Mid-Willamette Valley PAIN SUMMIT

summit highlightsOVERVIEWThe Oregon Coalition for the Responsible Use of Meds (OrCRM) and Oregon Health Authority (OHA) are working in partnershipto tackle the opioid crisis through community and prescriber education, encouraging implementation of CDC prescribingguidelines, promotion of non-opioid pain management strategies, improved access to addictions treatment services andnaloxone for overdose rescue and strategies for safely discarding unused medication. The complexity of this crisis requirescoordinated medical, behavioral, legislative and educational policy changes. All stakeholders need to be engaged and alignedif we are to prevent future opioid dependence and support the recovery of those already dependent. OrCRM’s regionalsummit model is based on the concept that communities succeed when they engage all stakeholders and work together tocreate action plans to address opioid abuse, misuse and overdose through system level change. To effectively engage thesedifferent actors, summit sessions focus on each core element essential to reducing opioid abuse.PLENARY SESSIONThe Plenary Session is an opportunity to hear from experts in the field on ways to build health system and communitystrategies for safe pain management. Speakers will present information on preventing opioid use and abuse, current bestpractices concerning the treatment of non-cancer chronic pain, strategies for providing compassionate care, systematic useof PDMP by providers and their delegates, improved access to non-opioid pain treatment options and ideas for solving thisproblem as a community.8:15 – 11:15 AM4 ”Why do so many people use drugs?What should we do?”David Labby, MD, PhD, Oregon Health ShareDr. Labby will discuss the epidemiology of the opioid epidemicin Oregon and the United States. He will look at emergingevidence on the social determinants of opioid use and thevariety of strategies that are needed to address the epidemic.Community response is vital and Dr. Labby’s presentationwill set the stage for the day as we seek to understand what itwill take to build a coordinated effort in the Mid-Valley region.4 The Team-Based Opioid Refill Clinic Salem Health Medical Group Pain ManagementClinic Team:Paul Coelho, MD,Ana Ramirez, CMA, Melanie Nixon, CMA,Heather Hawkins, MSW, LCSW,Joshua Steenstra, MBA, MHAThe Salem Health panel will briefly review traditional opioidpain management and then introduce participants to theSalem Health approach to pain management with their TeamBased Opioid Refill Clinic. Areas covered include: keepingthe primary focus on outcomes patients care about, aspecialty clinic by referral only, administrative support, usingCDC guidelines, structured processes and communicatingclear expectations.MID-WILLAMETTE VALLEY PAIN SUMMIT SEPTEMBER 22, 20174 S cience over Stigma: The Neurobiologyof Substance Use DisordersRachel Solotaroff, MD, Central City ConcernDr. Solotaroff will demystify substance use disordersby describing the neurobiological basis of the disease,grounded in the experience of a primary care patient.Her presentation will help participants: understand thealignment between the neurobiology of addiction and pain(and trauma); and provide sample strategies for enhancinghealing in addiction and persistent pain.4 S tate of the State: Statewide Initiativesto Reduce Rx AbuseMary Borges, Oregon Public Health DivisionDrew Simpson, Oregon Public Health DivisionMary and Drew will address the impact of the opioidepidemic in Oregon and how statewide organizations and theOregon Coalition for the Responsible Use of Meds (OrCRM)are working with the Oregon Health Authority (OHA) to tacklethis crisis through community and prescriber education,encouraging use of CDC prescribing guidelines, promotion ofnon-opioid pain management strategies, improved access toaddictions treatment services and naloxone and strategiesfor safely discarding unused medication.Summit Highlights 7

summit highlights11:15 – 12:30 AMMORNING BREAK OUT SESSIONSThe complexity of the opioid crisis requires coordinatedmedical, behavioral, legislative and educational policychanges. All stakeholders need to be engaged and aligned ifwe are to prevent future opioid dependence and support therecovery of those already dependent. To effectively engagethese different stakeholders, the summit includes breakoutsessions in the morning and afternoon focused on each coreelement essential to reducing opioid abuse.The sessions provide an overview by subject experts,followed by facilitated discussion and action planning toidentify barriers and best practices and help stakeholdersform core strategies to increase the community’s readinessto act. Action planning includes identification of regionspecific action steps in Marion, Polk and Yamhill countiesthat are in alignment with the OHA’s Prescription DrugOverdose (PDO) work plan, health system and communityinitiatives to reduce opioid abuse and overdose. At the endof the day, participants will come back together to report ontheir findings, develop a comprehensive list of action stepsand identify commitments and champions that will driveimplementation after the summit.BETTER PAIN MANAGEMENTReducing the risks to patients by making pain treatmentsafer and more effective must emphasize non-opioid andnon-pharmacological treatment. Effective strategies include:better access to effective & safer alternatives to opioids forpain treatment; increasing benefit coverage and availabilityof alternative treatment services; better provider educationon acute and chronic pain; and best practices for safer paintreatment. Underlying each of these key strategies is the needto educate the public about the problem by focusing effortson: better understanding about pain and opioids; risks anddangers of Rx; safe medication storage and disposal; andunderstanding Oregon’s opioid abuse problem through datacollection and monitoring.8 Summit Highlights4 R ecovery-Oriented Persistant PainManagement: Tools for the PrimaryCare TeamRachel Solotaroff, MD, Central City ConcernDr. Solotaroff will discuss the concept of a “recovery-oriented”approach to addressing persistent pain and provide samplesof teaching tools and pain phrasing for clinicians and staff.She will also describe a Pain Care Management Pathway foruse in the primary care setting.4 P ain School Models: Current Initiativesin Oregon Mark Altenhofen, MS, Oregon Pain AdvisorsMark will share his pain school model that seeks to supportthe development of patient centered integrated painmanagement practices based on a biopsychosocial model ofcare. Mark’s presentation will help participants; understandthe key movement, behavioral, and cognitive strategiesutilized in pain school curriculum; learn about successfulintegration of pain school and peer to peer models in theState of Oregon; and understand the barriers to patientengagement and access to these models.4 A CTive Living with Chronic Pain: ATreatment Approach Using Acceptanceand Commitment Therapy (ACT) David C. Brillhart, PsyD, Mid-Valley Pain ClinicDr. Brillhart will review and discuss how ACT differs fromtraditional CBT (Cognitive Behavioral Therapy) in thetreatment of chronic pain; Case conceptualize chronic painthrough the ACT Matrix; and Clarify ACTive living with chronicpain.SEPTEMBER 22, 2017 MID-WILLAMETTE VALLEY PAIN SUMMIT

summit highlightsREDUCING THE NUMBER OF PILLS INCIRCULATIONA state and regional focus on approaches for reducing theoverall number of pills prescribed must include improvementsto health system practices. Effective strategies include:better implementation of safe opioid prescribing guidelinesin health systems and clinics; better use of PDMP in healthsystems and clinics to improve monitoring and safety; andbetter access to safe drug disposal by expanding pharmacybased disposal programs. Underlying each of these keystrategies is the need to educate the public about theproblem by focusing efforts on: better understanding aboutpain and opioids; risks and dangers of Rx; safe medicationstorage and disposal; and understanding Oregon’s opioidabuse problem through data collection and monitoring.4 D ata Driving Results: ColumbiaPacific COO’s Approach to ImprovingPrescribing Safina Koreishi, MD, MPH, Columbia Pacific CCODr. Koreishi and her Columbia-Pacific team will share theireffective approach for improving prescribing. The team willhelp participants understand their team approach includinghow to monitor and hold prescribers accountable for followingstandards through clinic dashboards; and to create supportfor teams as they strive to manage and problem solve cases,share data and involve patients in the design of their plans.4 O pioid Reduction Initiative for SurgicalPatients at Kaiser Permanente David Parsons, MD, Kaiser PermanenteDr. Parsons will provide information and discuss how KaiserPermanente achieved opioid reductions for surgical patientsby: developing a progressive plan to reduce all patients toMED 90; no new starts of long-acting opioids; removingOpana and Oxycontin from the formulary; eliminatingconcurrent opioids and benzodiazepines; setting goal ofinitial prescribing of no more than 2 weeks supply post-opopioids; and goal of 45-day limit post-op opioids.MID-WILLAMETTE VALLEY PAIN SUMMIT SEPTEMBER 22, 20174 M edical Student Perspective ofReducing the Number of Pills inCirculationJonathan Robbins, MD, Oregon Health SciencesUniversityKatherine Fisher, DO, Western University of HealthSciencesMax Taylor, Matt White and Jessica HU, WesternUniversity of Health Sciences Medical StudentsDr. Robbins from OHSU and Dr. Fisher from Western Universitywill speak to the training of medical students on use of opioids,prescribing practices and efforts to increase the number ofdoctors waivered to prescribe and dispense buprenorphinefor opioid dependency treatment. Western University ofHealth Science Medical students will also present resultsof a 6 question survey sent out to classmates about whattrends they have seen on their clinical rotations in regards toopioid prescribing and how they see this affecting their ownprescribing habits in the future.EXPANDING ACCESS TO TREATMENTExpanding access to treatment is an essential, evidencebased strategy to reduce opioid abuse, misuse an overdose.The elements of expanded access include: better accessto substance use disorder treatment by removing barriersto treatment and medicated-assisted treatments; bettercoordinated care by integrating behavioral health servicesinto primary care; and better and wider naloxone distributionfor overdose rescue through pharmacies, first responders,social service organizations and others. Underlying each ofthese key strategies is the need to educate the public aboutthe problem by focusing efforts on: better understandingabout pain and opioids; risks and dangers of Rx; safemedication storage and disposal; and understandingOregon’s opioid abuse problem through data collection andmonitoring.Summit Highlights 9

summit highlights4 P romoting Wide Deployment ofNaloxone to Reduce the Number ofOverdose Deaths Speaker: Kim Toevs, MPH, Adolescent HealthMultnomah CountyApryl Herron, MPH, Public Health ClackamasCountyKristen Watson, Clackamas CountyFiona Kabowicz, R.PH, Oregon Board of PharmacyKim will share the deployment of Naloxone in MultnomahCounty and increase participant: understanding of lessonslearned from Portland metro area about a communitydistribution model of Naloxone use for opioid overdoseprevention; familiarity with recent changes in Oregonlegislative policy and how they reduce barriers to Naloxoneprogram implementation and partnerships.Apryl and Kristen will cover the deployment of Naloxonein Clackamas County with a targeted focus on the inmatepopulation. The speakers will: discuss the process andtools needed to implement a Naloxone overdose preventionprogram for inmates post-release; and share informationand data to support naloxone distribution among thosetransitioning from jail back into the community.Fiona will provide a brief perspective on pharmacist provisionof Naloxone, current DEA opioid manufacturing guidelinesand the legalities of drug take back program. Ms. Karbowiczwill provide an overview of Oregon’s 2016 HB 4124 andthe Administrative Rules associated with pharmacy andpharmacist provision of Naloxone, discuss the DEA’sAggregate Production Quota (APQ) of opioid manufacturingin 2017, and highlight federal laws and state rules related toDrug Take Back initiatives.2:00 – 3:30 PMAFTERNOON BREAK OUT SESSIONSBETTER PAIN MANAGEMENTtreatment. Underlying each of these key strategies is the needto educate the public about the problem by focusing effortson: better understanding about pain and opioids; risks anddangers of Rx; safe medication storage and disposal; andunderstanding Oregon’s opioid abuse problem through datacollection and monitoring.4 Keeping the Opioid Naïve, Naïve Speaker: Paul Coelho, MD, Salem HospitalJonathan Robbins, MD, Oregon Health SciencesUniversityKatherine Fisher, DO, Western University of HealthSciencesJacob Leroux, Derek Titus and Nam Nguyen,Western University of Health SciencesDr. Coelho, Dr. Robbins and Dr. Fisher will discuss centralsensitization and the limitations of opioids for treating noncancer pain. They will present information on how to identifythe common features of the “Central Pain” type; use of thePain Catastrophizing Scale and Fibromyalgia screening tool ;and discuss how to avoid opioids in central pain syndromes.Western University Medical students will also present on howto score the FSQ and the PCS and then ICD-10 code both.REDUCING THE NUMBER OF PILLS INCIRCULATIONA state and regional focus on approaches for reducing theoverall number of pills prescribed must include improvementsto health system practices. Effective strategies include:better implementation of safe opioid prescribing guidelinesin health systems and clinics; better use of PDMP in healthsystems and clinics to improve monitoring and safety; andbetter access to safe drug disposal by expanding pharmacybased disposal programs. Underlying each of these keystrategies is the need to educate the public about theproblem by focusing efforts on: better understanding aboutpain and opioids; risks and dangers of Rx; safe medicationstorage and disposal; and understanding Oregon’s opioidabuse problem through data collection and monitoring.Reducing the risks to patients by making pain treatmentsafer and more effective must emphasize non-opioid andnon-pharmacological treatment. Effective strategies include:better access to effective & safer alternatives to opioids forpain treatment; increasing benefit coverage and availabilityof alternative treatment services; better provider educationon acute and chronic pain; and best practices for safer pain10 Summit HighlightsSEPTEMBER 22, 2017 MID-WILLAMETTE VALLEY PAIN SUMMIT

summit highlights4 D ental Literacy: Responsible OpioidPrescribing - Dental Handout/ToolkitGary Allen, DMD, MS, Advantage DentalDr. Gary Allen will discuss the scope of the problem and the roleof dentists to decrease the opioid epidemic. Dr. Allen will providerecommendations for providers on how to manage acute dentalpain though guidelines and other professional practices.4 House Bill 3440 and the PDMPDrew Simpson, Oregon Public Health DivisionDrew will provide information on how to access and interpretdata from the Prescription Drug Monitoring Program (PDMP).The PDMP is a tool to help healthcare providers and pharmacistsprovide patients better care in managing their prescriptions.Drew will also discuss passing of House Bill 3440, whichremoves special training requirements from governingprescribing, dispensing and distributing naloxone; and createsa Prescription Monitoring Program Prescribing Practices ReviewSubcommittee.4 C onsumer Drug Take-Back in a HospitalBased Retail PharmacyJoseph Schnabel, Pharm.D, BCPS, Salem HealthJoseph Schnabel will provide an overview of the ConsumerDrug Take-back program at Salem Health. Participants willunderstand: the regulatory changes that enable consumerdrug take-back programs to be more widely available; theconsumer drug take-back registration process with DEA andBofP, and understand the benefits of having a consumerreceptacle in your pharmacy.EXPANDING ACCESS TO TREATMENTExpanding access to treatment is an essential, evidencebased strategy to reduce opioid abuse, misuse an overdose.The elements of expanded access include: better accessto substance use disorder treatment by removing barriersto treatment and medicated-assisted treatments; bettercoordinated care by integrating behavioral health services intoprimary care; and better and wider naloxone distribution foroverdose rescue through pharmacies, first responders, socialservice organizations and others. Underlying each of these keystrategies is the need to educate the public about the problemby focusing efforts on: better understanding about pain andopioids; risks and dangers of Rx; safe medication storage anddisposal; and understanding Oregon’s opioid abuse problemMID-WILLAMETTE VALLEY PAIN SUMMIT SEPTEMBER 22, 2017through data collection and monitoring.4 Treatment Gap AnalysisJohn McILveen, PhD, LMHC, Oregon HealthAuthorityJohn McILveen will explore “What does data tell us?” anddiscuss the need to bridge the treatment gap betweenaddictions, mental health and comprehensive painmanagement.4 E arly Warning Systems - Using Data asLinkage to TreatmentDagan Wright, PhD, MSPH, Public Health DivisionDagan Wright will present information about the OregonEMS Information System (OREMSIS), a Secure andProtected Health Information Exchange and Reportingfor Improved Care and Outcomes. This system providesclose to real time patient records within minutes of anevent. The Oregon EMS Information System providesdata and tools for: performance improvement, healthcareworker safety, public health investigations and crises, andcan securely push and pull information with other healthinformation systems.4 U sing Social Media to Reduce Stigmaand Increase AccessTim Murphy, Bridgeway Recovery ServicesMarion County has made successful strides in reducingstigma and increasing acc

Salem Convention Center, Salem Oregon Friday September 22nd, 2017 Mid-Willamette Valley PAIN SUMMIT. SEPTEMBER 22, 2017 MID-WILLAMETTE VALLEY PAIN SUMMIT Thank you to summit sponsors and recognition of planning team. . MID-WILLAMETTE VALLEY PAIN SUMMIT SEPTEMBER 22, 2017