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Oregon's new guidelines on opiate use include monitoring patients for marijuana use.

(The Associated Press)

The Oregon Health Authority has approved guidelines to help reduce opioid use that include testing patients for drugs and monitoring marijuana use.

The recommendations call on providers to test patients they suspect of sharing, misusing or selling opioids. They encourage them to consult peers when prescribing high doses of opiates and to document and discuss marijuana use, including asking patients what they use, how much and why.

"It's really about a discussion that needs to happen between the patients and their physician," Dr. Katrina Hedberg, Oregon's health officer, said about cannabis. "There's difference between an occasional Friday night versus a daily high dose for treatment of pain."

The guidelines are based on those issued by the Centers for Disease Control and Prevention in March. An Oregon task force adopted them this summer then spent several months hammering out recommendations that are specific to the state.

They include marijuana, which is legal in Oregon for medical and recreational use. Some patients use marijuana for pain. They might also take opiates. Hedberg said health leaders raised questions about that, pointing out that they are both are psychoactive. Some people worry that when taken together, they could deter patients from using alternative therapies.

The guidelines are not trying to eliminate any form of treatment or take patients' prescription painkillers away altogether. They do not address acute pain either or opioid use for cancer treatment, post-surgery relief or for dental treatment.

They are only concerned with chronic pain.

"The focus really is that what else can you offer patients," Hedberg said. "How can you make sure that patients are continuing to function, maintain or improve their function."

The opioid epidemic has been on the rise in Oregon since the 1990s, with a dramatic increase in the use, misuse, dependency and deaths from prescription-controlled substances. Between 2011 and 2015, nearly 900 people died in Oregon from an opioid overdose, and in 2014, enough opioids were prescribed in Oregon for nearly every person in the state to have a bottle. A national survey has also ranked the state No. 2 in the non-medical use of pain meds.

Following the rise in use, there's been an increased awareness of the need for other therapies for chronic pain. Studies show the drugs become ineffective over time because patients build up a tolerance, requiring higher and higher doses. That can lead to misuse and overdose deaths.

In December 2015, Multnomah County announced a plan to crack down on prescription painkillers for treatment of chronic pain. The state guidelines aim to ensure that the prescribing guidelines extend beyond the metro area. Health officials expect treatment to vary among areas, depending on what services are available.

The Oregon-specific recommendations cover provider documentation and evaluation; they call for "compassionate care" for those on high-dose prescription painkillers, which refers to tapering down their use rather than eliminating them entirely.

They also urge providers to keep up on the latest research on marijuana use for pain and ask them to track patient opioid use by regularly checking opioid use by chronic pain patients on the state's prescription database. It records all prescriptions for painkillers, allowing physicians, for example, to check past use or whether a patient has a prescription from more than one provider.

It is a tool to help providers identify when a patient is misusing the drugs, Hedberg said, but it is not an instrument to take away a practitioner's license.

All the medical boards, academies associations in Oregon were represented on the task force along with medical directors for coordinated care organizations. The guidelines are not mandatory. Providers and their networks will have to discuss and decide how they want to implement the recommendations.

-- Lynne Terry