Rep. Greg Walden was busy taking notes and asking questions at Good Shepherd Medical Center in Hermiston last week as Eastern Oregon residents on the front lines of the opioid crisis shared their ideas for change.
“We’re very concerned about the situation locally and nationally,” Good Shepherd CEO Dennis Burke told Walden.
The Republican congressman from Oregon is the chairman of the Committee on Energy and Commerce, which begin hearings on the opioid addiction epidemic this week. Walden said finding solutions to the crisis is his “top priority” for the committee right now. They plan to start by investigating case studies in West Virginia, where tiny towns have been receiving millions of highly-addictive pain pills per year — in total enough for every man, woman and child in the state to have 433 pain pills apiece.
“We think that’s been replicated elsewhere, but we can figure out the system here,” Walden said.
The system has failed Oregonians, too, the roundtable participants told Walden. Dr. Joel Rice, a psychiatrist who operates the Grande Ronde Recovery Center anti-addiction clinic in La Grande and Pendleton, said the highly dangerous fentanyl is “very common in Hermiston now,” and he is seeing more of a problem with another drug called Kratam.
Rice said he doesn’t believe any doctors in the area are “pill pushers” who are knowingly profiting off of feeding others’ addictions, but instead are sincerely trying to help their patients manage pain.
“Ninety-five percent of the people they give opioids to don’t have a problem, so they don’t think it’s a big deal, but I’m working with the five percent,” he said.
Rice said one thing that would really help in preventing overdoses is having more providers who have a waiver to prescribe Suboxone, an opioid that can help addicts transition away from more harmful opioids as they work to get clean. The certification takes about 10 hours to complete, and would only apply to a small number of patients a provider sees, so Rice said he has seen good success with convincing a Union County hospital to offer a $1,000 incentive to get certified. He suggested to Walden that a similar government-sponsored incentive could be useful nationwide, something Dan Marier, a recently-retired Pendleton physician, agreed with. Walden said he was interested, and would look into it.
Marier, Rice, Umatilla County Director of Human Services Amy Ashton-Williams and Bart Murray, a consultant from Baker City, all agreed that a major problem in treating addiction is that mental health services, addiction treatment and physical health care are all separated out, often with very little communication between three different entities working to help the same person.
Ashton-Williams said the system was so “silo’ed and segmented” that there are many patients who have physical health problems, mental health issues and an addiction that are all interconnected and yet they are getting talk therapy without medication, or medication without counseling — even though the research is clear that integrated care is cheaper and more effective.
Carrie Sampson, quality director of Yellowhawk Tribal Health Center, said the clinic on the Umatilla Indian Reservation does offer a more integrated care system, and it has been helpful for a physician to be able to walk someone with a mental health problem right next door to a behavioral health specialist instead of giving a referral and hoping the patient follows up.
She also said that they don’t prescribe opioids on a longterm basis, and patients given addictive painkillers in the short term have to sign a pain management agreement that involves safeguards to make sure they get off the drugs as soon as they can.
Short term pain management can morph into a full-blown drug addiction, something that Good Shepherd COO Jim Schlenker said he knows well. His brother-in-law died of an overdose in a parking lot after initially being prescribed painkillers for a knee surgery.
“My sister was shocked,” Schlenker said. “She didn’t see anything that was out of the ordinary until after, when she started putting the pieces together, and by then it was too late.”
He said patients need more education about the dangers of what they’re being prescribed and more safeguards. He couldn’t speak to exactly how his brother-in-law’s initial prescription had been handled, but all the pieces of the system “didn’t come together right for him.”
The group also pointed to a dwindling number of physicians and mental health professionals in parts of Eastern Oregon, low salaries for crisis workers and funding/billing structures that don’t allow Rice, for example, to bill the Oregon Health Authority for mental health services at his clinic even though he is a psychiatrist.
“There is a brain drain in Eastern Oregon because the people with brains can’t get paid,” he said.
Walden thanked the group for their stories and suggestions, and at several points during the meeting said he would follow up with what was being proposed. He also shared some things he would like to see. That includes closing loopholes that allow people to sell fentanyl and other synthetic drugs legally if they adjust the formula slightly, holding drug companies accountable for their role, developing new non-opioid pain management drugs and coming up with better ways to monitor prescriptions without sacrificing privacy or the ability to get opioids when they are legitimately needed.