S moke S ignals
DECEMBER 1, 2017
13
'A lot of this was driven by big pharma'
OPIOID continued
from front page
“This reduction will result in
changes of availability and cause
shifting of brands to try and accom-
modate fills for patients,” Grand
Ronde Pharmacy Director Leatha
Lynch says. “I also see things like
this causing increasing demands
of other medications to help cover
pain, which then causes those to go
into a shortage as well.”
Given recent statistics from the
Centers for Disease Control and
Prevention, the crackdown on opi-
oid use is no surprise. Since 1999,
there have been more than 165,000
deaths from overdoses related to
prescription opioids, which breaks
down to 40 people per day.
Additionally, a national survey
from 2014 indicated that 4.3 mil-
lion Americans used prescription
opioids recreationally in the last
month.
However, although the amount
of opioids prescribed and sold in
the United States quadrupled
since 1999, the overall amount of
pain reported by Americans hasn’t
changed.
The question on the minds of
local doctors, clinic managers,
pharmacists, addiction counselors
and others is: Will cutting off the
legal supply help curb the opioid
crisis or will users turn to street
drugs, such as heroin and synthetic
opioids, to avoid painful medication
withdrawals?
Just how far the pendulum has
swung since OxyContin was first
approved in late 1995 to how it
has now become a focal point for
opioid abuse issues was illustrated
by Grand Ronde Medical Director
Lance Loberg.
“A lot of problems originated due
to treatments such as massage,
physical therapy and acupuncture
not being covered by the Oregon
Health Plan,” he says. “Providers
were pressured to prescribe opi-
oids. Now, OHP is realizing it and
approving other modalities. But
now we have patients here who
depend on these medications for
back pain. Taking those away will
be a big desatisfier … but there is a
lot of research that shows the risks
of opioids outweigh the benefits.”
The other issue that arises is
that, over time, people build up
a tolerance to opioids and larger
doses must be taken to achieve the
same effect.
“People end up being in more
pain, and they think they need
more medication,” Loberg says.
“A lot of this was driven by big
pharma.”
According to an Oct. 30, 2017,
article in The New Yorker, after na-
tional studies showed inadequate
treatment of chronic non-cancer
pain by physicians, demands were
made to address the issue. Seeing
the trend for doctors to take pain
more seriously, drug companies
pitched products such as OxyCon-
tin, which was marketed as less
addicting because its formulation
allowed for dosing every 12 hours
instead of four to six hours.
Tribal physician Dr. Marion Hull
“We want to keep our patients safe and
provide a healthy lifestyle. It’s just one
of those things, as the rules get stricter
and stricter, we need to help patients
manage the best we can.”
~ Health Services Executive
Director Kelly Rowe
Tribal Police want to stay
ahead of synthetic opioids
By Danielle Frost
Smoke Signals staff writer
Synthetic drugs such as fen-
tanyl are making it dangerous
for police officers to perform their
jobs as traditional field testing of
these substances can be deadly
if it comes into contact with the
officer’s skin or lungs.
The Drug Enforcement Admin-
istration issued a memo recently
urging police to use caution from
the beginning of a traffic stop.
It also discouraged field testing
of drugs, saying these materials
should be sent straight to the
respective state crime lab.
Grand Ronde Tribal Police
Chief Jake McKnight says that
although the problem is “min-
imal” locally, outside sources
may bring drugs to nearby Spirit
Mountain Casino.
“We typically find more meth
than anything else,” he says. “It’s
not a big issue here, but when
you bring in outside players, it
said that in the 1990s, the Oregon
Medical Board required all Oregon
physicians to take a class on pain
management. At the time, there
were some physicians who were
sanctioned for not prescribing ade-
quate amounts of narcotics.
“Notably, this coincided closely
with the Oregon euthanasia legis-
lation,” she says.
Now, the pendulum has swung
in the opposite direction of very
limited opioid prescriptions.
“This is hard for us because our
goal in life is to help people,” Hull
says. “It is difficult when people
come in and have an agenda about
what they want to take when we
know it may not be the best thing
for them. It puts us in an adversar-
ial position with our patients and
we don’t like it.”
The Tribal Health & Wellness
Center is working toward imple-
menting new procedures, using
treatments such as physical ther-
apy, chiropractic, acupuncture
and opioid alternatives like an-
ti-inflammatories and nerve pain
medications.
Health Services Executive Direc-
tor Kelly Rowe says that the clinic’s
policy changes are being driven by
nationwide substance abuse issues,
as well as recommendations from
the CDC and Indian Health Ser-
vice. Also, having a pharmacy direc-
tor in place after the position was
vacant for a few years has helped
can become a problem. We need
to look at getting in front of it.”
McKnight says his officers car-
ry Narcan, an overdose antidote,
and he is also researching the
purchase of a handheld narcotics
analyzer TruNarc. The $23,000
device enables officers to safely
scan for more than 414 suspected
illicit substances in a single test.
According to the TruNarc
website, the device also allows
the scanning to be conducted
through a plastic container for
most samples to minimize con-
tamination, reduce exposure and
preserve evidence.
Currently, the Tribal Police
Department sends suspect sam-
ples to the state crime lab.
“I am hoping different de-
partments will help chip in for
this,” McKnight says. “Fentanyl
is here, but it hasn’t become an
epidemic yet. It is better to stay
ahead of it and keep officers safe
though.”
in the effort to streamline policies.
“We want to keep our patients
safe and provide a healthy life-
style,” Rowe says. “It’s just one of
those things, as the rules get strict-
er and stricter, we need to help
patients manage the best we can.”
After being hired as pharmacy
director last year, Lynch joined
the Tribe’s Controlled Substance
Management Committee.
“Since the pharmacy is the one
dispensing, I wanted to bring us
into the conversation,” she says.
Lynch says that although the
pharmacy had a pain agreement,
it wasn’t used consistently with
patients.
“That leaves a lot open for in-
terpretation,” Lynch says. “As
pain clinics are being closed down,
people are scrambling trying to
manage their pain. We decided to
have something more streamlined.
It is still in process.”
The group, which includes Health
& Wellness Center employees,
spent time during the past year
comparing guidelines, policies and
procedures at local, state and fed-
eral levels.
“With the changes to the Oregon
Health Plan, it will impact how
we process coordination of bene-
fits,” Rowe says. “It’s a huge shift
and there are other guidelines for
CDC. We are constantly shifting
and adjusting where they need to
be. For our patients (on pain med-
ication), their worst fears are that
the pain is going to come back and
get worse.”
The new rules put doctors in a
tough spot, too.
“They are under scrutiny as well
from the Oregon Health Board,”
Lynch says.
Loberg agrees. “I think sorting
things out with OHP is going to
be the big challenge,” he says. “Ul-
timately, it would be nice to offer
acupuncture and physical therapy
at the clinic, and other alternatives
beyond just saying, ‘No.’ ”
Currently, massage and chiro-
practic services are offered onsite.
When opioids must be used, the
CDC is recommending starting
with the lowest possible dose, pre-
scribing immediate release vs. ex-
tended release tablets and limiting
acute pain prescriptions to three
days or less since long-term opioid
use often begins with short-term
prescriptions.
“It is definitely going to be more
difficult to get them for acute use,”
Lynch says.
Rowe says that the restrictions
may unwittingly make it more dif-
ficult for doctors to treat patients.
“With smaller amounts (of med-
ication), prior authorization and
having to show that you aren’t
abusing it, everything slows down,”
Rowe says. “It puts up roadblocks
for people who don’t abuse their
medication and the providers … but
it is the climate we are in. We are
still committed to helping people
manage pain.”
Lynch says that the ultimate goal
is to still provide pain relief, but
without risking lives in the process.
“We have to go along with the
regulatory bodies,” she says.
A ‘profit-driven,
public health crisis’
At the time of OxyContin ap-
proval in 1995, the Food and Drug
Administration believed the con-
trolled-release formula would re-
sult in less abuse potential since
the drug would be absorbed slowly.
However, the FDA’s labeling of
the product unwittingly resulted
in widespread abuse. It noted that
crushing the controlled release
capsule and using it could result
in abuse and that injecting it could
be lethal because the controlled
release properties would no longer
be effective, giving users a “high”
all at once.
Purdue Pharma, manufactur-
er of OxyContin, was issued a
warning letter from the FDA in
January 2003 for misleading ad-
vertisements, among them ads that
omitted and minimized the safety
risks associated with the drug and
promoted it for uses beyond severe
pain.
In 2007, Purdue Pharma ul-
timately plead guilty in federal
court of misbranding its product
and agreed to pay $600 million in
fines, one of the largest amounts
ever paid at the time by a drug
company. According to an Oct. 30,
2017, article in The New Yorker,
See OPIOID
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