night versus a daily high dose for treatment of pain.”
The guidelines are based on those issued by the federal Centers for Disease Control and Prevention in March. An Oregon task force adopted them this summer then spent several months hammering out recommendations that are specific to the state.
They include marijuana, which is legal in Oregon for medical and recreational use. Some patients use marijuana for pain. They might also take opiates. Hedberg said health leaders raised questions about that, pointing out that both drugs are psychoactive. Some people worry that when taken together, they could deter patients from using alternative therapies.
The guidelines aren’t trying to eliminate any form of treatment or take patients’ prescription painkillers away altogether. They don’t address acute pain either or opioid use for cancer treatment, post-surgery relief or for dental treatment.
They’re only concerned with chronic pain.
“The focus really is that what else can you offer patients,” Hedberg said. “How can you make sure that patients are continuing to function, maintain or improve their function.”
The opioid epidemic has been on the rise in Oregon since the 1990s, with a dramatic increase in the use, misuse, dependency and deaths from prescription controlled substances.
Between 2011 and 2015, nearly 900 people died in Oregon from an opioid overdose, and in 2014, enough opioids were prescribed in Oregon for nearly every person in the state to have a bottle. A national survey has also ranked the state No. 2 in the nonmedical use of pain medication.
Following the rise in use, there’s been an increased awareness of the need for other therapies for chronic pain. Studies show the drugs become ineffective over time because patients build up a tolerance, requiring higher and higher doses. That can lead to misuse and overdose deaths.
