Pain Standards Task Force PacificSource Community Solutions Boardroom 2965 NE Conners Ave, Bend OR Agenda: October 3, 2018 from 7:00am-8:00am

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1 Pain Standards Task Force PacificSource Community Solutions Boardroom 2965 NE Conners Ave, Bend OR Agenda: October 3, 2018 from 7:00am-8:00am Call-In Number: Digit Access Code: :00-7:05 Introductions All 2. 7:05-7:20 Take Meds Seriously Oregon Media Campaign Update Julie Spackman State IVP Opioid Prevention Media Campaign Julie Spackman 3. 7:20-7:25 Pharmacy Report Dr. Little 4. 7:25-7: PIP Update Stevi Bratschie 5. 7:35-7:45 Don t Punish Pain Rally Erin Solomon, Kelsey Seymour & MaCayla Arsenault 5. 7:45-8:00 Monthly Updates Dr. Swanson Substance Use Counselors In ED Rick Treleaven Behavioral Health Learning Collaborative Update Erin Solomon Pain 101 Update Erin Solomon Pharmacy Education Update Erin Solomon Acute Pain Guidelines Update Stevi Bratschie Consent Agenda: Approval of the draft minutes dated September 5, 2018 subject to corrections/legal review 1

2 Pre-Paid Comprehensive Advertising Plan for Take Meds Seriously Oregon Purchase by 8/31/18 for implementation 9/1/18-6/30/19 Increased saturation in Crook and Jefferson Counties Overlap into Deschutes County where purchasing is possible Implementation Schedule Platform Vendor/Co. Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Newspaper Madras Pioneer/JC Disposal Storage Use Central Oregonian/CC Disposal Storage Use RoundUp Prineville Disposal Storage Use RoundUp Madras Disposal Storage Use Posters Spanish Posters Multi-theme English Posters Multi-theme Printed Rack Cards Spanish Rack Cards Multi-theme English Rack Cards Multi-theme Social/Digital Media Facebook/C.O. footprint Safe Disposal Safe Storage Safe Use YouTube 15 sec video (Engl only) - C.O. footprint Multi-theme Web Ads - C.O. footprint Multi-theme Movie Theater Slides Madras Cinemas 5 Safe Disposal Safe Storage Safe Use Billboard 7th and Main, Prineville Multi-theme W Hwy 126/Bowling Ctr Multi-Theme Cable TV + ZOLO: JeffCo/CrookCo Cable ZOLO: KOHD, C.O. footprint Multi- Theme Multi- Theme Multi- Theme Multi- Theme Multi- Theme Multi- Theme Multi- Theme Multi- Theme PDO Expansion Grant - Patient Materials $2,000 Comprehensive TMSO Media Campaign Funding for Central Oregon PSTF Grant - TMSO campaign $2,117 PDO Expansion Grant - TMSO campaign $4,000 DCHS Partnerships for Success Grant $723 St. Charles InKind Donation $1,750 PDO Tri-County Grant FY17-18 $15,547 Platform Est. Reach ZOLO: KOHD 186,875 WebAds/YouTube 26,054 Facebook/C.O. footprint 24,118 ZOLO: JeffCo/CrookCo Cable 11,100 Madras Cinemas 5 9,000 RoundUp Prineville 4,600 Central Oregonian/CC 3,200 Madras Pioneer/JC 3,100 RoundUp Madras 2,175 English Rack Cards 2,000 Spanish Rack Cards 1,000 English Posters 200 Spanish Posters 75 Billboard DT Prineville? Billboard Hwy 126 Prineville? Gratitude for Collaboration from: Katie Plumb, CCHS Prevention Coord; Kimberlee Jones, JC Prevention Coord; Angela Jensen and Donna Mills, COHC; Julie Vandersluis, St. Charles Health System; Jessica Jacks, Sarah Peterson, and DCHS Finance Team; and all of our media contractors - Thank you! This was a team effort! 2

3 INVESTIGATING COMMUNICATIONS FOR SAFE AND EFFECTIVE PAIN MANAGEMENT Project Goal: The Oregon Health Authority, Brink Communications, Western States Center and Goodwin Simon Research are developing a consumer outreach campaign to prevent the use of prescription opioids for pain management. We know the opioid crisis is complex and addressing it will require a variety of intersecting strategies (including provider education, changes to prescription guidelines, medication-assisted treatment and recovery support). This project is focused on: 1) educating consumers about non-opioid options for pain management, and 2) preventing people from starting doctor-prescribed opioids for managing pain. Using an upstream and equity-based approach, the project aims to engage communities who have experienced significant disparities in health including rural Oregonians, American Indian/Alaska Natives, African Americans and the Latinx community to introduce safe, effective and culturally-responsive interventions for pain management. Prevention: According to the SAMHSA, prevention is defined as services delivered prior to the onset of a disorder; these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use. What We Have Learned So Far: - The current media conversation presents the opioid crisis as the new normal to be managed, and a force beyond our control. - There are also many mixed messages about the nature of the problem, the people impacted, who is at fault, and how the crisis can be addressed. - People are largely confused about what opioids are, how they work, and what other effective, non-opioid options exist for pain management. Key Questions: - How do we help to shift a conversation heavily focused on addiction, overdose, and death toward prevention and safe, effective pain management? - What information and access do people need to make decisions about pain management that doesn t involve opioids? - What are the most effective messages in shifting the conversation, and who are the most effective messengers? Our Timeline: - Media audit, social listening: January March In-depth interviews: May June Change Advisory Team engagement and community conversations: Summer Message development; in-person and online focus groups: July October Online message testing survey: October December Campaign planning: January February Campaign: March December 2019 Want to Know More? To receive more information or periodic updates about this project, or to provide additional input, please Marian Hammond at marian@brinkcomm.com or Se-ah-dom Edmo, seahdome@wscpdx.org 3

4 Don t Punish Pain Rally Notes Interviewee #1 What are your personal reasons for attending today? My wife has Lupus and needs pain medications. She is constantly being pressured to decrease opioid treatment. She has never overdosed and she takes her medications responsibly. She cannot be here so I am here for her. What do you hope to gain from this rally? Fight against these restrictions and raise awareness. Most of the individuals suffering from pain do not have the energy to fight themselves. What do you think of the opioid crisis? Not an opioid crisis. It is a heroin and fentanyl crisis. How do you think prescription opioid drugs are related to opioid overdose issues? Not really, I don t believe they are related. It s because certain individuals have addictive personalities. If it weren t opioids it would be other drugs. Do you think there is room or where does alternative pain therapy fit within this conversation? It does fit in conjunction with opioids. Are you aware of the safe disposal sites for medications? Yes. Interviewee #2 What are your personal reasons for attending today? My husband is a cancer patient (terminal). They had given him 6 months to live. He was in a lot of pain. Stanford accepted him for a surgery and he is still with me but homebound and has little time left. After the surgery, insurance denied pain medications. The surgeon had to fight and eventually won to prescribe pain medications. It should not be this difficult for a cancer patient to receive pain relief. What do you hope to gain from this rally? I am a cancer survivor and this opioid fight is a big worry for cancer patients. They want us to sign pain contracts, participate in regular urinalysis. So many things to block our relief from pain. What do you think of the opioid crisis? I was a rehab counselor when I worked. Chronic pain patient s hardest to place in jobs. When they have no access to opioids and cannot function they cannot work. - Has known Karen a long time and support her and her husband. How do you think prescription opioid drugs are related to opioid overdose issues? Too long to answer, there is no simple answer. It is a systemic problem. 4

5 Do you think there is room or where does alternative pain therapy fit within this conversation? There should be lots of things in people s toolbox. It is an individual basis and good to have options. It is good cannabis is legal. Are you aware of the safe disposal sites for medications? Not really. Interviewee #3 What are your personal reasons for attending today? I have had no pain meds since June. They will not prescribe them to me. I have arthritis and am a cancer survivor. I need surgery but have an auto-immune disease that requires me to be on Coumadin. The surgery would help. They cannot do surgery because if they take me off the Coumadin I might have a stroke during surgery. If they leave me on I will bleed out during surgery so there is no way to fix my pain without surgery. Even a low dose opioid they want me to sign a pain contract and it makes me feel like I am not trustworthy. What do you hope to gain from this rally? Some awareness, some people need this stuff even though people die on it. I was on 3 60mg extended morphine and oxycodone 15mg extended once per day. Now I have none and can barely function. I use an electric scooter most of the time now. What do you think of the opioid crisis? I think it s serious but some people can t do without it. How do you think prescription opioid drugs are related to opioid overdose issues? They are the same thing. They calm pain and increase pleasure. Does it calm pain because it increases pleasure or the other way around? Some people may take it to increase the pleasure feeling. Do you think there is room or where does alternative pain therapy fit within this conversation? Alternative therapy depends on the health issue we are talking about. The swimming pool gives me some relief. My doctor has me go to the deep-end to exercise, but the pain is back as soon as I get out of the pool. I am not sure what good it actually does. Are you aware of the safe disposal sites for medications? Not aware of safe disposal but always use all of my medications. Interviewee #4 What are your personal reasons for attending today? I have newly diagnosed CIDP similar to MS/GBS and had an awful winter/spring. Diagnosed in one day. I have a pain contract. My wife works in a hospital/rehab setting. People with chronic pain have no voice. I am here for friends and others who can t physically/emotionally make it. It is criminal for Payers to stop covering pain meds. Understandable why people commit suicide. Weeks of just going from bed to chair all day, every day. My previous Primary Care Physician would not prescribe opioids. I am doing acupuncture, pool, no NSAIDs, no behavioral health. I am afraid they will take all the pain medications away. 5

6 What do you hope to gain from this rally? Cool if people will listen to this side of the story. CDC says no long term research established that opioids help with pain. This sends the wrong idea about opioids and addiction. It can lead to people refusing to take them even when they are needed. What are your thoughts on your pain contract? Pain contract is awesome. I am in support groups and I know others feel these contracts leave a feeling of distrust but there are other things to get mad about. I find it totally reasonable. What do you think of the opioid crisis? Sad for those addicts on heroin & fentanyl. Unfortunate but honestly the majority are fentanyl and just don t understand the potency levels. They are separate chapters. How do you think prescription opioid drugs are related to opioid overdose issues? Gotta let doctor s do their jobs. I saw my friend get addicted to prescription opioids after head-on collision is sober now. He recently had knee surgery and they gave him an alternative drug (I don t remember what it s called) for pain because they knew about his addiction. It all worked out. Doctors are being pressured. There is a possibility in certain people who are wired differently and develop tolerance and addiction. Do you think there is room or where does alternative pain therapy fit within this conversation? I believe alternative therapy should be addressed. Pool certainly helps me. I do physical therapy 3 times per week, Tai Chi. Acupuncture helps but is limited. But thinking these therapies are enough my disease is debilitating. Are you aware of the safe disposal sites for medications? Yes, there is one at St. Charles Community Pharmacy and I see announcements for safe return events. Other thoughts: Wal-Mart refusing to fill RX opioids over 7 days. Use separate overdose data between opioids and heroin/fentanyl Ortho Surgeon stopped to tell Karen Yeargain Thank You. They are not able to prescribe pain medications for surgery patients. Abbot Labs stopped by to provide information on a pain treatment: dorsal room ganglion (DRG) Stimulation 6

7 Pain Standards Task Force PacificSource Boardroom Bend, Oregon September 5, 2018 Present: Kim Swanson, Mosaic Medical, Chair Gary Allen, Advantage Dental Michael Allen, La Pine Community Health Center Matthew Cook, St. Charles Health System Mike Franz, PacificSource Alison Little, PacificSource Michael Powell, St. Charles Health System Scott Safford, St. Charles Family Care Divya Sharma, Mosaic Medical Julie Spackman, Deschutes County Health Services Heather Stuart, Crook County Health Department Rick Treleaven, BestCare Treatment Services Tom Watson, Rebound Physical Therapy Absent: Misoo Abele, Veterans Administration Wil Berry, Deschutes County Behavioral Health Muriel DeLaVergne-Brown, Crook County Health Department Shanna Geigle, Veterans Administration Sharity Ludwig, Advantage Dental Kerie Raymond, Hawthorne Healing Arts Center Robert Ross, St. Charles Medical Group Marie Rudback, Endeavor Chiropractic Others Present: Stevi Bratschie, PacificSource Donna Mills, Central Oregon Health Council Kelsey Seymour, Central Oregon Health Council John McIlveen, Oregon Health Authority Erin Solomon, PDO Coordinator 7

8 Introductions Introductions were made on the phone and around the room. Substance Use Counselors in the ED Rick Treleaven shared that this project has to be selected as a top priority by the ED before plans can move forward. He noted that additional funds are needed in order to staff two full-time positions. Naloxone Grant Dr. Swanson shared that PSTF members voted to fully fund all applicants, which was made possible by additional funds made available to cover the balance of all the requests. o ACTION: Dr. Swanson and COHC staff will begin executing the approved applications next week. OHA, Upcoming Priorities with Open Discussion Dr. Alison Little shared that the Acute Pain Task Force at the State met on July 30 th and assembled a set of draft guidelines to address post-surgical, dental and ED opioid prescribing. She noted there is a revised draft available and offered to share it with the group. o ACTION: Dr. Little will send the revised draft to Erin Solomon to share with the PSTF. Dr. Little noted that with PacificSource s new focus on acute opioids, she would like to bring a pharmacy report to the October meeting. o ACTION: Dr. Little s pharmacy report will be added to the October agenda. Stevi Bratschie volunteered to attend the upcoming meeting of the Acute Pain Task Force, and the group agreed to any concerns or comments to her beforehand. Oregon Opioid Prescribing Guidelines for Acute Pain Dr. John McIlveen shared that he is the State Opioid Treatment Authority for Oregon. He noted the state s low rural capacity for Medication Assisted Treatment (MAT). He emphasized the need for stronger Opioid Use Disorder (OUD) links to traditional SUD Treatment settings. Stevi asked what OHA is doing to influence bias discrimination and de-stigmatization. Dr. McIlveen shared that OHA is instituting a Statewide Recovery Month and will release a public education campaign focused on pain. Take Meds Seriously Update Julie Spackman shared that five sources have funded a campaign for October 2018 through June 2019 to increase saturation of Take Meds Seriously Oregon in Crook and Jefferson counties. Behavioral Health Learning Collaborative Update 8

9 Erin Solomon shared that the event is at maximum capacity for in-person attendance. Pain 101 Update Erin shared that she has procured nearly all of the speakers presentations, and registration is just over 50%. She noted that she plans to promote the event with s that highlight some of the speakers. Dr. Swanson asked Kelsey Seymour to contact participants and ask them to cancel their registration if they can t make the event. o ACTION: Kelsey will begin contacting attendees and asking them to cancel if they are unable to attend the workshop. Pharmacy Education Update Erin shared that she is considering two venues for this event on Nov. 1 st and 2 nd. She noted that educational credits will be available for pharmacists. Member Letters Update Stevi shared that 41 member letters were released and 86 provider letters regarding patients with coprescriptions of benzodiazepines and opioids. She noted that in most cases both prescriptions were coming from the Primary Care Provider. Approval of the Minutes Dr. Gary Allen motioned to approve the minutes, and Dr. Mike Franz seconded. The minutes were unanimously approved. 9

10 HEALTH SERVICES 2577 NE Courtney Drive, Bend, Oregon Public Health (541) , Fax (541) Behavioral Health (541) , Fax (541) Pain Standards Task Force September 14, 2018 Attn: Erin Solomon Central Oregon Health Council PO Box #6689 Bend, OR RE: Naloxone Grant Dear Ms. Solomon, and Members of the Pain Standards Task Force and Central Oregon Health Council: On behalf of Deschutes County Health Services, I want to express my deep appreciation for the naloxone grant that you have awarded the Syringe Exchange Program (SEP). As you know, I interact several days a week with people who inject opioids who are at extremely high risk for overdose. Exchangers regularly share their overdose incidents with me, including the close-calls and recent deaths (a young man just last week) they have experienced in their tightly knit community. These deaths are tragic and preventable. The commitment of naloxone funding from the COHC and PSTF to our most vulnerable community members will have an immediate and direct impact on people who inject, many of whom have suffered multiple overdoses. The presence of fentanyl in Central Oregon s heroin supply has created even more urgent risk related to injecting, making access to naloxone essential. With the help of your grant, I can get this vital medication into the hands of people who desperately need it. Thank you so much for your lifesaving partnership with the syringe exchange. Warm Regards, Laurie Hubbard RN, BA, MSW CD Prevention Coordinator Deschutes County Health Services 2577 NE Courtney, Bend, OR laurieh@deschutes.org Our Mission: To Promote and Protect the Health and Safety of Our Community. 10