Kaiser program leads to huge reduction in Vicodin and Oxycontin prescriptions
Much of the recent attention on the nation’s prescription drug epidemic has focused on corrupt or negligent doctors. But there’s another significant problem in the medical community -- many physicians are routinely prescribing powerful drugs like Vicodin and Oxycontin because they don’t know how addictive and dangerous they can be.
A two-year program at Kaiser Permanente has drastically reduced the number of prescriptions for these brand name drugs by teaching front-line doctors how to safely prescribe pain medication.
The Centers for Disease Control and Prevention says since 1999, the number of prescription drug deaths nationwide has more than tripled.
That drama is playing out in communities across the country. Every day, about a hundred calls come into the Action Family Counseling drug treatment center in the Santa Clarita Valley. Most are pleas for help in kicking addictions to prescription pain killers that are frequently turning deadly.
"We’re having an explosion of opiates – heroin and pain killers," says ACTION founder Cary Quashen. "In fact last year we had 15 deaths, but then Simi Valley, La Canada, Pasadena – it’s everywhere."
Quashen, who also is the head of behavioral health at the nearby Henry Mayo Newhall Memorial hospital, says teens and young adults get hooked on mom and dad’s supply. Once that dries up, youngsters turn to the streets, where the price tag for one brand-name pill can run between $80 and $100.
"They’re spending a lot of money when really all they have to do is smoke a little bit of heroin; for a fraction of the cost they’re getting the same exact high," says Quashen.
The skyrocketing number of heroin addicts among affluent teens who start first with prescription pain pills is disconcerting for doctors, such as family practitioner Elian Paiuk.
"The tension we’re always under is to make sure we’re helping to relieve their suffering but that we’re not doing something that will cause harm," says Paiuk.
Paiuk practices at Kaiser Permanente in Panorama City. He says during his medical school training in the late 1990s, patient advocates and even the California legislature were among those pushing doctors to provide something more for patients’ pain.
"Pain became the fifth vital sign along with blood pressure and pulse," says Paiuk, "and we were supposed to be paying more attention to it. And that was actually reinforced very heavily during my training that we needed to actually prescribe more pain medication."
It seemed to be a rationale response to a medical culture that most agreed did not treat pain enough. But then things spiraled out of control. Dr. Steven Steinberg is regional chief of family medicine at Kaiser Permanente Southern California. He co-founded what may be the nation’s first large-scale effort to reduce prescriptions of brand name narcotics. Steinberg says it was an idea that was born almost by accident, two years ago, when he and a colleague began looking into Kaiser doctors’ prescribing patterns.
"We got this report and number one we saw a giant spike of usage [of] Oxycontin," says Steinberg.
Vicodin prescriptions, too, were sky-high – and not just at Kaiser. Steinberg says the pressure on doctors to provide better pain care to patients collided with a nationwide marketing push by drug companies to doctors and hospitals.
A perfect storm resulted, and before long, he says, bottles of these powerful pain pills became nearly as commonplace as Tylenol, in medicine cabinets and in student backpacks.
"So our first mission was, we want to stop the drugs than can basically be resold into our schools," Steinberg recalls. "Stopping Vicodin was number one, stopping Oxycontin was number two."
Steinberg and his colleagues began carrying out their mission through a program that teaches Kaiser doctors how to safely prescribe pain medication. They learn facts about narcotics often overlooked in med school and residency.
They learn that these popular pain pills are – milligram for milligram – as potent as morphine; that above 120 milligrams a day, they can lead to addiction and death; and that the bigger the bottle of pills, the more likely they’ll be shared with family and friends or diverted to street sales, and into the hands of teens. Steinberg says two years into his program, it seems to be working.
"And what we’ve seen is about a 75 to 80 percent reduction in the prescribing of brand name Oxycontin within Kaiser Permanente," he says. "It represents a significant decrease in the amount of Oxycontin that’s floating around southern California."
Steinberg says Vicodin prescriptions, too, are down - by a whopping 95 percent. Kaiser doctors are now more likely to offer patients generic prescriptions that have little, if any, street value, as well as alternative treatments such as physical therapy.
Kaiser’s Dr. Pauik is a graduate of Steinberg’s training. Among the takeaways he now employs: limiting patients to one-month supplies of strong painkillers.
"That way we have the patient coming back more frequently," says Paiuk, "and if there’s a problem starting to come up , we catch it must faster because there’s only one month of pills at a time and it reduces the amount of pills in circulation at any given time."
Paiuk and Steinberg say they know of no other program that’s similarly aimed at the national prescription drug epidemic. They say the training can easily be adopted by most any medical practice. Those who treat addiction say there’s no time to lose.
"In this country, every 19 minutes somebody is dying from a drug overdose," says Cary Quashen. "We really better get a curb on this fast because we’re losing too many of our kids."
The CDC says that in 2010, 12 million people reported using prescription pain pills for something other than their intended purpose, and the most recent CDC data show that overdoses from such abuse claim nearly 15,000 lives a year.