A driving force for health equity

EPICENTER - An OHSU and OCHIN Study on Opioids and the Safety Net Population

By Dagan Wright, PhD, MSPH and the EPICENTER team

OHSU Department of Family Medicine and OCHIN are beginning work this fall on a ground-breaking five-year National Institutes of Drug Abuse (NIDA) funded project examining opioid prescribing in community health centers.

Opioid abuse and dependency is ravaging individuals, families and communities in the United States. During 2015, more than 33,000 people died from an opioid overdose, with nearly half involving prescribed medications. From 1999 to 2016, over 197,000 people died from overdoses related to prescription opioids. In addition to the health consequences, recent data suggests a diminished and negative workforce participation rate driven by the opioid epidemic. Beginning in 2014, the CDC added opioid overdose prevention to its top five public health challenges.

The causes of this problem are complex, but three factors are especially pertinent: 

1)      Chronic pain is common, and difficult to treat. More than 30% of adult Americans have some form of acute or chronic pain, and more than 40% of older adults experience chronic pain.  In the mid-1990s, a professional standard of care took place liberalizing use of opioids for chronic, non-cancer pain. Between 1999 and 2010 sales of opioid pain medications quadrupled with little evidence of improvement in pain symptoms, but with a concomitant increase in the incidence of opioid overdose deaths in our population.

2)      While opioid addiction and overdose occurs through all demographics, it disproportionately affects those of low socio-economic status.  Yet, little is known about drivers of chronic opioid prescribing among vulnerable populations, especially among the 11% uninsured and/orhomeless.

3)      Patients receive prescriptions for opioids in many settings, but most long-term prescribing is managed by primary care clinicians.

The purpose of the study is to understand factors associated with problematic use of opioid pain prescriptions in the OCHIN collaborative of community health centers. In addition to information contained within the electronic health records, community level information (such as poverty, population health characteristics) will be linked using geographic information system-matched data.

Aim 1: Describe opioid prescribing trends in the safety net/community health centers and compare them with national trends.

Aim 2: Assess the relationship between chronic opioid treatment and multilevel variables including patient-level demographics (race/ethnicity, sex, percent of federal poverty level, etc.), diagnoses, community-level social determinants of health and clinic level factors (size, location, provider type) in the safety net setting.

The study population within the OCHIN collaborative will be those ages 18 years and older, who have had one or more visits to an OCHIN clinic between January 1, 2009 to December 31, 2018.

Evidence-based resources that address what can be done now:

Center for Disease Control and Prevention (CDC) based information sources:

1)      In 2018, the CDC releasedmultilevel, evidence-based guidance for all to follow, in order to help prevent opioid overdose, titled “Evidence-Based Strategies for Preventing Opioid Overdose: What’s working in the United States.”

2)      In 2016, the CDC released prescribing guidelines titled, “CDC Guideline for Prescribing Opioids for Chronic Pain.“

Behavioral Health and learning collaborative resources called NIATx:

1)      Key guides include Medication-assisted Treatment Fact Sheets, Buprenorphine Implementation Toolkit, and many other NIATx toolkits along with “Promising Practices.”

OCHIN and OHSU look forward to sharing results with OCHIN members and the nation, to be used for evidence-based management and prevention of opioid overdose.

Please contact Dagan Wright, OCHIN Research Informatics Scientist, with any questions.