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Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic

The Oregon Health Authority's Opioid Initiative

Hedberg, Katrina, MD, MPH; Bui, Lisa T., MBA; Livingston, Catherine, MD, MPH; Shields, Lisa M., BA; Van Otterloo, Joshua, MSPH

Journal of Public Health Management and Practice: July 18, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000849
Practice Full Report: PDF Only

Context: Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state.

Program: The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions.

Implementation: Four OHA projects highlight the integration: (1) a Medicaid Coordinated Care Organization Performance Improvement Project focused on decreasing risky opioid prescribing; (2) Health Evidence Review Commission guidelines that set coverage standards for opioid and nonopioid back pain treatments for Medicaid recipients; (3) statewide opioid prescribing guidelines; and (4) an opioid data dashboard. Each project involves a partnership between governmental public health, public and private health care systems, and external stakeholders.

Progress: From 2015 to 2017, the number of Oregonians on 90 or more Morphine Equivalent Doses (MEDs) decreased by 37%, from 11.1 per 1000 residents quarterly to 7.0 per 1000 residents quarterly. Prescription opioid overdose deaths decreased 20% from 4.5 per 100 000 in 2015 to 3.6 per 100 000 in 2016. Within the Medicaid population, the percentage of clients on 120 or more MEDs for 30 consecutive days decreased 27%, from 2.3% in December 2015 to 1.6% in September 2017.

Discussion: Oregon's integrated approach to address the opioid crisis spans public health and health care systems, engages key stakeholders, and uses data and evidence to inform policies. The progress to date is promising and may assist other states seeking to identify effective strategies to decrease opioid prescribing, misuse, and overdose.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Public Health Division (Dr Hedberg, Ms Shields, and Mr Van Otterloo) and Health Policy and Analytics (Ms Bui and Dr Livingston), Oregon Health Authority, Portland, Oregon.

Correspondence: Katrina Hedberg, MD, MPH, Public Health Division, Oregon Health Authority, 800 NE Oregon St, Ste 930, Portland, OR 97232 (

The authors thank members of the Oregon Health Authority's Opioid Initiative, the Health Evidence Review Commission, the Oregon Opioid Prescribing Guidelines Task Force, and the Oregon Prescription Drug Overdose Advisory Committee.

Human Participant Compliance Statement: The components of this project were implemented as part of the Oregon Health Authority's broad mandate to deliver evidence-based medical care services; the surveillance data presented were deemed to be public health practice and not research by the Oregon Health Authority's institutional review board.

The authors declare they have no conflicts of interest to report.

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