Multilevel Intervention to Reduce Opioid Overprescribing and Opioid Overdose in Oregon

Background and Purpose:

The prescription opioid crisis in the United States continues to affect millions of people in both urban and rural regions. The complexity of the prescription opioid epidemic requires systems-level changes and state policy interventions. The Oregon Prescription Drug Overdose Prevention is a multilevel intervention being conducted by a partnership between the Oregon Health Authority, Portland State University, and health-related community based organizations. We describe a multilevel intervention delivered at the individual (i.e., prescribers), community (i.e., community work groups) and policy levels (i.e., prescribing guidelines; prescription drug monitoring programs; legislative changes) with the overall goal to decrease opioid overprescribing and opioid overdose in Oregon. 

Methods:

Mixed methods were used to evaluate the impact of the intervention. We conducted qualitative in-depth interviews with key stakeholders throughout the state. Prescription opioid prevention groups were organized in diverse regions of the state. Annual summits were also organized in different counties. We conducted systematic observation of these meetings, and conducted surveys to evaluate the impact of such gatherings. Key stakeholders also lobbied for legislative changes to health insurance programs and overdose rescue strategies. State health surveillance data and PDMD data were also used to evaluate the intervention.

Results:

Community: During the first year of the project, diverse community stakeholders responded to the calls to attend the different groups and summits.  These meetings were used to educate medical providers, counselors, police, tribal representatives, policy makers, and other community members. Policy: The state health insurance changed its policy to cover alternative treatments (i.e., acupuncture, chiropractor, etc.). Registration for PDMP was streamlined (e.g., more user friendly). Oregon law allowed lay people to carry and use Naloxone. Individual prescriber: prescribers receive up-to-date information on their prescription practices (from PDMP) and are offered evidence-based information regarding their clinical practice. During year 1 of the intervention, the number of prescribers enrolled in the PDMP increased by 29%. The number of PDMP queries increased by 11%. The number of opioid prescriptions filled decreased by 9%, and the number of risky prescribing (i.e., >120 MED) was reduced by 12%.

Conclusions and Implications:

The complexity of the prescription opioid overdose epidemic requires structural, multilevel interventions.  The preliminary results of the Oregon intervention are promising, and demonstrate that community members will rally around this problem if provided with the mechanisms and strategies to make changes. While overdose and mortality data for the past year are not yet available, the changes in PDMP use, law changes, and increased community engagement, all point towards a reduction of overprescribing, which in turn should result decreased overdoses.