State shows progress on reducing opioids

Looking at the entirety of the opioid addiction epidemic that has taken hold of Alaska and the rest of the country, it’s easy to get overwhelmed.

Andy Jones, the director for the Office of Substance Misuse and Addiction Prevention, said one of the big reasons the state has committed so many resources to fighting the epidemic is because there are so many paths a person can take to becoming addicted to opioids. Attacking those paths one by one, he said, might be the easiest way forward.

“If we have to fight from the big pharma side of it, the medical provider side of it, the drug trafficking organizations, that makes it hard when you’re fighting on all those multiple fronts at once,” Jones said, “but taking one down at a time, or partnering and changing things up one at a time, does I think make quite a bit of change.”

According to recent numbers from the Alaska Prescription Drug Monitoring Program (PDMP), efforts in the realm of prescription opioids are starting to pay dividends. From 2016 to 2017, Alaska saw a decrease in total opioid prescriptions and the number of patients receiving opioid medications such as oxycodone or hydrocodone.

From 2016 to 2017, according to PDMP numbers, the number of opioid prescriptions decreased by 10 percent, while the number of patients receiving prescription opioids decreased by 10 percent. Providers and government leaders attribute this drop to a few factors, including changing the way opioids are prescribed and putting an emphasis on education.

A local approach

The danger of opioid addiction has been especially apparent in Juneau, according to the Alaska Department of Health and Social Services. From 2013 to 2017, there have been 25 opioid overdose deaths in Juneau, which is an age-adjusted rate of 15 opioid overdose deaths per 100,000 people.

That’s above the state average (11.3 opioid overdose deaths per 100,000 people) and the average in Anchorage (12.6 opioid overdose deaths per 100,000 people), according to DHSS numbers.

Dr. Cate Buley, the medical director of primary care clinics at the Southeast Alaska Regional Health Consortium (SEARHC), said SEARHC has made a few major adjustments since 2015 in the way it allows its physicians to prescribe opioid medication.

The largest, she said, is the way SEARHC’s Pain Management Committee functions. At SEARHC’s large clinic locations in Haines, Juneau, Klawock, and Sitka, there is a Pain Management Committee comprised of physicians, pharmacists and physical therapists that meets regularly to evaluate patients’ needs and treatment options.

In the past, a physician who recognized a warning sign that a patient might be developing an addiction could refer that case to the committee so they could decide whether to take that patient off opioid medication and what kind of alternative treatment plan they could pursue. For example, a patient might respond better to a different medication or even something like acupuncture than opioid medication.

Now, Buley said, the committee steps in before that. When a new patient is pursuing an opioid medication for chronic pain, that request goes to the committee before the medication is prescribed. The committee meets once every few weeks, and during the time between meetings the patient can work with his or her doctor to pursue a temporary treatment plan while waiting for the committee to make its determination.

Buley said it’s not very common for the committee to totally reject a patient’s request for an opioid medication, but they do like to find alternatives.

“We try not to turn patients away, because we’re open to our patients and our population,” Buley said. “We try not to send them away, but come up with a treatment plan for them.”

This new process is only in place for non-cancer patients, Buley said. This process mostly deals with chronic pain such as rheumatoid arthritis. Buley made sure to mention that she’s only been in her position for a month, and that Dr. Janice Sheufelt, who previously had the position, did much of the work to get this process in place.

From 2014 to 2017, according to numbers provided by Sheufelt, SEARHC cut down its opiate prescribing by 30 percent.

Buley said there’s always the concern that if a patient is denied access to opioid medication, they could turn to heroin. That’s why SEARHC and other providers try to work with other community organizations to find alternative methods of pain treatment.

Still, she said, she’s personally worked with many patients who end up in much better shape after they get off opiates.

“I’ve had several patients who have said, ‘Thank you for making me get off those. I didn’t know how awful it was until I was on those,’” Buley said. “That’s pretty amazing when someone comes back and thanks you after they initially said, ‘Don’t take those away from me.’”

Jones wasn’t as concerned with a switch to heroin, due to the difference in price between prescriptions and heroin. He said opiate pills usually run between $60-100 per pill, while heroin is much more expensive than that in Alaska.

During a recent presentation to the Chamber of Commerce, Juneau Police Department Chief Ed Mercer said JPD estimates heroin costs nearly $500 per gram in Juneau while it costs about $60-100 per gram in the Lower 48.

A statewide approach

In June 2017, Gov. Bill Walker signed House Bill 159, which institutes a number of measures to cut down on prescription opiates. Most notably, it cut the amount of pills a doctor could prescribe at one time down from a month’s worth to a week’s worth.

The bill also helped establish the PDMP, which is a database for all the physicians in the state to track a patient’s history as it pertains to prescriptions. Providers are required to check the PDMP prior to prescribing opioid medication, Jones said.

Jones said one of the most important efforts is to further educate doctors and community members. For about a year, Jones and other state employees have been traveling around the state and leading community meetings (including one in Juneau in March) to learn more about the distinctive challenges each region faces.

As he’s met more and more doctors around the state, Jones said he’s realized that there hasn’t been a huge amount of training for them in the realm of chronic pain. The state has procured federal funding, he said, to help supply more training for providers and physicians. He said one of the next steps is to involve the University of Alaska system, which he said is in the works.

He said numbers such as the statewide decrease in opioid prescriptions are exciting, but there’s still a huge amount of work to be done. Providers around the state are also starting to see results of changing their practices, and the progress in Juneau has been encouraging, he said.

“I would say Juneau’s no different than some of our different communities,” Jones said, “just one of the first to spearhead a lot of what’s going on.”

• Contact reporter Alex McCarthy at 523-2271 or Follow him on Twitter at @akmccarthy.

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