Providence change sends pain-med addicts to OnTrack

Hospital emergency departments have enough to do without dealing with people trying to scam prescription narcotics.

Doctors and nurses get to know the folks who show up regularly looking for pain meds. In some hospitals, there's even a nickname for them — "frequent fliers." Some will do almost anything to get opiates. In one infamous local case, a Medford man hit his daughter in the ankle with a hammer and then brought her to the hospital, hoping to score her pain pills.

Providence Medford Medical Center has developed a new approach to get drug-seekers out of hospital emergency departments and into treatment. When people looking for drugs come to the Providence ED, they're given nonopiate pain medicine and referred to OnTrack, the addiction treatment center. OnTrack counselors can help them find better ways to manage genuine pain or help them overcome addiction.

Providence donated $50,000 to OnTrack specifically to work with people who are referred for counseling.

"Providence contacted us," said Susan Nebelsick, OnTrack's pain management coordinator.

"There's a big concern in the community about all the opioids going out."

The goal is to reduce inappropriate use of the emergency department, which is expensive for hospitals and the health-care system at large, and get people into appropriate care, said Brian Herwig, chief operating officer for Providence Medford.

Herwig stressed that the emergency department will still treat people who have genuine pain problems or serious medical conditions.

"For people who need us, we're here and we'll continue to be here," he said.

"We'll treat the underlying illness," he said, "but if it's an addiction, the ED isn't the place to treat it."

OnTrack counselors help people assess their drug use. Those who have real pain problems are guided to a physician.

"They need to have a medical home," said Rita Sullivan, OnTrack executive director. "If they don't, we'll help them get one."

Sullivan said people who are dependent on prescription drugs don't all fit in one convenient category. Some have been using painkillers for legitimate pain, and their drug use got away from them. For others, their addiction preceded their use of prescription drugs.

"There are multiple pathways into this problem," she said. "We need multiple solutions."

Prescription-drug dependency has been a problem in Southern Oregon for years. The region accounts for just 6 percent of the state's population, but it produces 20 percent of the overdose-related deaths.

"We seem to be overmedicating," Herwig observed.

People who use hospital emergency services inappropriately also drain resources that could be used to treat patients with genuine need. Herwig noted that 99 patients accounted for 2,918 ED visits over a recent 22-month period.

Other hospitals have the same problem. At Rogue Valley Medical Center, just 98 ED patients accounted for 2,143 visits from February 2007 to February 2009.

Emergency physicians have to walk a fine line when patients repeatedly seek prescription medication for pain, said Dr. Ken Boccino, medical director for RVMC's emergency department.

"Each time you have to take (the request) with a fresh look," he said, because the patient might be having a genuine emergency.

RVMC and Ashland Community Hospital also have signed on to the same treatment protocol, to prevent drug-seekers from going from hospital to hospital to score drugs.

While there's no way to force drug-seekers to get treatment, for some the referral to OnTrack may help them realize they need help, Nebelsick said.

"There are some people saying to themselves (drug addiction) is not working for me," she said. "It's a chore. It's a necessity. They don't know what they're doing.

"This is a way to let them know there's some help out there."

Reach reporter Bill Kettler at 776-4492 or e-mail

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