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Prescription Drug Overdose Prevention
Prescription Drug Overdose Prevention

According to CDC, the United States is experiencing the worst drug overdose epidemic in [US] history. In 2015, opioid-related overdoses surpassed vehicular deaths in the U.S. From 1999 to 2012, deaths from prescription opioid analgesics continuously increased. Oxycodone and hydrocodone use quintupled and doubled, respectively. In 2014, the US spent $75 billion for healthcare and social costs related to opioid misuse. The complexity of the prescription opioid epidemic requires systems-level changes and state policy interventions. In 2015, we partnered with the Oregon Health Authority to apply for funding from the CDC to develop a multilevel intervention to reduce opioid overprescribing and opioid overdose in Oregon. We were awarded a multiyear grant that is now being implemented..

The project is a multilevel intervention delivered at the individual (i.e., prescribers), community (i.e., community work groups) and policy levels (i.e., prescribing guidelines; prescription drug monitoring programs; legislative changes) with the overall goal to decrease opioid overprescribing and opioid overdose in Oregon. We lead the scientific evaluation of this intervention. Our RRI team is conducting qualitative in-depth interviews and focus groups with key stakeholders throughout the state. We also evaluate prescription opioid prevention groups in diverse regions of the state. We are also using State health surveillance data, including data from the Prescription Drug Monitoring Program (PDMP) in order to evaluate the intervention.

During the first year of the project, diverse community stakeholders responded to the calls to attend the different groups and meetings.  These meetings were used to educate medical providers, counselors, police, tribal representatives, policy makers, and other community members. At the policy level, the state health insurance changed its policy to cover alternative treatments (i.e., acupuncture, chiropractor, etc.). Registration for PDMP was streamlined (e.g., more user friendly). Oregon law allowed lay people to carry and use Naloxone. At the individual level, prescribers received up-to-date information on their prescription practices (from PDMP) and were offered evidence-based information regarding their clinical practice. During year 1 of the intervention, the number of prescribers enrolled in the PDMP increased by 29%. The number of PDMP queries increased by 11%. The number of opioid prescriptions filled decreased by 9%, and the number of risky prescribing (i.e., >120 MED) was reduced by 12%.

The complexity of the prescription opioid overdose epidemic requires structural, multilevel interventions.  The early results of the Oregon intervention are promising, and demonstrate that community members will rally around this problem if provided with the mechanisms and strategies to make changes. While overdose and mortality data for the past year are not yet available, the changes in PDMP use, law changes, and increased community engagement, all point towards a reduction of overprescribing, which in turn should result in decreased overdoses.