Prescribe Safe Initiative - Santa Barbara County
Confidential Referral and Treatment
If you need help with substance abuse or addiction, please call 2-1-1 for confidential referral and treatment. Or, follow this link for a listing of Treatment Facilities in Santa Barbara County
The Prescribe Safe initiative was created by health care facilities, law enforcement, and local physicians in response to concerns about prescription medication misuse in our county.
Prescribe Safe is meant to guide, educate, and provide resources for our local physicians and patients in the safe use of prescription medications and promote safe and effective pain management in Santa Barbara County.
Information for Health Care Professionals
Clinical Guidelines
Emergency Dept. and Urgent Care - Safe Pain Medicine Prescribing
Confidential Referral and Treatment
If you need help with substance abuse or addiction, please call 211 for confidential referral and treatment. Or, follow this link for a listing of Treatment Facilities in Santa Barbara County
We care about you. Our goal is to treat your medical conditions, including pain, effectively, safely and in the right way.
Pain relief treatment can be complicated. Mistakes or abuse of pain medicine can cause serious health problems and death.
Our emergency department will only provide pain relief options that are safe and correct.
For your SAFETY, we routinely follow these rules when helping you with your pain.
- We look for and treat emergencies. We use our best judgment when treating pain. These recommendations follow legal and ethical advice.
- You should have only ONE provider and ONE pharmacy helping you with pain. We do not usually prescribe pain medication if you already receive pain medicine from another health care provider.
- If opioid prescriptions are needed for controlling pain, we will only provide a limited amount, no more than 20 pills.
- We do not refill stolen prescriptions. We do not refill lost prescriptions. If your prescription is stolen, please contact the police. We do not prescribe long acting pain medicines such as: OxyContin, MSContin, Fentanyl (Duragesic), Methadone, Opana ER, Exalgo, and others.
- We do not provide missed doses of Subutex, Suboxone, or Methadone.
- We do not usually give shots for flare-ups of chronic pain. Medicines taken by mouth may be offered instead.
- Health care laws, including HIPAA, allow us to ask for all of your medical records. These laws allow us to share information with other health providers who are treating you.
- We may ask you to show a photo ID when you receive a prescription for pain medicines.
- We use the California Prescription Drug Monitoring Program called CURES. This statewide computer system tracks opioid pain medications and other controlled substance prescriptions.
Departamento de Emergencia - Recetar Medicinas de Manera Segura
Usted nos importa. Estamos comprometidos a tratarlo de manera correcta y segura.
Los tratamientos de alivio para el dolor pueden ser complicados. Errores o abuso de medicinas para el dolor pueden causar serios problemas de salud y muerte.
Nuestro departamento de emergencias solamente proveerá opciones para el alivio del dolor que son seguras y correctas.
Por su SEGURIDAD, seguimos rutinariamente las siguientes reglas para ayudarle con su dolor.
- Buscamos y tratamos emergencias. Usamos nuestro mejor juicio cuando se trata de dolor. Estas recomendaciones siguen reglas éticas y legales.
- Usted debe tener solamente UN doctor y UNA farmacia para ayudarle con su dolor. Generalmente, nosotros no damos recetas médicas para el dolor si usted ya recibe medicinas para el dolor de parte de otro proveedor de salud.
- Si las prescripciones de opioides son necesarias para controlar el dolor, sólo proporcionaremos una cantidad limitada, no más de 20 pastillas.
- Nosotros no renovamos recetas médicas robadas. No renovamos recetas médicas perdidas. Si su medicina ha sido robada, por favor llame a la policía.
- Nosotros no prescribimos las siguientes medicinas de larga duración: OxyContin, MSContin, Fentanyl (Duragesic), Metadona, Opana ER, Exalgo y otros.
- No proveemos dosis perdidas de Subutex, Suboxone, o Metadona.
- Generalmente, no damos inyecciones para ataques de dolor crónico. Se le podrán dar solamente medicinas tomadas oralmente.
- Las Leyes de Salud, incluyendo HIPAA, nos permite preguntarle por su historial médico. Estas leyes nos permiten compartir información con otros proveedores de salud que lo estén tratando a usted.
- Le pedimos que nos enseñe una Identificación con foto cuando usted recibe la prescripción de una receta médica para el dolor.
- Usamos el Programa de Supervisión de Drogas de California (California Prescription Drug Monitoring Program) llamado CURES (por sus siglas en Inglés). Este sistema estatal lleva un control de narcóticos y todas las demás prescripciones de sustancias controladas.
Outpatient Care - Safe Medicine Prescribing
WE CARE ABOUT YOU. Our goal is to treat your medical conditions, including pain, effectively and safely. Pain relief treatment can be complicated. Mistakes or misuse of pain medicine can cause serious health problems to include addiction and death.
FOR YOUR SAFETY we routinely follow these rules when helping you with your pain.
- We look for and treat the underlying disease causing the symptom of pain. Sometimes that is a self-limiting injury, a terminal illness, permanent disability or a psychological disorder.
- We usually try non-medication modalities first to manage pain or recommend these modalities at the same time as we are prescribing non-habit forming medications to minimize your exposure to opioid medications.
- If a pain prescription is necessary, we will start with anti-inflammatory medications or other non-opioids first. Alternatively, localized pain patches or roll-on medications may be tried instead of medications by mouth.
- If opioid pain prescriptions are needed for pain, we will ONLY give you a limited amount at the lowest dose possible to achieve reasonable pain control. Absolute pain control at all times is not an appropriate or achievable target.
- In the rare circumstance where long-term use of opioid medication is necessary you will be asked to engage in a monitoring contract to ensure safe use of your medication. This contract will require your active adherence to guidelines to limit the possibility of addictive behavior or misuse of your medications.
- If you demonstrate characteristics of addiction, we will work with you to seek help in stopping the opioids.
- We follow similar guidelines for other medications that are high risk for addiction. These medications include sleeping pills, anti-anxiety medications or mood stabilizing medications, muscle relaxants, etc.
- Concomitant use of sleeping pills, anti-anxiety or certain classes of mood stabilizing medications and opioids can lead to a high risk of overdose. For your safety, your physician may refuse to start or continue these medications in combination.
Publications Related to Prescribe Safe
1. Grover CA, Close RJ. Frequent users of the emergency department: risky business. West J Emerg Med. 2009; 10: 193-4.
This was an opinion piece highlighting the problems associated with ED frequent users.
2. Grover CA, Close RJ, Villarreal K, Goldman LM. Emergency department frequent user: pilot study of intensive case management to reduce visits and computed tomography. West J Emerg Med. 2010; 11: 336-43.
This was a publication on the first 100 patients in the Frequent Users Group (original EDRVP). We reduced ED visits by 83% and CT scans by 67%.
3. Grover CA, Wiele ED, Close RJ. Narcotic Bowel Syndrome. J Emerg Med. 2012; 43: 992-5.
One of our EDRVP patients had chronic abdominal pain - and was ultimately diagnosed with Narcotic Bowel Syndrome after referral to a tertiary care center. As the opiate pain medications caused her recurrent abdominal pain - she asked us to write up the case to teach other providers about her diagnosis.
4. Grover CA, Close RJ, Wiele ED, Villarreal K, Goldman LM. Quantifying drug-seeking behavior: a case control study. J Emerg Med. 2012; 42: 15-21.
Since many of the EDRVP patients exhibit drug seeking behavior from chemical dependency issues, we looked at their behaviors to understand more about drug seeking behavior.
5. Grover CA, Garmel GM. How do emergency physicians interpret prescription narcotic history when assessing patients presenting to the emergency department with pain? Perm J. 2012; 16: 32-6.
We provided a number of fictitious cases of patients presenting with back pain - each with a different prescription drug history (we varied medication potency, number of prescribers, and number of prescriptions) - to see how providers interpreted the data in regards to the possibility of drug seeking behavior.
6. Grover CA, Elder JW, Close RJ, Curry SM. How frequently are "Classic" Drug-Seeking Behaviors Used by Drug-Seeking Patients in the Emergency Department? West J Emerg Med. 2012; 13: 416-21.
Since many of the EDRVP patients exhibit drug seeking behavior from chemical dependency issues, we took another at their behaviors to understand more about drug seeking behavior.
7. Grover CA, Crawford E, Close RJ. The Efficacy of Case Management on Emergency Department frequent users: An Eight Year Observational Study. J Emerg Med. In press
All previous studies of case management have followed patients for 3 years or less. We had the data on patients for 8 years - and found that case management continues to work in the long term.
8. Grover C. State prescription drug monitoring programs: Are they the answer to America's new public health epidemic? ACEP Trauma and Injury Prevention Section Newsletter. March 2012
This was an informational piece on prescription drug monitoring programs.
9. Grover C. Prescription Drug Monitoring Programs. Modern Resident. Apr/May 2013.
This was another informational piece on prescription drug monitoring programs.
Warning Signs That Someone May Be Misusing Opioids
Pain Management, Prescription Opiods, and Addiction
Watch videos produced by Cottage Health that discuss the safe use of prescription medications and promote safe and effective pain management.
1. The most important warning sign is tolerance to the pain relief being provided by the medication. If the effects of the pain medicine are wearing off faster or there is less relief from the medication then this needs to have a reassessment of the pain condition and its treatment.
- Has a new injury happened or has something become unstable? If so then this can be evaluated.
- Is the person having difficulty pacing themselves within the limits that the painful area of their body imposes. This can be assessed as well and perhaps guidelines be reviewed with the patient and their loved ones.
- If there is no new injury or mechanical change and the activity level has not increased then the nervous system may be becoming resistant to the medication. This is called tolerance. The most common cause of tolerance is anxiety or stress. Depression can also impair the pain relieving benefit of pain medication.
- These two areas of anxiety and depression then need to be assessed if there is loss of effectiveness of pain medication.
- Tolerance can be both a symptom of addiction or the first step of the body moving towards addiction. When pain medications provider relief not only for pain but also for anxiety, stress, depression, insomnia and other states of alarm of the nervous system, these symptoms rapidly become tolerant to the effects of opioids and lead to emotional dependence and later physical dependence upon these medications.
- If this is happening the addiction consultation in conjunction with pain consultation should be undertaken.
Opioid Overdose Danger Signs
Overdose that involves opioids, whether prescribed medications like Oxycontin, Percocet and Vicodin, or illegal opioid drugs like heroin, can be fatal and are the most pressing cause for concern. Dangerous situations also can arise when opioids are used in combination with alcohol, tranquilizers, sleeping pills and other powerful drugs such as Xanax, Clonazepam, Valium, SOMA, Fiorinal and others.
Call 9-1-1 if a person exhibits any of these symptoms:
- Face is extremely pale or feels clammy to the touch
- Body has gone limp
- Fingernails or lips have a purple or blue color
- Vomiting or making gurgling noises
- Cannot be awakened or is unable to speak
- Breathing or heartbeat slows or stops
If you are taking opioids for pain relief, make sure to follow the doctor’s directions and dosage in your prescription. Also, if you see more than one health care provider, be sure to disclose all drugs you are taking to safeguard against harmful interactions.
Withdrawal Symptoms
While overdose cases are common, the Emergency Department sees even more patients who are suffering the effects of opioid withdrawal. Those affects can include:
- Runny nose
- Anxiety
- Prickly skin
- Diarrhea
- Nausea
- Feeling cold, clammy and sweaty
- High intensity pain or cramps in muscles and joints
In these cases, treatment is not as urgent, but a physician can suggest or prescribe non-narcotic medications to help control nausea, diarrhea and muscle cramps caused by the withdrawal, as well as short-term medications for anxiety.
Addiction Recovery
If you are dependent on opioids, it can be difficult to stop using them on your own. To increase your odds for success, first consult with a primary care physician or an addiction specialist.
Cottage Residential Center offers affordable treatment programs for those recovering from alcohol and chemical dependency. CRC provides solutions that empower recovery, restore dignity, and reconnect families. Since 1975, Cottage Health has been dedicated to providing the most up-to-date, effective, and dignified treatment for alcoholism and drug addiction.
Recovery Road Medical Center in Santa Barbara offers a multi-disciplinary program specific to people dealing with chronic pain that can also addresses related drug dependency and addiction. Center co-founder Dr. Joseph Frawley is an internist who has special training in chronic pain management and in treating addictions. He’s a member of Cottage Health’s new opioid task force, too.
There are also several AEGIS Treatment Centers located on the Central Coast. AEGIS offers replacement therapy, in which a patient who is dependent on a prescription opioid receives an alternative opioid, such as methadone, to help relieve cravings and withdrawal symptoms while working toward recovery with medical supervision and at the person’s own pace.
COPE, Cottage Outpatient Center of San Luis Obispo, is a licensed outpatient facility providing intensive treatment for substance abuse and chemical dependency. Our Chemical Dependency treatment program provides group therapy and multi-family group therapy facilitated by licensed clinicians with specialized programs offered for women and dual diagnosed patients.
Changes offers dual diagnosis outpatient treatment for substance abuse and mental health through a variety of programs including our Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP),and Outpatient Program (OP).
The Project Recovery Treatment Center provides a safe, structured and low-cost outpatient treatment program for adults with alcohol and substance dependence issues including dual diagnosis or co-occurring disorders. Clients have a primary counselor who develops their treatment plan and links them with services to support their recovery including health care, mental health services, job placement, and sober living environments.
Sanctuary House Residential Program is for adults who do not need (or prefer an alternative to) psychiatric hospitalization but who are unable to live independently. Sanctuary House provides attractive surroundings with an ideal combination of privacy and family atmosphere. The facility is an historic, beautifully furnished late-Victorian house, which offers a warm, home-like environment.
Narcotics Anonymous Santa Barbara provides daily 12 step recovery programs at multiple locations in Santa Barbara.
Multidisciplinary Pain Management
When pain becomes chronic it usually is no longer just a symptom that needs to be calmed down but it also often alters how one earns a living, connects to other people, how one sees oneself and the overall quality of life.
Depression and anxiety often aggravate the pain and interfere with the quality of life as well. Recovery from chronic pain is often best done as part of a multidisciplinary approach which addresses each of the above areas that have affected the chronic pain patient.
Finally, if you do use prescription opioids, make sure they are in a secure place, even a safe, where other family members, especially teenagers and other children, cannot access them.
