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LA County and private hospital ER's join forces to combat opioid over prescription

The opioid crisis is so challenging because the drugs are being prescribed for legitimate reasons.
Photo by Ian Sheddan via Flickr Creative Commons
The opioid crisis is so challenging because the drugs are being prescribed for legitimate reasons.

Los Angeles County's public health department announced Friday that it has joined with dozens of private hospitals to adopt standardized  guidelines for their emergency departments to avoid over prescribing opioid pain medications.

"There is a national epidemic of prescription opioid abuse," said Jeffrey Gunzenhauser, interim health officer for the Department of Public Health. "Nationally, deaths from prescription opioids are greater than those from motor vehicle accidents each year, and greater than deaths from heroin, cocaine and benzodiazepine drugs combined each year."

Abuse of prescription opioids - such as Vicodin® and OxyContin® - is responsible for 400 deaths each year in L.A. County and 16,000 deaths nationwide, according to the public health department.

The guidelines are designed to educate emergency room doctors on proper opioid prescription practices, as well as help them foil those who go "doctor shopping" in search of these drugs, according to the Department of Public Health.

The guidelines include:

  • Use opioids as a last resort and only for non-cancer patients with severe pain;
  • Give the lowest dose possible;
  • Avoid intravenous or injectable opioids in patients already taking opioid meds;
  • Do not replace "lost" or "stolen" opioid prescriptions;
  • Only prescribe a limited supply;
  • Use the state’s CURES database to determine if a patient is a drug seeker (Controlled Substance Utilization Review and Evaluation System).

Other high-risk opioids are Norco®,  Percocet® and Opana®.
In addition to L.A. County hospitals, those adopting the guidelines include UCLA Health, Providence Health & Services, Dignity Health, Memorial Care, Adventist Health, Daughters of Charity Hospitals and others. A total of 75 emergency departments signed on to the rules, according to the county.

"The goal is that if all ED’s follow the same guidelines and communicate the same message to patients, we can establish a consistent ED practice throughout the County that can help lead to reduce opioid overuse, abuse, diversion and ED and doctor shopping for pain medications," said Maureen McCollough, a doctor at the county's Olive View-UCLA Medical Center.

The rules are based on guidelines issued by the American Academy of Emergency Medicine in late 2013. The California Chapter of the American College of Emergency Physicians, San Diego and Imperial Counties and Kaiser Permanente had already adopted them. 

Kaiser, which adopted the guidelines in Jan. 2014, has been a leader in fighting opioid over prescription. It implemented the guidelines at all of its facilities and emergency departments, and it held classes for its physicians on the health risks of brand name opioids, and on how they can be diverted to family members or street sales.  The effort led to a huge drop in brand name prescriptions in favor of generics that have little, if any, street value.

The broader effort announced Friday began when Kaiser approached the county in late 2013 about working together on a countywide project, Gunzenhauser said. That led to the creation of the Los Angeles County Prescription Drug Abuse Medical Task Force about a year ago, an initiative that includes doctor and nursing groups, hospital associations, public health officials and community clinics.

The task force distributed the guidelines last July. The formal announcement of the effort was delayed until now because it took this long to educate emergency departments on what they need to do as they implement the rules - such as ensuring they can refer patients who need it to drug counseling. Health facilities have also been distributing fliers with the guidelines to patients.

While health officials want to greatly reduce the number of brand name opioid prescriptions, California has done well compared with other states. Last year a study by the Centers for Disease Control and Prevention found that California prescribes fewer opioid painkillers than any other state except Hawaii.  The study showed that in 2012 doctors in California wrote 57 opioid drug prescriptions for every 100 people. In several states the number was over 100.

The audio report accompanying this story was corrected on March 24, 2015. The original version misidentified the official quoted in the story.