Taking Pains

One medical group’s quest to sidestep dangerously addictive opioids

- Julia Lurie

In 2013, leaders at Partnership Health Plan, the main public insurance provider for Medi­Cal patients in rural Northern California, discovered an alarming trend: Many counties where Partnership operated had among the highest rates of opioid prescribing and overdose in the state. Hydro codone was the top­prescribed medication among Partnership patients, who include more than 570,000 Medi­Cal recipients from the vineyards of Sonoma County to the redwoods on the Oregon border. In Lake County, a poor, rural area bordering Sonoma, enough opioid painkillers were prescribed in 2013 to provide every man, woman, and child with opioids for five months.

“If people were needing more, you just prescribed more,” said Dr. Marshall Kubota, a regional medical director for the provider. “That was a recipe for disaster.”

Opioids, a highly addictive class of compounds that in­ cludes OxyContin, Percocet, and Vicodin, are a uniquely American form of pain treatment: In 2014, the United States consumed nearly 70 percent of the world’s supply. As prescriptions have soared since 1996, when Purdue Pharma introduced OxyContin, opioid addiction and overdose rates have outpaced the trend. Yet chronic pain levels have increased, according to a recent study in the medical journal Pain— and many people who started on painkillers have transitioned to other illicit, stronger opioids like heroin or fentanyl. As a result, drug overdoses, most involving opioids, kill more than 1,000 Americans each week on average—more than cars or guns.