Fighting for patient safety: The Colorado Consortium for Prescription Drug Abuse Prevention

In 2012, the Substance Abuse and Mental Health Services Administration issued its annual National Survey on Drug Use and Health (based on 2010-2011 data). For Colorado, the results were eye-opening. The state ranked second nationally for self-admitted, non-medical use of prescription painkillers among young adults ages 12 to 24.
 
At the time more than 255,000 Coloradoans misused prescription medications, and related deaths had almost quadrupled since 2000. In response to this dire situation, Gov. John Hickenlooper organized a committee to formulate a strategic plan to address the problem. After seven to eight months of planning, the Colorado Consortium for Prescription Drug Abuse Prevention was born.
 
Its strategy would revolve around restricting access to the illegal use of prescription drugs by focusing on eight pillars:

• Improving surveillance of prescription drug misuse data
• Strengthening the Colorado Prescription Drug Monitoring Program
• Educating prescribers and providers
• Increasing safe disposal to prevent diversion and protect the environment
• Increasing public awareness
• Enhancing access and referral to evidence‐based, effective treatment
• Expanding access to the overdose reversal drug Naloxone
• Increasing the voice of those who are affected by the opioid epidemic.

Under the leadership of director Robert Valuck, PhD, EPh, FNAP, professor, clinical pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Studies, the consortium was designed to be different than blue-ribbon panel or commission models established in other states. Those immediate taskforces, Valuck points out, “get together, generate a report, then disband. Sometimes there’s an ongoing taskforce, but they’re usually not as involved as ours.”
 
With more than 500 people spread across 10 workgroups to dictate and execute strategy, the consortium was positioned to reach as many key organizations and individuals as possible. As Valuck notes, “Each workgroup is led by two co-chairs that are well-placed, either at a state agency, a major treatment provider organization, a health professions organization, a major health system, or a harm reduction action center.”
 
Because the consortium is well-connected, the steering committee — along with about a half dozen key people from other local public health agencies, such as the Area Health Education Center (AHEC) and the Colorado Association of Local Public Health Officials (CALPHO) — can better organize state-level responses. This entails coordinating what each workgroup is focusing on, emphasizing open communication between workgroups, advocating for change and working on policies, programs and partnerships.
 

Raising public awareness

One of the biggest challenges in addressing the opioid epidemic is public awareness. Hence, one of the consortium’s 10 workgroups focuses on educating the public about prescription drug abuse and promoting the safe use, storage and disposal of prescription medications.  
 
Four years ago, with funding from the Colorado attorney general, the consortium launched its first statewide public awareness campaign, Take Meds Seriously, on safe use, safe storage and safe disposal. The notion that prescription drug safety starts with Coloradans continues to resonate: “We still think those messages are relevant today … those are still some of our core messages,” says Valuck.
 
During the past two years, the consortium has placed more emphasis on the safe disposal of unused and expired prescription medications through its Take Meds Back program, which is administered by the Colorado Department of Public Health and Environment (CDPHE). The state has funded safe disposal boxes and collection systems for them, which the consortium has found is the most cost-effective form of collection. 
 
With its next round of messaging, which began this year, the consortium is focusing on stigma reduction, in collaboration with the Office of Behavioral Health (OBH), and ways to combat opioid overdoses through the use of the medication naloxone. “Our next wave of this will have some provider education money, public awareness about naloxone and then more on first responders as well,” says Valuck.
 
Beyond these initiatives, the consortium will eventually turn its attention to raising awareness of opioid alternatives for patients. The consortium has already begun to lay the groundwork with physicians, but changing people’s thinking on opioids will require a tremendous educational effort. “We’re not saying that opioids shouldn’t be available, but maybe they should be last-resort drugs, not first-line drugs,” says Valuck. However, before any of this can happen, physicians first need to be ready to have this conversation with their patients. 
 

Measuring success

Ultimately, the consortium’s goal is to be the leader for research and prevention in the Western United States. To that end, in May 2017, the State of Colorado approved the establishment of the Center for Substance Abuse Prevention at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, which will go a long way in helping the consortium confront the opioid and prescription drug abuse problem in Colorado.
 
The consortium already serves as a model for other states in that it has done better than its peers in most of its initiatives, including the number of providers educated and in raising public awareness about the issue. “You can measure knowledge, attitudes and behavioral intent … for those dimensions we would have shown statistically significant gains in all of those things – about the issue in general, about safe use and storage and disposal and for intent to store safely and dispose of things,” says Valuck.  
 
Colorado is the only state in its region, which also includes Montana, North Dakota, South Dakota, Utah and Wyoming, and was one of the first states nationwide to start a state-funded permanent safe disposal system. “We take back more pounds [of drugs] per capita than all of our neighboring states in our EPA region,” says Valuck. As he points out, raising public awareness has been the impetus behind this. Simply seeing a take-back box can change people’s behavior regarding opioid abuse.
 
Over the coming years, a challenge for the consortium will be working toward being able to measure key performance indicators. “Ultimately what we want to see is fewer people self-reporting non-medical use or fewer people going to the emergency room or dying,” says Valuck. “Those are the things we want to measure, but those indicators take years to effect, so we know we’re not going to see immediate change in those.”
 
This is largely due to the “pain=opioid” culture we live in. As Valuck notes, “It’s hard to shut that faucet off … It took us 25 years to get into that, and it’s going to take us a little while to untangle.” That may be true, but in Colorado the consortium is making great progress in turning the tide.
 
For more on clinical guidance on opioid prescribing and insights from practice leaders, access the MGMA Research & Analysis Report, Combating the Opioid Epidemic: Effective Policies and Communication Strategies, a free MGMA member benefit.
 
Reference:
“Valuck testimony to Senate HELP committee.” December 8, 2015.