ATrain Education

 

Continuing Education for Health Professionals

OR: Pain, Healthcare's Persistent Challenge, 6 units

Module 4

Oregon Pain Management Programs

The Oregon legislature has taken a number of positions on the treatment of pain, including establishing the Oregon Pain Management Commission, the Oregon Prescription Drug Monitoring Program, the Oregon Medical Marijuana Act, the Oregon Pain Guidance Group, and further medical and nursing policy statements.

Oregon Pain Management Commission

The Oregon Pain Management Commission (OPMC) was established to improve pain management in Oregon through education, pain management recommendations, research, policy analysis, and model projects. The Commission relates the concerns of patients in Oregon on issues of pain management to the Governor and the Legislative Assembly (OHA, 2015).

Most licensed healthcare professionals practicing in Oregon are required to take a comprehensive course on pain management. The pain management continuing-education requirement, which went into effect on January 1, 2006, includes six hours of coursework on a variety of pain topics and an additional one-hour requirement provided by the Oregon Pain Management Commission.

Currently, physicians who continually treat patients in chronic or terminal pain must complete a pain management education program for relicensure. In addition, physician assistants, nurses, psychologists, chiropractic physicians, naturopaths, acupuncturists, pharmacists, dentists, occupational therapists, and physical therapists licensed in Oregon must complete a pain management continuing-education course (OHA, 2015).

Oregon Prescription Drug Monitoring Program (PDMP)

The Oregon Prescription Drug Monitoring Program (PDMP) is a state-run, electronic database used to track the prescribing and dispensing of controlled prescription drugs to patients. It is designed to monitor suspected abuse or diversion (the channeling of the drug into an illegal use) by providing a prescriber or pharmacist with critical information regarding a patient’s prescription history. This information helps identify high-risk patients who would benefit from early interventions (CDC, 2016a).

Oregon’s prescription drug monitoring program (PDMP) was established in July 2009. In 2015 Senate Bill 71 was signed into law, which requires pharmacies to report data electronically no later than 72 hours after dispensing a prescription drug that is subject to the prescription monitoring program (OPDMP, 2016).

Pharmacies are required to submit prescription data to the PDMP system for all Schedules II, III and IV controlled substances dispensed to Oregon residents. The protected health information is collected and stored securely. Only Oregon-licensed healthcare providers and pharmacists are authorized to access information from the PDMP system. By law their access is limited to patients under their care.

During 2015 more than 7.5 million controlled-substance prescriptions were reported to the Oregon PDMP. The top 12 prescribed drugs were:

  1. Hydrocodone (22.3%)
  2. Oxycodone (16.6%)
  3. Zolpidem (5.7%)
  4. Lorazepam (5.7%)
  5. Tramadol (5.4%)
  6. Alprazolam (4.7%)
  7. Amphet ASP/AMPHET/D-AMPHET (4.5%)
  8. Clonazepam (4.5%)
  9. Methylphenidate (3.4%)
  10. Pseudoephedrine (3.4%)
  11. Morphine (3.3%)
  12. Diazepam (2.3%) (OHA, 2015)

Oregon Medical Marijuana Act

In 1998 Oregon voters approved Measure 67, which removed state-level criminal penalties on the use, possession, and cultivation of marijuana by patients who possess a signed recommendation from their physician stating that marijuana “may mitigate” debilitating symptoms. The Oregon Medical Marijuana Program oversees the medical marijuana cardholder registry for patients and regulates medical marijuana dispensaries, processors, and grow sites.

 

Cannabis Sativa

image: cannabis sativa plant

Source: Wikipedia Commons. Originally from the U.S. Fish and Wildlife Service.

 

The state has established state-run registries for patients and caregivers to document their eligibility to engage in medical marijuana use, which requires physician documentation of a person’s debilitating condition. A physician must state in writing annually that the patient has a qualifying medical condition and that medical marijuana may lessen or relieve the symptoms or effects of that condition. The allowed medical conditions include:

  • Cancer
  • Glaucoma
  • A degenerative or pervasive neurologic condition
  • HIV/AIDS
  • Posttraumatic stress disorder (PTSD)

Medical marijuana can also be used for any other medical condition or treatment that produces one or more of the following:

  • Cachexia (a weight loss disease that can be caused by HIV or cancer)
  • Severe pain
  • Severe nausea
  • Seizures, including but not limited to seizures caused by epilepsy
  • Persistent muscle spasms, including but not limited to those caused by multiple sclerosis (OMMP, 2016)

More than 72,000 people are registered as medical marijuana users in Oregon as of April 25, 2016. More than 66,000 reported they used marijuana for severe pain, about 21,000 reported its use for muscle spasms, including for multiple sclerosis, and about 9,800 reported its use for nausea (OMMP, 2016).

 

Did you know . . .

It is now legal in Oregon for adults 21 and older to possess and use recreational marijuana from approved medical marijuana dispensaries within limits. Adults 21 and older can share or give away recreational marijuana, receive it as a gift, grow their own (four plants per residence), or purchase it from approved medical marijuana dispensaries (Oregon.gov, 2016).

 

Oregon Pain Guidance Group (OPG)

The OPG group is a group of seventy healthcare professionals from Jackson and Josephine Counties. The group was formed in response to the growing number of prescription opioid overdose deaths in their community. The goal of OPG is to decrease the morbidity and mortality associated with the inappropriate use of opiates and to shift the focus to non-opiate treatments for complex chronic pain, so that patients experience an overall improvement in well-being (OPG, 2015).

In 2016 the OPG published Pain Treatment Guidelines, a comprehensive resource that includes recommendations on the treatment of acute and chronic pain, pain in adolescents and children, pain control in older adults and those with dementia, trauma-informed pain care, and pain control for cancer and palliative care. The guidelines also discuss the use of opioids during pregnancy, managing pain in the emergency department, and recommended opioid policies for dentists. The guidelines are available online hereavailable online here.

Oregon Medical and Nursing Policy Statements

The Oregon Medical Board (OMB) urges the skillful use of effective pain control for all patients. Providers are encouraged to treat pain within the scope of their practice and refer patients to the appropriate specialists when indicated. In all cases of pain management, practitioners should maintain records to track prescriptions and coordinate care with other treating practitioners. Healthcare providers are encouraged to use the Oregon Prescription Drug Monitoring Program (PDMP) (OMB, 2016).

The Oregon State Board of Nursing maintains an interpretive statement on pain management. The statement promotes patient access to the appropriate, therapeutic, and effective assessment, diagnosis, and management of acute and chronic pain. The management of pain must be a priority for nurses and all others who provide care to individuals in pain. The interpretative statement:

  • Promotes a balanced approach to pain management.
  • Promotes the optimal level of nursing practice in pain management using pharmacologic, nonpharmacologic, and multimodal approaches.
  • Establishes a framework leading to sound clinical judgment in managing acute, chronic, and end-of-life pain (OSBN, 2015)
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