Erin Johnson, MPH, has been the Prescription Pain Medication Program Manager for the Utah Department of Health’s Prescription Pain Medication Program since 2007. PainEDU interviewed her in April 2009 about their plan to increase medication safety. The content for today’s interview comes from her written report in November and a telephone interview in December, 2009. For further history about this project see the April 6, 2009, interview. Go to “click for more” to access the archives.

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Questions

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Evelyn Corsini, MSW:

It has been 8 months since we last spoke. Can you please summarize what has happened since then in the state of Utah to increase the safe use of pain medication.

Erin Johnson, MPH: This two-year project was funded by the Utah State Legislature in 2007, in response to the alarming increase in the number of deaths in Utah from prescription opioids used for the treatment of chronic pain. The primary goal of the program was to reduce the incidence of prescription pain medication-related deaths by 15%, by the year 2008. In addition, there were three specific program objectives:

1. Create written guidelines for providers
2. Educate providers, patients, insurance companies, and the general public
3. Conduct research about these deaths

Our statistics show that in 2008 we saw a 12.6% reduction in the number of deaths, from 317 in 2007 to 277 in 2008. Our research on these deaths is continuing. We are conducting structured interviews with the next of kin for all drug related deaths investigated by the Utah Medical Examiner in 2008, including suicides.

EC: Please describe some of the educational initiatives about prescription pain medications.

EJ: We have had a multi-pronged effort that focused on provider, patient, and public education, as well as the development of clinical guidelines on prescribing opioids. Each initiative has involved many groups and individuals.

A consensus panel developed the Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. These have been published and are available to health care providers and the public on two web sites, meant to educate providers and the public.

Health care providers, targeted at controlled substances licensees, were educated by small group trainings, large group presentations, and mass mailings. Participants in the presentations were tracked to monitor their adoption of the Guidelines. This follow-up report is not yet available.

To educate patients and the general public we ran a Statewide Media Campaign from May 2008 to May 2009 with the slogan Use Only As Directed. This became the name of our general public web site. We targeted adults between the ages of 25-45 as they account for the majority of prescription overdose deaths in Utah, with the average age of death being 40 years old. The campaign included news coverage, TV and radio spots, posters, pamphlets and other collateral material, as well as newspaper ads. A lot of press coverage and interviews were generated by this effort. The public’s web site useonlyasdirected.org has been very effective, peaking at over 200 hits per day, and will continue for the next seven years.

EC: Can you describe the results of some of the key public education initiatives and knowledge surveys?

EJ: We did a great deal of sampling and learned that we reached over 60% of the population through all of our media efforts and web site.

We did a random sampling population survey both before and after the media campaign. Some of what we learned was:

• While most people were aware that they should avoid alcohol when taking prescription pain medication, few were able to name other substances to avoid (like sleep-aids and anti-anxiety medications), which led us to include this in our public education.

• A key message to the public was to keep prescription pain medications locked in a safe place. In the post-survey there was a decrease in the number sampled who reported storing them in their medicine cabinet (35% to 28%).

• The number of respondents who were familiar with how to dispose of expired prescription medication remained unchanged at less than half, but more reported disposing leftover medications after the media message.

EC: While your interviews with the family members of those who died are not yet completed, can you describe some preliminary findings?

EJ: We started the interviews in October 2008 and we are just beginning our last group of interviews. We initiate contact with the next of kin or close friend, one month after any death that the medical examiner believes may be the result of a drug overdose. Since it can take 3 months for the Medical Examiner’s Office to determine the final cause of death, we are conducting over 500 interviews. We expect that when we are done, we will have interviews from about 300 drug overdose deaths (including illicit and non-illicit drugs) and 200 suicides (this is part of a separate study to learn more about suicide deaths in Utah and is not restricted to suicides by drugs).

We are using a lengthy questionnaire and conduct in-person or telephone interviews that take about one hour. We have had about an 85% response rate to the survey. We believe this is because the survey is initiated in behalf of the Medical Examiner’s office. Our primary goal for doing this is to identify risk factors that we can use in the future to develop interventions to prevent these kinds of deaths.

While we are still analyzing the data, we have been struck by the number of deaths that include information that provides a history of suffering from chronic pain, as well as the the number with a history of prescribed pain medication, and the number with a history of substance abuse. In addition, so far, we have determined that 49% were unemployed in the two months prior to their death, and 32% had no health insurance.

EC: What is the best way for interested health providers and other states with similar goals, to obtain information about this program in Utah?

EJ: The state maintains websites that contain important documents including the full text of the guidelines. The site www.health.utah.gov/prescription is more of an internal website that contains all of the work the program has done including minutes of all committees and workgroups and research reports. The site www.useonlyasdirected.org is aimed at the general public, and has a wealth of information on the topic of prescription medications. The guidelines can be found at both sites.