HHS Announces Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use

On October 10, 2019, the U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

“Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”

> HHS Announces Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use,, October 10, 2019
> Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics

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Ventura County: 2018 Overdose Report

dr young

 Christopher R. Young, M.D. Chief Medical Examiner

1,563 deaths were reported to the Ventura County Medical Examiner’s Office during calendar year 2018. Jurisdiction was accepted for 806 of these deaths, requiring further investigation and certification. Postmortem examinations were performed on 626 cases. Of the cases investigated, 170 deaths were due to medications, alcohol and or illicit drugs. Of the 170 deaths, 156 were accidents, 13 were suicide and one death was undetermined.

Of the overdose deaths, men accounted for 112 deaths (65.7%) and women accounted for 58 deaths (34.3%). Multiple drugs or medications may be involved in one case; therefore, one should not add the numbers of individual substances. The same case may be represented multiple times by different drugs or drug categories.

Noteworthy trends:

  • Total overdose deaths jumped by 49 between 2016 and 2017 but only increased by 5 between 2017 and 2018. Accidental overdoses rose by 37 between 2016 and 2017 and by 14 between 2017 and 2018.
  • Of the specific drug types and categories, the largest increase in 2018 involved methamphetamine (up 28 compared to 2017).
  • Except for ethanol, all drug types and categories increased compared to 2017 (opioid, heroin, fentanyl, benzodiazepine, methamphetamine and cocaine).
  • The highest rate of overdose deaths in 2018 was between ages 51 to 60 years (48 deaths).
  • Of the 40 deaths involving benzodiazepines, all were mixed substance overdoses with the exception of one suicide.

> Download the Report

> Letter from the Medical Examiner

> HOOKED | Overdose deaths up in 2018, though no one drug is to blame, VC Reporter, May 20, 2019

Ventura County will sue opioid makers and distributors to recoup expenses

Ventura County supervisors voted Tuesday to sue manufacturers, marketers and distributors of opioids, joining the large number of public entities across the nation lining up to recoup costs of treatment, law enforcement and other expenses linked to the addictive painkillers. Voting 5-0, the Board of Supervisors authorized the litigation that is expected to be decided in federal court. County officials say commonly misused opioids include Vicodin, OxyContin, tramadol and codeine. County Counsel Leroy Smith provided a list of potential defendants that included Purdue Pharma, Johnson & Johnson and other drug companies, along with about a dozen distribution companies. The list of distributors, which were defined as firms that get the drugs to market, included CVS Health Corp., Rite Aid and Walmart.

> Read Ventura County Star article

VCBH Medical Directors present the Benzodiazepine Project at the National Rx Drug Abuse & Heroin Summit in Atlanta

Deaths resulting in accidental overdoses related to benzodiazepines has been rising in Ventura County. Of all benzodiazepines, alprazolam is the most commonly prescribed, misused and diverted; however, it is no longer the drug of first choice for most conditions. To help reduce morbidity, mortality and drug diversion, VCBH focused on incorporating good practices into its medical decision-making regarding controlled substances. The project dealt with multifaceted challenges: a growing epidemic of Rx drug abuse in the community, consumers’ lack of awareness of the dangers these substances pose, providers’ lack of awareness of evidenced-based practices, and resistance to change on the part of both patient and prescriber.

> Watch the Video
> Download the Presentation

Opioid Solutions Summit, August 29, 2017

1opioid summit

 

The Opioid Solutions Summit presented Ventura County's response to the growing problem of prescription pain medication and heroin abuse. Labeled a nationwide crisis and epidemic, reports from professionals and the community made it clear that this region was far from immune. Confronting prescription drug and heroin abuse is essential to protecting the public health and safety of all Ventura County residents. Featured speakers included Sam Quinones, Journalist and Author of Dreamland: The True Tale of America’s Opiate Epidemic, and Danny Trejo, Iconic Actor, Producer and Recovery Advocate.

Read more at Opioid Solutions Summit

Preventing Overdose through Safe Prescribing - Benzodiazepine Project

Ventura County’s Benzodiazepine Performance Improvement Project

The Ventura County Health Care Agency won the prestigious 2016 CAPH/SNI Quality Leaders Award for Data-Driven Organizations for “Safe Alprazolam Prescribing”. This award was presented to the HCA team at the CAPH/SNI Annual Conference in December 2016 in Pasadena, CA. In 2017, the County of Ventura Board of Supervisors also presented the team with the California State Association of Counties (CSAC) Challenge and Merit Award for the Safe Alprazolam Prescribing and Benzodiazepine Monitoring Program. Accidental overdoses resulting in death related to benzodiazepines have been rising in Ventura County. Of all benzodiazepines, alprazolam (brand name Xanax) is the most commonly prescribed, misused and diverted. To help reduce morbidity, mortality and drug diversion, Ventura County Health Care Agency focused on incorporating good practices into medical decision making regarding controlled substances. This project helped to learn whether providers were prescribing safely. This challenge was multifaceted: dealing with a growing epidemic of prescription drug abuse in the community, consumers’ lack of awareness of the dangers these substances pose, providers’ lack of awareness of evidenced-based practices and resistance to change on the part of both patient and prescriber.

VCHCA’s Safe Prescribing Initiative uses a multi-level approach, beginning with the establishment of practice guidelines. The initiative also accesses reports from the CURES prescription drug monitoring program, uses a medication treatment agreement (MTA) between prescriber and patient, utilizes urine drug screens, and ensures that patients have access to non-pharmacologic treatment options, which has included training therapists in cognitive-behavioral therapy. The project was innovative by using data to design report cards, offering medical providers feedback about their prescribing practices, and providing them with data that reflected how their practice compared to the practice of their peers and the organization as a whole. Through the initiative, VCHCA has cut its number of patients prescribed alprazolam to less than a third of what it was in 2014, it has doubled its rate of medication treatment agreements, and increased the percentage of CURES reports run from 18.7% to 97.7%.

benzo project

> See the Ventura County’s Benzodiazepine Performance Improvement Project Video

Informing the Community: Plane of Pills Media Event 2016

To earn media attention and spread the word about the epidemic of painkiller overdoses, the Ventura County Rx Abuse & Heroin Workgroup hosted a press event on May 18, 2016, to unveil the Plane of Pills campaign. Featuring concerns by the CA Department of Justice and the Ventura County Sheriff’s Office, resulting stories in local papers, radio and social media increased awareness of the enormity of the painkiller overdose problem. The workgroup is a multiagency collaboration, including the Medical Examiner, Public Health, Sheriff’s Department, Behavioral Health and others committed to reducing Rx drug-related problems. Featured speakers included Mike Small, California Department of Justice, CURES Program Manager, Gary Pentis, Undersheriff, Ventura County Sheriff’s Office and Patrick Zarate, Ventura County Prescription Drug Abuse Workgroup Chair.

The mission of California's Controlled Substance Utilization Review and Evaluation System (CURES) is to facilitate safe prescribing and dispensing of controlled drugs to minimize prescription drug related deaths and injuries. Local prescribers are registering and utilizing the CURES 2.0 at increasing rates. The interactive CURES database provides the highest level of prescription drug monitoring available. It discourages “doctor shopping,” reduces overprescribing, contains information on the prescribing and dispensing of controlled substances, including opioids, and protects patients who require painkiller medication. Our objective is to encourage and facilitate CURES registration and utilization with local education, on-site training, and promotion.

Read more at California's Prescription Drug Monitoring Program (CURES) Media Event

 

plane of pills poster

Safe Pain Medicine Prescribing Policy Launched Countywide, January 29, 2015

Hospitals Unite on New Pain Meds Policy – Collaboration to Counter Drug Abuse, Improve Emergency Department Care

This multi-agency collaboration focused on preventing Rx drug misuse. Agencies included Ventura County Behavioral Health, Ventura County Public Health, Los Robles Hospital & Medical Center, and Allied Emergency Departments Countywide. The new policy, used by all eight emergency departments includes:

  • When necessary, limited amounts of pain killers will be prescribed
  • EDs will not refill stolen prescriptions, but may refer patients to police
  • May ask people to show a photo ID when receiving a pain prescription
  • All patients will be provided copies of new prescribing policy

By adopting uniform policies, a consistent message was provided to patients countywide about how powerful prescription medications are made available in the Emergency Department.

Read more at Safe Opioid Prescribing Media Event

 

vcr safeprescribing er event

L. to R.: Dr. Julia Feig, Dr. Celia Woods, Dr. Neil Canby, Dr. Carlo Reyes, Dr. Anthony H. Ho, Dr. Thomas Duncan and Dr. Martin Ehrlich



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