Why Opioid Safety?

Opioid analgesics are currently responsible for more deaths in the U.S. than the number of deaths from both suicide and motor vehicle crashes combined. Overdose deaths from prescribed medications exceed those from illicit substances including  cocaine and heroin. This trend is mirrored by the rise in per capita prescribing and dispensing of pain medications by licensed physicians.

Opioids, natural and synthetic forms of opium widely used as painkillers, include hydrocodone (Vicodin or Norco), oxycodone (Percocet or Oxycontin), fentanyl, codeine, morphine, and methadone. As a result of misleading claims from pharmaceutical companies and consumer demand, clinicians have underestimated the risks of addiction and prescribed opioids for more conditions, longer durations, and higher doses than at any other time in the past. Communities and health centers in RCHC’s four-member counties are significantly impacted by this national epidemic.

PROGRAM

What We Do

The epidemic is taking its toll in local communities throughout Marin, Napa, Sonoma, and Yolo counties. Local coalitions have been shown to be effective by uniting health care providers, health plans, public health advocates, victims, and concerned citizens to take action. Together we can change how pain is managed and still treat people in pain.

Guidelines and Protocols

Clinical Decision Support

Under Development

Promising Practices

Under Development

Trainings

RCHC Training Calendar

Interventions

The Collaborative Action for Opioid Safety Project, sponsored by the California Health Care Foundation for 2016-2017, has focused on three interventions:

a) Support safe prescribing practices through the development and implementation of common opioid prescribing guidelines among primary care provider and hospital emergency departments in Sonoma County

b) Expand access to buprenorphine treatment for health center patients in Yolo, Napa, Marin and Sonoma counties including induction and maintenance

c) Develop policies, procedures and funding options to assure access to naloxone for opioid overdose prevention for high risk Partnership Health Plan managed care Medi-Cal patients.

RCHC has  convened a Substance Use Disorder Services workgroup that meets every other month for health centers to continue progress in implementing Medication Assisted Treatment (MAT) programs across the network.

Who We Serve

Health Center prescribers, staff and patients.

Funders

This project is funded by California Health Care Foundation (CHCF).

Project Timeline

November 2016 – June 2017

Measures

Process Measures Outcome Measures
# health care organizations providing primary care in Sonoma County implementing  common opioid prescribing guidelines Decreased number of new opioid prescriptions in member health centers
# Sonoma County hospital emergency departments implementing common opioid prescribing guidelines
Guidelines for buprenorphine/naloxone (Suboxone) treatment adopted by RCHC medical directors Increase number of health center patients receiving buprenorphine treatment across Marin, Napa, Sonoma and Yolo counties
# of RCHC health center providers with DATA 2000 Waiver (X license)
# of RCHC health centers with procedures and workflows in place for co-prescribing  naloxone overdose prevention

PERFORMANCE/RESULTS

Baseline Performance

In May 2016, RCHC health centers reported 29 waivered physicians with their “X” license treating approximately 140 patients with buprenorphine-naloxone.

Survey results from  May 2017 indicated a total of 58 RCHC providers with X license, a 50% increase from one year earlier. This number now includes eight NPs and PAs, which are now eligible for the waiver.  A total of 575 of health center patients were receiving buprenorphine treatment across the network as of May 2017.

PROJECT PARTNERS

Health Centers:

  • Alexander Valley Health Center
  • Alliance Medical Center
  • Coastal Health Alliance
  • CommuniCare Health Centers
  • Marin City Health and Wellness
  • Marin Community Clinics
  • OLE Health
  • Petaluma Health Center
  • Ritter Center
  • Santa Rosa Community Health Centers
  • Sonoma County Indian Health Project
  • Sonoma Valley Community Health Center
  • West County Health Centers
  • Winters HealthCare Foundation

Strategic Partners:

  • Sonoma County Department of Health Services
  • Partnership HealthPlan of California (PHC)
  • California Health Care Foundation (CHCF)

Evaluation Assistance:

  • California Health Care Foundation (CHCF)

PROJECT CONTACT

For more information, please contact Michelle Rosaschi.

ALIGNMENT WITH OTHER INITIATIVES

  • Behavioral Health Integration
  • Complex Care Integration

ADDITIONAL RESOURCES AND COMPANION DOCUMENTS