Striking a Balance: Safety-Net Leaders Explore Solutions to the Prescription Painkiller Epidemic

Kristene Cristobal, Consultant
Cristobal Consulting


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Clinics and health plans serving populations with low incomes face a tremendous challenge — how to provide compassionate care for patients dependent on high-dose opioids, in the face of a growing epidemic of narcotic addiction and overdose deaths.

CHCF’s California Improvement Network (CIN), a community of organizations engaged in improving health care delivery, convened leaders from health plans, community clinics, and government agencies to come up with a menu of approaches appropriate for California clinics and Medi-Cal health plans.

The group talked about the current challenges facing providers caring for patients on high-dose opioids and promising models for treatment. They converged on a set of recommended approaches:

Meeting participant takes notes on butcher paper during small group discussion.
  • Create broad community coalitions
  • Build a culture of safe prescribing by establishing consistent clinical and operational practices
  • Offer providers training programs and resources
  • Create multidisciplinary teams to work with patients on high-dose opioids or those with complex conditions
  • Spread medication-assisted addiction treatment options
  • Deploy utilization and reporting tools to support safer prescribing
  • Explore payment reform to support integrated care
  • Develop and report outcome measures

This report describes the topics discussed over the course of the day: the problem of high-dose opioid use, the challenges involved in changing prescribing practices, and promising models that could be piloted and spread in organizations caring for populations with low incomes.

The complete report is available below.