Dr. Reb Close, Dr. Casey Grover, and their colleagues in the Emergency department at Community Hospital of the Monterey Peninsula were seeing an alarming increase in patients returning again and again for pain medications or, worse, arriving after an overdose.

Though clearly wrestling with addiction, many didn’t fit the stereotype of an addict. There was the construction worker who became dependent on pain pills while recovering from a back injury. An honors student who got started at a “pill party,” where everyone dumps pills from the family medicine cabinet into a bowl and then swallows a random sample. A

teacher who got steadily stronger prescriptions for migraines until it seemed like it was never enough.

“We had a big problem,” says Grover. “About one person every week was dying in Monterey County from a prescription overdose. We were seeing, routinely, 15-year-olds and 16-year-olds addicted to prescription medications. We were seeing families just torn apart by addiction. It was awful.”

Awful, but not unique. Similar scenes play out in hospitals around the country as addictions to powerful painkilling opioids have multiplied into a national crisis. In Monterey County, like many places, prescription drugs cause more deaths than car accidents.

A teenager approached me at the hospital and asked if she could give me a hug. I thanked her and asked her why. With tears in her eyes she said, ‘I’m meeting my real mom for the first time she’s not high. Thank you for bringing her back to me.’ I get goosebumps just thinking about it.Dr. Casey Grover Emergency department Community Hospital of the Monterey Peninsula

25,000

20,000

15,000

10,000

5,000

0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

19,354

National overdose deathsNumber of deaths involving opioid pain relievers (excluding non-methadone synthetics)

Source: National Center for Health Statistics, CDC Wonder male female

Prescribing more safely: Targeting opioid abuse, misuse

From left: Dr. Reb Close and Dr. Casey Grover Photo courtesy of Nic Coury, Monterey County Weekly

California deaths — all opioid overdoseTotal population: age-adjusted rate per 100,000 residents

2012 2017

0 10 20 30 40 0 5 10 15 20

ModocPlumas

LakeHumboldtCalaveras

SiskiyouTuolumne

AmadorShastaLassen

MaderaVentura

Santa CruzButte

MariposaSan Diego

OrangeSan Luis Obispo

ColusaSan FranciscoMONTEREYSan Joaquin

MarinRiverside

KernSonoma

SutterFresno

San BenitoDel Norte

NevadaCalifornia

SacaramentoTehama

YoloContra Costa

KingsTrinity

El DoradoSanta Barbara

MercedImperial

MendocinoSan Bernardino

StanislausPlacer

Santa ClaraLos AngelesSan Mateo

TulareAlameda

SolanoNapaYuba

SierraMono

InyoGlennAlpine

ModocHumboldt

MendocinoLake

ShastaLassen

YubaDel Norte

SiskiyouVentura

San FranciscoSan BenitoTuolumne

San JoaquinKern

San DiegoSan Luis Obispo

ButteOrange

Santa BarbaraSanta Cruz

MarinSonoma

RiversideMariposa

NevadaCalifornia

PlacerSan Mateo

MercedFresno

ImperialKings

Contra CostaTrinity

Los AngelesSacramento

MaderaStanislaus

Santa CalraInyoYolo

NapaAmador

San BernardinoTulare

SolanoEl Dorado

SutterAlameda

PlumasMONTEREY

CalaverasTehama

SierraMonoGlenn

ColusaAlpine

The statistics, and the stories behind them, were the impetus for Prescribe Safe Monterey County, a collaboration of nearly 20 agencies and organizations to reduce the misuse, abuse, and diversion of controlled addictive medications. Working together, they’ve achieved measurable successes in Prescribe Safe’s first three years:

❚ A 32-percent reduction in opioid deaths in Monterey County

❚ A 54-percent reduction in opioid medications prescribed in participating physician offices, and greater than 50-percent reduction in county health clinics

❚ At Community Hospital, a 59-percent decrease in recurrent Emergency department visits by people seeking opioid painkillers, and nearly $1 million in savings treating those patients

“I am most proud of the collaboration,” Dr. Close says. “We all care so much. We all

come together with one common goal, and it’s the safety of our community.”

Close’s intent from the start was to find ways to help those suffering from pain-medication dependence and to prevent the addiction from happening in the first place. She found pockets of good practices around the nation, including a San Diego program, and met with Dr. Anthony Chavis, chief medical officer for Montage Health, Community Hospital’s parent company, to plot a road map for moving forward.

The county’s other three hospitals, many doctors, the Monterey County District Attorney’s Office, pharmacies, law enforcement agencies, substance abuse treatment centers, and others signed on and began going at the problem from their respective angles:

❚ Doctors are prescribing fewer addictive pain medicines, directing patients as much as possible to alternative pain relief and, when needed, to recovery programs.

Prescribe Safe partners

Community Hospital

of the Monterey Peninsula

Mee Memorial Hospital

Natividad Medical Center

Salinas Valley Memorial

Healthcare System

Doctors on Duty

Urgent Care

Monterey Bay Urgent Care

Montage Medical Group

Monterey County

Community Health Centers

Community Health

Innovations

Monterey County Office

of the District Attorney

Monterey County

Sheriff’s Department

Monterey County

Coroner’s Office

Monterey County Public

Health Department

Monterey County Mental

Health Department

Monterey County Fire

Chiefs Association

Hospital Council

of Northern and

Central California

Monterey County

Medical Society

Central California

Alliance for Health

Community Human Services

Hospital Council of

Northern

and Central California

Sun Street Centers

Central Avenue Pharmacy

All opioid overdose deaths: Monterey vs. CaliforniaTotal population — age-adjusted rate per 100k residents

MontereyCalifornia

6

4

2

2008 2010 2012 2014 2016 2018

❚ A database now enables prescribers to look up patients’ prescription medication histories statewide, so they can be alerted to recurrent visitors shopping for pills from multiple sources.

❚ Law enforcement is being flagged to potential abuse and misuse.

❚ Public awareness is being raised to encourage people to seek alternatives to addictive pain relief, to keep their prescription medicines out of the hands of others, and to dispose of them properly when no longer needed.

❚ Drug take-back bins, for safe disposal of medications, have been added around Monterey County, including at Community Hospital.

Key to the effort is redirecting people to effective but non-addictive relief, not simply cutting them off. Opioid medications have a place in helping patients get through the initial traumatic pain of an injury, illness, or surgery, Grover says, but they do not address problems long-term. The goal is that if opioids are necessary, they be closely monitored; the plan from the start is to help patients taper off the addictive medication by addressing the root cause of the pain through physical therapy, surgical and non-surgical interventions, non-addictive medications, and complementary therapies.

With its broad approach and successful outcomes, Prescribe Safe was a finalist for a national hospital quality award and has become a model for other communities.

“The whole idea of Prescribe Safe is novel,” says Amy Patterson, a Monterey County deputy district attorney. “We’re one of the top mentor counties doing this in California. I go out and speak to local law enforcement agencies and other counties’ district attorney’s offices and explain Prescribe Safe, and it’s amazing how excited they are about starting something in their own county and following our lead.”

The problem ❚ Prescription drug abuse is the nation’s fastest-growing drug problem.

❚ Prescription drugs are the second-most-abused category of drugs after marijuana.

❚ Prescription drug-related deaths now outnumber those from heroin and cocaine combined.

❚ Prescription-drug overdose deaths exceed motor vehicle-related deaths in 29 states and in Monterey County.

❚ Misuse and abuse of prescription drugs cost the country an estimated $53.4 billion a year in lost productivity, medical costs, and criminal justice costs.

Most addictive or abused prescription drugs ❚ Hydrocodone (brand names: Norco®, Vicodin®)

❚ Carisoprodol (brand name: Soma®)

❚ Oxycodone (brand names: OxyContin®, Percocet®)

❚ Meperidine (brand name: Demerol®)

❚ Fentanyl (brand names: Actiq®, Duragesic®)

❚ Alprazolam (brand name: Xanax®)

❚ Clonazepam (brand name: Klonopin®)

❚ Methylphenidate Hcl (brand name: Ritalin®)

❚ Amphetamines (brand names: Adderall®, Benzedrine®)

Disposing of medication

Community Hospital now

has drug disposal bins where

the public can safely dispose

of medications that are no

longer needed or are out of

date. Bins are also available

throughout Monterey

County. Find locations at

chomp.org/prescribesafe.

Resources Learn more about Monterey

County Prescribe Safe

and find resources at

chomp.org/prescribesafe.

❙ Alcohol and drug

counseling and treatment

❙ Pain-management options

❙ Safe medication-disposal sites

❙ Complementary

medicine options

❙ Teen or young adult

prescription drug guide

Narcotic pill prescriptionUrgent care clinic in Monterey County

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0

60,740

29,441 27,948

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