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2B ❚ WEDNESDAY, JANUARY 24, 2018 ❚ APPEAL TRIBUNE Officials take stand on opioid epidemic Lauren Hernandez Salem Statesman Journal USA TODAY NETWORK A recent incident of a man purposely dislocating his wrist to gain access to fentanyl is just one example of how far people will go to satisfy opioid addic- tions. Woodburn Ambulance personnel had responded to a call from a man whose hand was hanging limply from his forearm. They loaded him into the ambulance and gave him a dose of fen- tanyl to manage the pain until he could be treated. But when they arrived at Legacy Me- ridian Park Medical Center in Tualatin, the man hopped out of the ambulance, popped his wrist back into its joint, thanked the first responders for satisfy- ing his fix and walked away, according to a report relayed to Woodburn Police Chief James Ferraris. Farraris was among more than a doz- en Marion County health and public safety officials sharing a conference ta- ble at the commissioners' boardroom Tuesday to strategize how best to tackle the region's growing opioid epidemic. "I think this showcases how people who are addicted stay (high), even to the point of causing themselves pain," Fer- raris said. "It showcases the power of addiction." Members of the Public Safety Coor- dinating Council examined several de- velopments in their respective fields: ❚ Gov. Kate Brown's Opioid Epidemic Task Force's legislative concept, which addresses opioid misuse, promotes treatment options and calls for manda- tory registration of all licensed prescrib- ers. ❚ Health officials' growing focus on Centers for Disease Control and Preven- tion guidelines and Oregon Medical Board recommendations to prescribe fewer opioid pills and shift toward alter- native treatments ❚ Police agencies growing use of anti- opiate overdose drugs, providing drug disposal sites and calling for multi- agency coordination regarding opioids. Gov. Brown's top legislative priorities Oregon health and law enforcement officials are shifting their focus to opioid treatment following Gov. Brown's opioid epidemic designation. The state has one of the highest rates of prescription opioid misuse in the na- tion, with roughly three people dying from prescription opioid overdoses ev- ery week. Brown created an Opioid Epidemic Task Force to address misuse of the drug, reduce the number of prescription opioid pills and promote treatment op- tions for people addicted to both pre- scription and illicit opioids. The task force introduced a legisla- tive concept pushing for mandatory reg- istration of all licensed prescribers in the Prescription Drug Monitoring Pro- gram. The statewide program allows pre- scribers to see where patients are get- ting their prescriptions from and how many pills patients are acquiring in or- der to identify illegal actions or negative health trends. There are currently 25 states man- dating enrollment in a prescription drug monitoring program for both prescrib- ers and dispensers. Thirty-eight states require some form of a "mandatory que- ry" when prescribing opioids, according to the task force. Oregon is one of 12 states where that requirement doesn't exist. "There is no class and no sector in the state that is immune to addiction," Cary Moller, health administrator for the Marion County Health Department, told the group. "Addressing the stigma is go- ing to be a critical component for us to start addressing this crisis." Health officials work to prescribe fewer pills Roughly 32.2 million prescription pills were dispensed in Marion County in 2016, according to the Oregon Health Authority. Data from the monitoring program, vital records and hospital discharge da- ta sets show 110,823 people received a refill on 535,922 prescription fills in 2016. Moller said she has recorded a 10 per- cent increase of prescription and illicit drug users between 18 and 29 years old asking for treatment specifically for drug misuse. "Most of the kids who start using pre- scription drugs start after getting into medicine cabinets at home," Moller said. "So this collaboration among county officials is intentional as this problem reaches into many sectors of our communities." She said treatment is at the heart of curbing the opioid epidemic in the state. In 2000, Moller said physicians were allowed to treat a limited number of pa- We do this for you. DOC Continued from Page 1A There is a dedication at work at the Statesman Journal. To uncover the truth. To tell the real story. To give you the facts, clearly and completely. And what we do has never been more important. Here and now, our award-winning journalists deliver unbiased stories that impact our home. From city council and school board decisions to the debates on Capitol Hill and how the outcomes there affect us here. The awards we’ve earned recognize hard work and genuine storytelling with integrity throughout the USA TODAY NETWORK. And we do it for you. 50 states. 112 local news teams. ONE NETWORK. Introduce yourself to what we do. As low as 99¢ per week for the first 12 months, billed monthly. * CALL 1-800-452-2511 VISIT StatesmanJournal.com/PPB *Offer expires 3/31/2018. Certain restrictions apply. For complete details, call or visit website. Price per week is based on a full access subscription including Sunday and Wednesday print delivery at $4.30 per month for the first 12 months. EAST5211 tients in clinics with buprenorphine, a generic name of a drug that helps con- trol withdrawal symptoms and is an al- ternative to opioids. Primary care doc- tors can now treat up to 265 patients with the drug. "That is a direct response to the com- munity's need," Moller said. She also reported that 19 primary care doctors in Marion and Polk coun- ties are certified to provide suboxone, another alternative to opioids meant to control withdrawal. Paul Coelho, the medical director of the Pain Clinic at Salem Health, said there are thousands of physicians in the state, but only 5 percent are certified, and only 50 percent of those regularly prescribe buprenorphine. In order to stem the tide of addiction, Coelho said more physicians must com- plete the 8-hour online training course and pass the test as part of the certifica- tion process needed to prescribe bupre- norphine. Dr. Holly Hodges, of WVP Health Au- thority, said Oregon physicians hope to curb overprescribing by following guidelines established in March 2016 by the CDC and Oregon Medical Board. Both agencies recommend urine testing patients before prescribing opioids to ensure they don't already have prescription or illicit drugs in their systems. Drug screenings are also recom- mended to be done when patients re- turn for a refill to determine whether they are following their regimen, or if they are consuming too many pills, di- verting their medication by selling it on the streets, or using other opioids from other prescribers. Hodges said drug screenings can also differentiate between different kinds of medication. She added that the pharmaceutical industry plays a substantial role in the opioid epidemic nationwide. Hodges said she remembers when doctors had fewer options for pain con- trol roughly 25 years ago, including co- deine, hydrocodone and had just started incorporating oxycodone into her train- ing. Fentanyl, a potent and deadly syn- thetic narcotic now commonly laced into heroin and methamphetamine, was only used in operating rooms by anes- thesiologists during that time. "Pharma companies are developing more and more types of pills that are long-acting, addictive opioids," Hodges said. "It's a whole different world." P-PB struggling to find qualified applicants. Prisons face the additional challenge of trying to overcome the negative percep- tion people have of public safety jobs. As employees become eligible for re- tirement, the shortfall could worsen. "If you went to an elementary school and you interviewed a bunch of fifth graders, you would have some that say 'I want to be a police officer,' 'I want to be a fireman,' 'I want to be a ballerina'," Cox said. "It's not often you hear someone say, 'I want to be a correctional officer because it's just not a very recognized profession." The number of Oregon corrections retirements has climbed steadily since 2014 when 98 employees retired. By the third quarter of 2017, 178 employees re- tired. Almost 20 percent of the staff is eligi- ble to retire today, Cox said. And in the next five years, more than one-third of the workforce could retire. "If they all decide to file their paper- work today ... we could be in a world of hurt," he said. Thankfully, he added, many have chosen not to retire because they enjoy their work, feel like part of a family or believe in the agency's mission. The operations divisions, which in- cludes 2,549 security staff, could see the most retirements. Just under 300 cor- rectional officers are eligible to retire this year. Within five years, that number will almost double. The department is also facing a shortage of medical professionals, es- pecially nurses. Officials have changed their tactics to draw in a new generation of employees and retain the ones they have, Cox said. The department offers good health benefits and retirement benefits. Al- though they struggle to compete with private sector pay and hiring bonuses, especially when it comes to nursing jobs, wages are still decent. Many jobs, like correctional officers, do not require a college degree and come with great benefits, Cox said. But security jobs are only a fraction of what the department offers. Each prison is like a small town, needing maintenance, public safety, medical, psychological, food service, electrical and transportation officials. "Anything that is in a small city, we pretty much have those same jobs," Cox said. Each prison faces different hiring “There is no class and no sector in the state that is immune to addiction. Addressing the stigma is going to be a critical component for us to start addressing this crisis.” Cary Moller, health administrator for the Marion County Health Department Police respond to overdoses A rise in fentanyl hospitalizations, in addition to Oregon's growing overdose deaths, has also prompted law enforce- ment agencies to add naloxone to their toolbox. Naloxone, commercially known as Narcan, can be administered for heroin, morphine, oxycodone and fentanyl overdoses. For Woodburn Police Chief Ferraris, law enforcement's role is only one facet of what he called the "three-legged stool" concept. Enforcement, preven- tion and education, and treatment can't survive without each other, he said. "We have to educate people to pre- vent them from going down that path and treat those that are addicted," Fer- raris said. "I think ... we're struggling on the prevention side." In Oregon, 779 people died from overdoses between 2014 and 2016. That's significantly more than between 1999 and 2001 when 257 people died, ac- cording to Oregon Health Authority da- ta. Nationwide, 64,000 Americans died in 2016 from opioids, including resi- dents in both rural and urban areas. While more Oregon law enforcement agencies are keeping naloxone in their patrol cars and jails, Ferraris said every officer in the state should be armed with the lifesaving drug. At about $75 for a two-dose kit, he estimates it would cost about $1 million to equip Oregon's roughly 5,500 certi- fied police officers with one package of naloxone to carry and one package for backup. "If we engage with someone in an overdose and we save a life using nalox- one, $1 million is a drop in the bucket in my perspective," Ferraris said. Email Lauren Hernandez at leher- nande@statesmanjournal.com, call 503-399-6743 or follow on Twitter @LaurenPorFavor struggles and employee markets. Snake River Correctional Institution, with its proximity to the Boise metro area, draws in applicants from Idaho because of its higher wages. Coffee Creek Correctional Facility in Wilsonville and Two Rivers Correction- al Institution in Umatilla struggle the most with attracting new hires. Turnover rates also vary, with Snake River reporting a turnover of about 4 percent and Two Rivers logging a rate of more than 12 percent. As part of its 10-year mission plan, the agency has made mental and phys- ical wellness a priority. "The focus we have as an agency to- ward work-life balance and focusing on our staff and their families, I think is one thing that does help retain employees," Cox said. "I've seen other law enforcement agencies where that focus isn't there as much." While older generations might dis- parage millennials as lazy or short- sighted, Cox said his staff has worked to understand the younger generation's strengths and priorities. "I think the millennials actually have some wisdom when it comes to work- life balance," he said. "A lot of them watched their parents put many years in and watched the economy crash and realized they didn't come out so well." They realize the importance of put- ting family first and having a supportive work environment, Cox said. But mil- lennials often shy away from shift work and government jobs. They also tend to not stay in posi- tions for very long — a trait that DOC could turn into a positive by offering cross-training and room for advance- ment. Recruiters have doubled down on technology-based hiring. Gone are the days when you could just post a "help wanted" billboard and wait for appli- cants to stream in, Cox said. Now, a so- cial media recruiter focuses on Face- book, LinkedIn, Instagram and Craig- slist. They also host virtual career fairs and have streamlined the hiring process into one-day recruiting events, where applicants can tour facilities, take profi- ciency tests and undergo interviews. Cox said the once eight-month ordeal is now condensed into one day plus a medical exam and background check. For questions, comments and news tips, email reporter Whitney Wood- worth at wmwoodwort@statesman- journal.com, call 503-399-6884 or fol- low on Twitter @wmwoodworth
