CONTRIBUTED

The use and abuse of prescription pain medications has increased markedly in the past 10 years.

During this period, sales of pain relievers quadrupled. Enough pain relievers were prescribed in 2010 to medicate every American adult with 5 mg of hydrocodone, taken every four hours, for an entire month, according to a news release from Community Care of the Sandhills.

Pain relievers prescribed legally for acute or chronic pain are frequently diverted for nonmedical use by patients or friends or are sold on the street. Likewise, the number of deaths from overdose of such medications has increased at a rate that is quickly approaching the number of deaths from motor vehicle accidents.

North Carolina has one of the highest rates nationally, and almost all of these deaths involved prescription pain relievers, such as methadone, oxycodone, fentanyl and morphine. Such abuse of pain relievers costs the U.S. health care system $72.5 billion annually.

To address this crisis, Community Care of the Sandhills (CCS) is implementing the chronic pain initiative, an effort that seeks to provide clinically appropriate pain relief for patients suffering from chronic pain. The initiative includes a broad partnership between CCS, the N.C. Hospital Association, local hospitals and emergency departments, health departments, primary care physicians, faith-based programs and local law enforcement agencies.

CCS is one of 14 networks participating in a statewide health care quality improvement strategy titled Community Care of North Carolina (CCNC). With the goal of enhancing health care quality, increasing efficiency, improving patient safety and lowering costs, CCS is a local nonprofit network serving more than 65,000 N.C. Medicaid enrollees in Harnett, Hoke, Lee, Montgomery, Moore, Richmond and Scotland counties.

Fred Wells-Brason II is the project director for the chronic pain initiative and is also president and CEO of Project Lazarus. The initiative is modeled after Project Lazarus, Brason's highly successful overdose prevention program in Wilkes County - an area where overdose death rates were among the nation's highest.

Since its inception, Project Lazarus has resulted in a decreased overdose death rate, a lower substance abuse-related hospital emergency department admission rate, improved emergency room approaches to reversing respiratory depression due to opioid toxicity, as well as encouraging the area's local hospital to change its emergency department policies around narcotic prescribing. It also established discharge planning policies that more effectively manage pain control.

To further promote community involvement toward this initiative, CCS is partnering with Southern Regional AHEC (Area Health Education Center) to host a meeting Thursday at the Cole Auditorium, Richmond Community College.

The meeting will be held for hospitalists, area physicians, physician assistants and nurse practitioners to learn more about proper chronic pain management of patients.

Brason will speak with health care providers and present opioid abuse and overdose statistics in both Richmond and Scotland counties - areas among the state's highest in unintentional poisoning deaths, as well as rates of outpatient dispensed prescriptions for controlled substances. He will also discuss approaches to promoting greater awareness in the community.

"Chronic pain is difficult to monitor, so it's a top concern among many primary care providers these days," Brason says. "Providers tend to worry about the potential for addiction to pain meds, and separating patients with bona fide pain from those with substance abuse issues can be an ongoing and complex process."

However, the problem does not appear to be the result of a lack of resources. A recent report published by the Institute of Medicine suggests that the U.S. may be spending as much as $635 billion annually to treat chronic pain - a condition that impacts more patients in the U.S. than heart disease, cancer and diabetes combined, according to a CCS news release.

To better share information between health care stakeholders, Brason also encourages authorized prescribers to participate in the N.C. Controlled Substances Reporting System, established to improve the state's ability to identify people who abuse and misuse prescription drugs classified as schedule II-V controlled substances.

CCS care managers are also working with local hospital emergency department staff to coordinate care for chronic pain patients and facilitate referrals for appropriate treatment of the underlying causes of chronic pain. CCNC's integrated care model is well-positioned to offer such an evaluation and support for addressing the complexities of pain management, the release said.

At the system level in practices and emergency departments, the chronic pain initiative outlines models to use and processes to follow in the development of a best practice model for a pain management program. It also provides safe and respectful evaluation and treatment for the individual with pain symptoms.

"Statistics report that several of the network's counties have some of the highest rates of prescription drug abuse and misuse," says Leah Terrell, CCS network pharmacist. >"We want to actively encourage a better understanding among medical providers and the public of the appropriate use of controlled substances." >

Prior to working with CCS, Terrell served with Brason on the N.C. Medicaid Controlled Substances Task Force. As the CCS pharmacist, Terrell is responsible for development of programs to impact patients and physicians use of medications.

In addition to working with CCNC to promote the chronic pain initiative, Brason serves on the SAMHSA/CSAT Emerging Opioid Overdose Surveillance Group and is a member of the N.C. Division of Medical Assistance Task Force for the misuse, abuse and diversion of prescription narcotic drugs.

He is also a member of the National Association of Drug Diversion Investigators (NADDI), and serves on the Advisory Board for the N.C. Controlled Substances Reporting System. He co-chairs the SAMSHA/ASTHO/NASADAD expert panel for publication of the opioid prescriber toolkit.

CCS will host future meetings at other area hospitals to further coordinate the medical communities' involvement on opioid use and abuse.

"I look forward to talking and working with those who want to take an active stand against the misuse of opioid medications," Brason says. "As long as there is a need, we will continue to promote and encourage this initiative."

To learn more about Brason or Project Lazarus, visit http://www.projectlazarus.org. To learn about Community Care of the Sandhills, call at (910) 246-9806.