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Amid nationwide opioid crisis, SF health providers reduce painkiller prescriptions

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Blue Shield of California and Kaiser Permanente, the largest health care providers for city government employees, have each seen a decrease in opioid consumption since implementing initiatives to reduce their prescription. (Jessica Christian/S.F. Examiner)
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Health insurers of San Francisco’s workers and retirees say they have significantly reduced addictive painkiller prescriptions in response to the opioid crisis gripping the nation.

Not only are prescription opioid painkillers like fentanyl, oxycodone and morphine blamed for leading to destructive addictions, but also for prompting people to seek alternative street drugs like heroin.

Kaiser Permanente and Blue Shield of California, the largest health providers for city government employees and retirees, have significantly reduced the prescription of opioids, they reported to the Health Service System Board Thursday.

“Our approach was to first turn off the tap, so to speak. And prevent people from starting prescription opioids if there were other options that they could use,” said Salina Wong, director of Blue Shield of California’s clinical pharmacy program.

Hearing concerns of opioid abuse, Blue Shield of California launched in 2014 a Narcotic Safety Initiative to reduce the use of opioids prescribed to patients in 2018 by 50 percent, meaning writing less prescriptions for drugs like Percocet or Vicodin.

“As of the first quarter of this year we’ve observed a 32 percent reduction in the overall consumption of opioids,” Wong said. “We are tracking to our 50 percent goal by the end of next year.”

For San Francisco’s city workers covered by Blue Shield, the decrease is also seen.  Since 2015, there was a 13 percent decrease in opioid consumption and a 16 percent decrease in the dosage amount.

When the initiative began in 2014, Wong said those impacted by substance abuse and their family members “were telling us that often they were observing was that a prescription was what started the cascade of events and then perpetuated by continuing refills for those prescription opioids.”

“It used to be that a lot of substance use disorders started with street drugs. What we are seeing more and more of [is] it is starting with a prescription,” Wong said.

She added that Blue Shield is increasing access to drugs like suboxone and vivitrol to reduce opioid cravings.

Sameer Awsare, associate executive director for Kaiser’s The Permanente Medical Group, said a decade ago physicians “were taught to treat pain at any cost and actually a lot of that education was funded by Pharma who said most of these drugs, ‘No problem, you can just give it, nobody will get addicted and nobody will die.’”

But the statistics have proven otherwise. The practice has left more than 2.2 million Americans addicted to opioid prescriptions and 91 Americans die daily from an opioid overdose, including heroin and prescribed opioids.

Awsare said that Kaiser Permanente Northern California has seen a 42 percent decrease in opioid prescriptions since reduction strategies began in late 2013.

Some techniques included electronic prompts if a physician was to prescribe an opioid, such as after surgery or chronic pain. “If it’s going to only hurt for three days write them for 10 pills,” Awsare said, describing the prompt. “There is no reason to give 30 or 100 — or 200 as it used to be in the old days.”

He said physicians were trained to review painkiller data of their patients and reduce it where possible. “This has to be done in a slow fashion because often patients will go through withdrawal. You can’t suddenly just turn off their pills,” Awsare said. “Then they are off to heroin.”

But patients do need pain relief. “One in three patients in America has chronic pain of some sort,” Awsare said. “If you are not going to give them this you better make sure that they have access to physical therapy, or Tai Chi, or Yoga, acupuncture, cognitive behavioral therapy.”

The board will continue to discuss the opioid epidemic with these health providers, who provide health coverage for city employees and retirees, at future meetings.

“We really believe that health plans have a very important role in helping to mitigate the crisis,” Wong, of Blue Shield, said.

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