Primary Care Providers, Health Departments, Behavioral Health Providers and Hospitals
Join Forces in Community-based “Chronic Pain Initiative”
March 14, 2012, Raleigh, N.C. – Most people never dream that they could become addicted to a pain drug. Yet because of the difficulty our health care system has in determining a proper role for these medications, thousands of patients from all income levels and walks of life are running into issues of dependency. The U.S. is in the grip of an epidemic of prescription drug abuse fueled in part by legitimate prescriptions written by well-meaning physicians.
The sheer volume of the problem is staggering: According to the CDC, enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for an entire month. A recent report by the Institute of Medicine suggests that the U.S may be spending as much as $635 billion annually to treat chronic pain and that long-term pain impacts more patients in the U.S. than heart disease, cancer and diabetes combined.
In an unfortunate corollary, this flood of narcotics is driving an epidemic of prescription drug overdoses. Nationally, such deaths rose five-fold between 1990 and 2007. This loss of life has had a devastating impact on families all across our state. And even when problems aren’t fatal, the inappropriate use of pain medications significantly impacts the entire community.
To address this public health challenge, a broad coalition of stakeholders has launched the Chronic Pain Initiative. This expansive partnership includes Community Care of North Carolina (CCNC), Project Lazarus, the North Carolina Hospital Association (NCHA), the North Carolina College of Emergency Physicians, local hospitals and emergency departments, local health departments, primary care doctors, faith-based programs, law enforcement, and others.
CCNC has developed a series of toolkits aimed at providing information and resources to key players in chronic pain treatment: a Primary Care Provider Toolkit, designed with input of CCNC physicians, includes national best practice protocols for safe prescribing of controlled substances and alternative pain control modalities; an ED Toolkit helps hospitals implement policies regarding prudent prescribing of narcotics; and a CCNC Care Manager Toolkit that provides tools to better manage patients who present with chronic pain. The basic toolkits, available on CCNC’s website, have been distributed to the Chronic Pain Initiative Coordinators in each of CCNC’s 14 local networks and, in many cases, are being customized to suit each local region. The aim is to get the appropriate pain control medication to patients who need it while minimizing the risk of developing issues of dependence and addiction – and dealing effectively with dependence issues if they do exist.
The CPI approach is modeled on a highly successful Wilkes County overdose prevention program known as Project Lazarus. The program began with a series of public meetings organized by the Wilkes County Health Department to heighten community awareness of the county’s exceptionally high rate of mortalities attributable to overdoses of prescribed opioid pain relievers. In 2008, Project Lazarus, a secular, non-profit drug overdose prevention program, was formed to develop and disseminate a set of strategic action plans for the community and tool kits and medical training for local medical care providers to address opioid misuse and abuse.
An evaluation published by members of the Project Lazarus study team found that the implementation of their program in Wilkes County generated a 47% reduction in the overdose death rate from 2009 to 2010. More recent data show that the overdose death rate in Wilkes County decreased by 69% between 2009 and 2011, from 46.0 to 14.4 per 100,000 per year. Substance abuse-related ED admissions dropped by 15.3% from 2008 to 2010. Most remarkably, in 2011 not a single prescription overdose decedent received a fatal prescription from a Wilkes County prescriber, down from 82% in 2008. As of 2010, 70% of Wilkes County prescribers were registered with the State’s prescription drug monitoring program, compared to a statewide average of only 26%. The successful Wilkes County pilot project will be expanded statewide through the Chronic Pain Initiative with the goal of attaining similar success in saving lives and treating pain.
CCNC is a community-based, public-private partnership that takes a population management approach to improving health care and containing costs for North Carolina’s most vulnerable populations. Through its 14 local network partners, CCNC creates medical homes for North Carolinians in all 100 counties, including Medicaid beneficiaries, individuals eligible for both Medicare and Medicaid, privately-insured employees and uninsured people.
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