Professionals discuss opioid epidemic


By Sue Cody


Opioid panel 1Waiting for a panel discussion, “The Opioid and Heroin Epidemic,” at a Jan. 26 Connect the Dots meeting in Astoria, it is impossible not to notice the happy, healthy-looking young man smiling from two large screens on either side of the room.


The young man is Jordan Strickland, we learn from his mother, Kerry. He died of a heroin overdose in 2015. “He was a kind, caring, happy-go-lucky kid,” she says. Jordan was a star athlete in Knappa, winning honors in football and baseball. He was 24 when he died. *


The story hits home for Clatsop County. “There is an epidemic of drug abuse in the county,” says Clatsop County District Attorney Josh Marquis, one of five people on the panel. “We have a standalone heroin problem. People are moving from opioids, such as oxycodone and hydrocodone to heroin.”


“Heroin is cheaper and the potency is through the roof,” he says.


Lisa Millet, of the Oregon Public Health Division, speaks about pain – emotional, physical and psychic pain. Over the last 15 years, use of opioids, including heroin, has become epidemic in Oregon, she says. When oxycodone and other opioids were introduced, they were thought to be the great new drugs, non-addictive. “They were prescribed to everyone,” she says.


“It’s like a tsunami in a big city,” Millet says as she projects an image on the screen of a big wave heading to a large metropolis. “It’s like trying to teach kids to swim in a tsunami.”


Being awash in opioids is partly the fault of prescribers, panel members say. Because they were thought to be non-addictive, opioids were liberally prescribed. Now there needs to be a paradigm shift, says John McIlveen, with the Oregon Health Authority.


“We need better agreement on how to address opioid addiction,” he says. “It is very complex, more complex than other drugs of abuse. You need treatment options for acute pain. Opioids have a place. They do what they’re supposed to do.”


But, studies have not proven opioids are effective for chronic pain, adds Safina Koreishi, medical director of the Columbia Pacific Coordinated Care Organization (CPCCO). It is imperative to get providers to write fewer prescriptions for opioids.


She showed an image from an old commercial of a doctor recommending smoking Lucky Strike cigarettes. “We are in the midst of a cultural shift, similar to that of cigarette use in the 20th century,” she says.


Elsewhere, Koreishi writes, “For decades the medical community, and the community at large have been told that chronic pain is not being treated effectively, and that opioid medications were a safe and effective option to treat pain. During this time, little attention was placed on the behavioral health components of chronic pain, or on the actual evidence regarding the benefit of opioids for chronic pain (which is lacking).


“In recent years, the medical community is learning about the pathophysiology of chronic pain and how this is fundamentally different from acute and terminal pain. We are learning that often chronic pain is rooted in issues related to anxiety, trauma and depression. We are also learning about the harm related to opioid prescribing, and how this can often lead to dependence, addiction and death.”


Marquis says, the county jail has become a drug asset, because when people are arrested they are screened for drug use, just to find out what drugs are in the community. “Now 18- to 30-year-olds are starting off with heroin,” he said.


Marquis said the county’s Drug Court helps because it offers treatment that can keep offenders out of jail if they stay clean and sober.


opioid panel 2Changes and treatment options


Oregon is now trying health system interventions, says Millet. One step removes methadone from the formulary, she says. It has been proven that opioids don’t help chronic pain. Now it is recommended that doctors prescribe lower doses and progress from chronic use to episodic use.


The opioid guidelines for the state to reduce overdose, misuse and dependency include:

• Reducing problematic prescribing practices

• Using the Prescription Drug Monitoring Program (PDMP) to assess high-risk behavior

• Providing reimbursement for non-opioid pain treatment therapies for chronic pain

• Implementing pharmacy opioid management strategies


Millet says it is time for all agencies to work together. Primary physicians and addiction care facilities have not worked together much in the past. She stresses that it is really important to coordinate and communicate with the health care system.


Koreishi says Columbia Pacific CCO has started a behavior-based pain clinic to help patients with chronic pain learn how to cope. The North Coast Pain Clinic, started in Clatsop County and because of the success of that model, has now spread to Tillamook and Columbia counties.


“CPCCO recognizes the relationship between opioid prescribing and addictions,” writes Koreishi. “We have sponsored a detox center, called Pathways, in Columbia County, to help patients who need this vital service. This center is being under-utilized, and we truly hope that those who need it access the service. There is no referral necessary. We are also exploring methods to increase the availability of medication assistance treatments within our CCO.”


Talk to children and friends, “The more and more it percolates through the community, the better,” Koreishi says. “Everybody is responsible.”


* A comprehensive article about Jordan Strickland’s journey is available on the Way to Wellville website



• Josh Marquis, Clatsop County district attorney

• Kerry Strickland, Clatsop County parent

• Lisa Millett, Oregon Public Health Division, State Prescription Drug Monitoring Program, Overdose EPI/Injury and Violence Prevention

• Dr. John McIlveen, PhD, LMHC, Oregon State Opioid Authority, Operations & Policy analyst, manager/Health Professionals Service Program

• Dr. Safina Koreishi. MD, MPH, medical director Columbia Pacific CCO