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  • Doctors continue fight against prescription drug abuse

  • Doctors are teaming up with treatment centers to combat addiction and drug overdose deaths in Jackson County.
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  • Doctors are teaming up with treatment centers to combat addiction and drug overdose deaths in Jackson County.
    Health care practitioners are also recognizing that they have started many patients on the road to addiction by prescribing opioid pain medication, according to the Opioid Prescribers Group.
    When patients can no longer get their medication, they often turn to heroin, said OPG.
    Medication can also fall into the hands of people who were not prescribed the drugs, including teens and young adults.
    More than 70 doctors, nurses, counselors, pharmacists and others involved in the group have been meeting since 2011 to devise better ways to assess addiction risk for patients, treat chronic pain and get treatment for addicted patients.
    Since 2008, more Americans have died each year from drug overdoses than from car crashes, according to the National Center for Health Statistics.
    For the past several years, Jackson County has averaged about 30 overdose deaths annually, said Dr. Jim Shames, OPG lead and medical director for Jackson County Health and Human Services.
    The majority of those deaths were related to prescription medicines, he said.
    From 2004 to 2011, the county saw 18 heroin overdose deaths, he said, or about two deaths per year on average. The county saw seven heroin overdose deaths in 2012 alone, Shames said.
    Numbers are not yet available for 2013, he said.
    Opioids can suppress breathing, leading to death. Men, people who snore or have thick necks, and those suffering from sleep apnea are especially at risk for respiratory failure, according to the OPG.
    People who vomit while in a sedated state can aspirate the vomit and die, case histories show.
    Shames said opioides such as heroin and the prescription pain medication oxycodone stimulate the pleasure centers of the brain. Many people become addicted and suffer severe withdrawal symptoms if they stop using.
    "The real issue is they crave the drug. It becomes uncontrollable to them," he said. "Their lives are controlled by using and obtaining drugs. At first, it's pleasurable, but then it becomes about avoiding withdrawal. After a few months of using, the push to keep using is, mostly, 'I can't stand to be sick.'"
    Withdrawal symptoms are similar to extreme flu symptoms and include vomiting, diarrhea, nausea, abdominal cramps, insomnia and muscle aches, according to the National Institutes of Health.
    Addicted patients may be placed on methadone or buprenorphine therapy to reduce withdrawal symptoms. Dosages are decreased slowly over time.
    Shames said the replacement therapy curbs cravings but doesn't cause patients to get high — allowing them to function in daily life.
    To prevent addiction in the first place, OPG is educating health care providers, setting standards for pain medications, providing screening tools and taking other actions, said Dr. Anne Alftine, director of clinical strategy for Jackson Care Connect, which serves people on the Oregon Health Plan.
    Depression, anxiety, past substance abuse and past sexual abuse are among the factors that could put patients at greater risk for addiction if they are prescribed opioides, according to screening tools developed by OPG.
    If health care providers notice a problem, they are encouraged to talk to their patients about the risks of opioid pain medications and refer them for treatment, Alftine said.
    "The trusted relationships between doctors and patients is invaluable," Alftine said.
    Jackson Care Connect is collaborating with the county government and local addiction treatment centers, according to the organization.
    Addiction treatment is covered by the Oregon Health Plan and health insurance companies, said Rita Sullivan, executive director of OnTrack, Inc., which has treatment centers in Ashland, Medford, White City and Grants Pass.
    She encouraged anyone with a problem to seek help, whether the person is covered by insurance or not.
    "We never turn anyone away for inability to pay," Sullivan said.
    OnTrack has pain specialists who can help patients who suffer from chronic pain.
    Long-term opioide pain medication use is at best 30 percent effective in managing pain, she said.
    Pain specialists can teach patients to manage their pain through exercise, yoga, relaxation techniques, therapeutic touch and other methods, Sullivan said.
    The specialists can help patients taper down their use of medication to levels recommended by their doctors, or get off opioide painkillers altogether, she said.
    Shames said just as with diabetes, chronic pain should be managed with exercise, diet and lifestyle changes in addition to any medication.
    He said opioides are still appropriate for people suffering from cancer pain and acute pain, but they have been overprescribed to people suffering from long-term, less acute pain, such as lower back pain.
    Unfortunately, as health care providers become more cautious about prescribing opioides for non-acute pain, opioides will become more expensive on the black market, Shames said.
    That will cause more people to turn to illegal heroin, which is less expensive. Heroin overdose cases will rise, he said.
    "As we try to fix one problem, we deal with another," Shames said.
    Still, Jackson County health care providers remain committed to keeping patients off the path to addiction that often starts with prescription opioide painkillers, he said.
    Staff reporter Vickie Aldous can be reached at 541-479-8199 or vlaldous@yahoo.com. Follow her at www.twitter.com/VickieAldous.
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