Sonoma Medicine | The magazine of the Sonoma County Medical Association | July 2016

EDITORIAL: Reducing Opioid Prescriptions

Mary Maddux-González, MD

Seventy-eight Americans die every day from an opioid overdose, and more than half of these overdoses involve an opioid prescribed by a physician. Since 1999, both opioid prescriptions and opioid overdose deaths have quadrupled. Meanwhile, evidence is mounting that opioid pain medications are less efficacious than initially thought for chronic pain management. Indeed, we now know that opioids can worsen pain at higher doses and are associated with an increasing number of serious adverse health effects.

How are we doing in Sonoma County in terms of physician prescriptions for opioids? Unfortunately, our local rates of opioid prescriptions, of residents on high daily doses, and of opioid/benzodiazepine prescriptions exceed statewide rates. On the positive side, many local efforts are underway to reduce what has become an unsafe community standard of practice for opioid prescribing. The articles in this edition of Sonoma Medicine highlight some of these efforts . . .

Dr. Gary Pace, chief medical officer of Alexander Valley Healthcare, discusses medication-assisted treatment for opioid addiction, including current research on addiction and brain chemistry. He challenges our biases as a medical community regarding addiction and recovery, particularly when that addiction is iatrogenic.  TO BE FEATURED IN THE AUGUST ISSUE OF MEDICAL TUESDAY.

As we move together as a medical community to reverse the overprescribing of opioid medications, we need to ensure that we don’t restrict access to appropriate use of these medications. . .

The Sonoma County Medical Association has joined forces with other local health care leaders to address the opioid epidemic. SCMA is a member of the Opioid Prescribing Work Group . . . A consistent community standard of practice across primary care and emergency departments, supported by evidence-based prescribing guidelines, will increase patient safety while reducing “doctor shopping,” “ER shopping” and other drug-seeking behaviors.

Unfortunately, physicians have played a central role in what is largely an iatrogenic epidemic of opioid addiction and overdose deaths. This fact weighs heavily on physicians who have prescribed these medications in a genuine effort to do right by providing their patients with relief from pain. In recent years, physician decisions to increase their prescribing of opioids were heavily influenced by the active promotion of opioids, not only by pharmaceutical companies, but also by state medical boards, national health care agencies and professional medical associations. These well-intentioned but poorly informed policies and practices have led to the dramatic increase in the availability of prescription opioids in Sonoma County and elsewhere, with the accompanying negative consequences of addiction, diversion and overdose deaths.

To protect the health and safety of patients, physicians need to play a central role in reversing ill-informed and unsafe opioid policies and prescribing practices. SCMA is pleased to offer this special issue of Sonoma Medicine on the opioid epidemic, and we will continue to work collectively with the medical community in Sonoma County to address this important issue. :: 

Dr. Maddux-González, chief medical officer for the Redwood Community Healthcare Coalition,
is the immediate past president of SCMA.
Email: mmgonzalez@rchc.net

SONOMA MEDICINE | Summer 2016 | Sonoma County Medical Association

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