Moving the needle on opioid and other narcotic addiction epidemic

Friday, September 01, 2017 12:07 PM

by Alfred Gilchrist, CEO, Colorado Medical Society

When the March-April 2013 cover story of Colorado Medicine outlined the emergent opioid abuse and misuse crisis, Colorado ranked 12th nationally in the self reported non-medical use of opioids, and first responders and emergency departments were confronting growing waves of overdose patients. Caregivers were at different stages of struggling with the moral, clinical and economic consequences of the crisis.

CMS joined Gov. Hickenlooper’s call from the beginning to combine forces on what he called the “winnable battle” to reduce the escalating trend of opioid abuse and its often tragic consequences. Since then a dedicated group of your colleagues, frontline experts appointed by the board of directors, have been diligently working to address the crisis by focusing on professional education and development, bringing local and national expertise to the governor’s Colorado Consortium for Prescription Drug Abuse Prevention, and supporting public policy initiatives.

Other physician-led organizations have stepped up since 2013 when the governor brought stakeholders together. Our friends and strategic partners at COPIC have aggressively increased their prescribing awareness seminars and have confirmed over 2,000 of their insured physicians have taken these courses since 2013. The University of Colorado School of Public Health launched a two-hour online course to retrain health care professionals on the current guidelines for management of chronic, non-cancer pain, in conjunction with the state’s Division of Workers’ Compensation under the leadership of Kathryn Mueller, MD. The training is required for all members of Pinnacol Assurance’s network of providers, and is incorporated into the division’s Level II accreditation course for workers’ compensation providers in the state. To date, more than 2,200 physicians have completed the training. Notably, of those completing the course, 91 percent said that they would use the information to change the way they manage patients with chronic, non-cancer pain.

The Colorado Physician Education Program, or CPEP, offers two intensive educational seminars on safe prescribing for managing chronic pain. CPEP has assessed and educated over 400 physicians since the winnable battle began in 2013. Component and specialty medical societies have stepped up by promoting safe prescribing courses and other educational material and forums. There wasn’t time to perform a full accounting of what all health care organizations in Colorado are doing, but as Dr. Lesley Brooks’ cover story and other articles in this issue confirm, physician-led organizations have intensified their educational efforts since the governor announced his winnable battle in 2013.

Physicians know that addiction is a mean, almost intractable condition. Because of the combined and coordinated efforts of many starting in 2013, Colorado is experiencing a reduction in the volume of opioid prescriptions. Perversely, to the extent the supply of prescription opioids have shrunk, the severely addicted have tragically moved to street narcotics, most notably black tar heroin and Fentanyl, with more lethal consequences. As Colorado ACEP warns, people who are addicted to prescription opioids are 40 times more likely to be addicted to heroin.

This is an issue of common cause, a public health threat that has helped our political leaders in both parties to close ranks and work together to reverse a crisis that is systematically hurting or killing, nearly every day, our fellow Coloradans. We are fully engaged with the leadership of the executive and legislative branches of our state government and a broad range of stakeholders. A bipartisan, interim House-Senate study committee has been appointed. Many of the proposals under consideration come from other state experiences and are under careful scrutiny by our frontline experts to determine their adaptability to Colorado and the real world of health care delivery. We understand that some strategies that have worked in other states that are under consideration in Colorado will be met with a healthy dose of skepticism. We won’t get trapped in the policy weeds and argue away your hard-earned standing as a profession dedicated to reversing the crisis. We will advocate appropriate exceptions and two-to-four-year sunset triggers on some of the proposals to ensure that future general assemblies and stakeholders have the ability to assess the effectiveness of legislation enacted in 2018.

The opioid crisis urges us to take some policy risks. It is literally a life-or-death choice that we are attacking with elected officials and other stakeholders. Your board of directors has already determined that CMS will remain steadfastly committed to this substantial movement of caregivers and advocates to aggressively develop and support strategies that will move the needle of opioid and other narcotic addiction.