Oregon Public Broadcasting

Oregonian Turns To Heroin For Pain Relief After Opioid Prescription Cut

John is a carpenter, OPB is only using his first name for reasons that’ll become clear in this story.

John grew up in southern Oregon and for 20 years had a successful business installing kitchens. Then, in 2005, he was in a car crash. “I mean, fractured my neck, fractured my back. I had to have my right shoulder replaced," he said.

John was prescribed opioids to deal with the pain.

“After about four years I was on 160 milligrams of oxycontin … and then it was 56 milligrams of oxycodone and that went on for maybe four years.”

Today, he’s a mess. He lives in his pick-up truck and is in constant pain.

Without pain killers he said, he misses work. Which is why he was alarmed recently when his doctor — following new state guidelines — started reducing his dosage.

“The first thing he did was cut me back by a full one-third," he said. "It became an argument with him. Two months later, he cuts me back by another full third," he said.

John concedes he was using too many opioids — but points out it was all legal and under a doctor’s supervision. He said tapering off the drugs left him with terrible pain in his neck and back.

“Your body becomes so jittery and moving around. And just, I mean there’s no place of comfort," he said. "I mean it’s torture.”

John said he stuck with the low doses for seven weeks, then decided to visit Old Town Portland to buy heroin.

 He was incarcerated for cocaine use in the 1980s, which is how he knew where to go for illegal drugs. He said he turned to heroin because he had to have something to deal with his chronic pain.

He didn’t want to inject it, so his solution was to cook the heroin in tin-foil with a lighter — like he’d seen others do — then inhale the fumes.

“But most of the drug just goes up in smoke. So the next time I went to this dealer, I said, ‘Well, how do you do it?’ And he said, ‘Well, I snort it.’ And I said, ‘Well this is black tar, how do you snort it?’ And he said, ‘Oh! You cook it and you put it in a needle except you take the needle off and you shoot it up your nose and snort it,'" explained John. John said he understands the need to crack down on opioids. He knows more than 28,000 Americans overdose and die abusing the drugs every year. But, he said, acupuncture and physical therapy just don’t give him much relief.

“It’s a really upsetting story and one thing that’s so upsetting about it is that it’s actually quite common,” said Dr. Eve Klein, a neurologist working on pain management. She said when somebody’s been on opioids so long, tapering often doesn’t work. She hasn’t met John but thinks he should probably go to a methadone clinic.

“And then once he’s on something like methadone and he’s stable and he’s out of that rat race of needing heroin every six hours. Then he can start looking into things like, 'OK, what am I going to do about pain management now?,'” she said.

Congress just passed a bill to reduce opioid addiction. Democratic Oregon Sen. Ron Wyden voted for it, but said it’s only a ‘half measure.’ He’s said more legal options for dealing with pain are needed, “If all you do is restrict choices to medication, the addiction does not vanish magically. You’ve got to have prevention and treatment.”

Meanwhile, John lives in his truck and seeks relief where he can. He’s terrified of the traffic stop that could land him in jail.

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Oregon Tries To Improve Access To Dental Care

About a quarter of Oregonians on Medicaid get a dental visit each year. That compares to almost three-quarters of the general population.

Cavities and gingivitis might not sound like a big deal. But over time, poor dental health can lead to inflamed gums. And the bacteria from inflamed gums travel through the bloodstream causing everything from heart disease to cancer.

Oregon Tries To Improve Access To Dental Care

About a quarter of Oregonians on Medicaid get a dental visit each year. That compares to almost three-quarters of the general population.

Cavities and gingivitis might not sound like a big deal. But over time, poor dental health can lead to inflamed gums. And the bacteria from inflamed gums travel through the bloodstream causing everything from heart disease to cancer.

Rep. Alissa Keny-Guyer, D-Portland, especially wants women who are pregnant to be seen.

“It’s a very short window of opportunity and we know that at least 50 percent of them have dental carriers. And we know that that leads to premature birth," she said. "So how do we get to them really quickly and make sure that they see a dentist?”

The state has launched a work group to improve dental care access for Oregon’s poorest residents. It's expected to have a list of ways to improve access by September.

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Is Oregon's Public Health System Meeting Needs?

Oregon’s public health system is “minimal” in a third of communities, according to a new report commissioned by the Oregon Health Authority.

Public health deals with everything from immunizations to ending tobacco use. It also covers tests for lead and monitors factory emissions, which have been relevant issues in Portland and elsewhere statewide lately.

The state estimates it can conduct about five health assessments a year, but five times as many are needed to address environmental risks.

Lynne Saxton, director of the OHA, said the shortage of health workers is apparent across Oregon.

“In my travels across the state in the last year, many counties have said to me, 'We have one person trying to meet the entire needs of the public health system in our county and it’s simply not sustainable,'” she said

Oregon spends about $25 a person on public health each year. That compares to $40 in Washington and $95 in Idaho.

The state estimates it needs an extra $30 million out of the next legislature to modernize the system.

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Oregonians Spent More Than Needed On Health Prodcedures Last Year

Oregonians could have saved 28 percent on their health procedures last year if they’d shopped for the best price, according to a new study from the Portland cost transparency company HealthSparq.

People with health insurance don’t usually shop the best cost on procedures like an MRI or hip replacement.

But over the last five years, insurance deductions have increased from around $300 a year to $3,000 a year. HealthSparq CEO Scott Decker said that increase is pushing people to shop more.

He estimates 11 percent of unnecessary spending in overall health care costs in Oregon could be eliminated by shopping.

“You can find even with your insurance, three, four or five times variation in price. So we need to be conscious consumers of health care, just like we are of anything else we shop for,” Decker said.

The HealthSparq study found patients could save 5 percent by shopping for tests and surgical procedures; 1 percent by shopping for medications; and 5 percent by using telehealth — that is, contacting a doctor over a video call service like Skype.

Such savings would amount to about $90 per person, per month.

The HealthSparq report used data from 237,000 people, who accounted for more than 500,000 cost estimates during 2015.

HealthSparq's shopping applications is embedded in 70 health plans across the U.S. and allows comparison shopping within network.

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Oregon Adopts Federal Opioid Prescribing Standards

Oregon has adopted new federal standards for the prescribing of opioids.

More people die from drug overdoses every year in Oregon than in car crashes.  And 43 percent of those overdose deaths are associated with opioids prescribed by a doctor.

State epidemiologist Dr. Katrina Hedberg said doctors and the public need to be educated on using fewer opioids, for shorter periods of time.

“It is not that we want people to be in pain. It is that we have one tool and there need to be a variety of tools that are used to address chronic pain."

She said patients need to look to tools like acupuncture, exercise, and learn to function with low levels of pain.

The state task force on opioids will continue to meet into the summer to consider other issues, like how to deal with pain from dental work.

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Oregon Hospitals To Provide Costs For Procedures

Oregon hospitals have joined together to say they’ll provide patients with an estimate for services within three business days.

Getting a hospital estimate may not seem like a big deal. But hospital prices are notoriously hard to pin down, and they vary widely.

For example, a recent study on hip replacements in Oregon found prices 20 times higher in one hospital than another.

Felicia Hagins with Service Employees International Union called the hospital estimate a welcome idea, but not a fix. “Since most Oregonians, 95 percent of us have insurance, oftentimes, we don’t actually get to choose which hospital we go to," she said.

That means you can’t comparison shop.

Other problems are that to get an estimate, the procedure has to be scheduled — and that isn't always possible, as when surgery is needed after a car crash. Also, the five percent of Oregonians who don’t have insurance probably can’t afford to get a procedure done, even if they’re told how much it would cost.

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Oregon Health Insurance Cheaper Than National Average, For Now

Health insurance premiums in Oregon are lower than the national average, according to new numbers from the Robert Wood Johnson Foundation — but that may not last.

Some Oregonians were shocked last week when health insurance companies like Moda and Providence asked for rate increases of about 30 percent for next year for the individual marketplace.

But Kathy Hempstead with the Robert Wood Johnson Foundation, said the companies are just catching-up with national pricing.

“Even though you might have felt like you had sort of a lot of price increase between 2015 and 2016, the Oregon market is still kind of under priced, compared to the national market,” she said.

The Oregon Consumer Department will analyze the proposed new rates over the next two months, to make sure they’re sustainable.

About 70 percent of Oregonians who don’t get insurance through their jobs are eligible for tax credits to help reduce the cost.

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