“Like much of the nation, Montana is confronted by the growing problem of opioid abuse. As a health care system, we have both the responsibility and opportunity to address this crisis,” said North Valley Hospital Chief Medical Officer Jason Cohen, MD. “By working together across the Kalispell Regional Healthcare System, we can positively impact the opioid crisis in the Flathead Valley by implementing a safe, consistent and comprehensive approach to opiate prescribing.”
Like other states, Montana has seen a steady increase in opioid deaths in recent years. In 2014/2015, the Montana Department of Health and Human Services reports that opioid overdoses caused an average of 4.2 deaths per 100,000 people. Nationally, the rate of opioid deaths has quadrupled in the last 15 years, with death rates in rural communities now exceeding those in urban communities.
One of the reasons for this disparity – and the corresponding impact on Montanans – is the high number of opioid prescriptions in rural counties. Health policy experts suggest that the availability of alternative treatments for pain – such as physical therapy or steroid injections – tends to be worse in rural settings, while opioids are widely available. As well, the type of jobs people do in rural areas typically involve more physical labor and are associated with higher rates of injury. And for patients who do develop problems with abuse, addiction-related services are significantly less available in rural areas.
When discussing how to address the issue, Dr. Cohen delved into the underlying cause. “Essentially, the advertising for opioids and their widespread availability in the United States occurred before we had a complete understanding of the risks around their use. Now, medical providers are a lot more selective about prescribing opioids, and spend more time with patients discussing those risks.”
“In most cases, opioid medications should only be used on a short-term basis to treat severe pain,” said Dr. Cohen. “There is very little evidence that long-term opioid therapy (more than four weeks) increases function, improves quality of life or even reduces perception of pain. For chronic noncancer pain, opioids should be the last therapeutic option we use, after all other treatment modalities have been exhausted.” This change in approach has already helped to shift the problem toward a slight decline in prescription rates, according to the Centers for Disease Control and Prevention (CDC).
Dr. Cohen emphasized that opioid abuse is a problem that affects almost all of us in some way. “Many people who now have a problem with opioids started on pain medication for a legitimate medical reason. These are our friends, our neighbors and our family members. This is not a problem that is isolated to one town, or one neighborhood or one group of people.”
Montana has already taken one of the first most important steps toward addressing the opioid problem – the creation of the Montana Prescription Drug Registry. This database allows physicians to view the opioid prescription history for their patients. The physician can see when the last prescription for an opioid was made, as well as the strength and number filled, and can make sure that multiple providers are not writing prescriptions for the same patient.
Finally, Dr. Cohen outlined a current project that Kalispell Regional Healthcare is working on for patients and providers across the health system. “We are working with physicians to develop a standardized process for prescribing opioids, based on what the CDC has identified as best practice. This includes implementing systemwide prescribing standards, as well as adopting monitoring policies and assessing alternatives to opioids on a regular basis.”
“This is one of tangible benefits of the hospital affiliation – the ability to work together and impact a major health problem in a way we couldn’t as an individual hospital,” Dr. Cohen stated. “Our medical providers and community members identified opioid abuse as a health care priority, and we are committed to improving the lives of our patients by taking a comprehensive and collaborative approach to this problem.”