Silent Epidemic: Heroin In Southern Oregon Part Two

Jul 21, 2015

This week, Jefferson Public Radio’s Liam Moriarty is introducing us to several people with a front-row view of Southern Oregon’s epidemic of heroin and opioid addiction. Today, we meet Dr. Jim Shames, an addiction specialist and the medical director for Jackson County Health and Human Services. He says doctors like him played a key role in creating that epidemic. Now, he’s leading innovative efforts to turn it around.

Dr. Jim Shames is an addiction specialist and medical director for Jackson County. He's leading innovative efforts to get a handle on heroin and prescription painkiller addiction in the region.
Credit Liam Moriarty / JPR

In the 1990s, Shames was a family physician in private practice. And when patients came to him complaining of pain, like most other doctors, he’d often prescribe opioid painkillers such as OxyContin or Vicodin.

Jim Shames: "It made sense to everybody. It made sense to me. That’s the way I was practicing in the ‘90s."

Shames says doctors were being pressured to provide more pain relief. Research papers, many funded by the pharmaceutical industry, contributed to a growing professional consensus that opioid painkillers were safe and should be used more liberally.

Jim Shames: "When your state medical board says, ‘Hey docs, you need to be more compassionate about treating pain.’ When you go to the hospital and they say, ‘Don’t let people suffer with pain. Otherwise, we will look negatively upon your recertification.’ After a while you’ve created an entire thought bubble that supports your point of view, and that’s where we have been for a while."

Shames reached a turning point several years after he became medical director for Jackson County Health and Human Services. In 2006, he says, the county medical examiner brought to his attention a stunning fact.

Jim Shames: "‘Do you realize we have about one citizen a week dying from accidental overdoses in Jackson County?’ And I said, ‘I cannot believe those numbers. You’re going to have to show that to me.’ And we sat down in his office and we pulled file after file after file of people who died from prescription drug overdoses."

Confronted with this grim toll, Shames started looking for ways to, as he put it, “turn off the spigot” of the opioid drugs that had become so ubiquitous. He formed the Opioid Prescriber Group and invited doctors and other health care professionals to develop new ways of treating their patients’ pain that don’t risk turning them into addicts.

He says the existing treatment model simply doesn’t work.

Jim Shames: "You walk in, we close the door, we spend 15 minutes. You expect a pill, I expect to give you a pill, and out you go and everybody’s happy. This requires something very different."

Shames’ group has devised guidelines for appropriate use of opioids, based on research that suggests for most chronic non-cancer pain, opioids are not the best treatment.

The group has also developed alternatives to opioids that involve a range of practitioners, from physical therapists and mental health counselors to acupuncturists and yoga teachers. Shames says this is a new approach for most doctors. But, he says …

Jim Shames: "Whatever the modality is, whether it’s way out there in terms of what a physician is comfortable with or something that really resonates in terms of the therapy they’re used to, it’s got to be coordinated. And that’s where I think the difference is."

Shames says many doctors are getting onboard with the new approach. Others, not so much. But, he says, the numbers show the effort is making a difference.

Jim Shames: "The most hard data you can look at is, who lives and who dies. We had 46 accidental overdose deaths in 2006. And we’re now down into the low teens or single digits."

But it turns out there’s a perverse consequence of this success.

Jim Shames: "The more successful we are at reducing the number of pills being prescribed, the more expensive they become on the black market. And the price of heroin’s just going down."

The result? What Shames calls “a huge upswing” in overdose deaths from heroin … The irony is not lost on him.

Jim Shames: "We’ve been concentrating initially on the upstream, which is, as I said, turning the spigot down. But there’s a lot of downstream public health measures we need to take as well."

Among those measures, Shames says, is making effective treatment available to those who got addicted by following their doctors’ orders. He says he still carries that sense of responsibility.

Jim Shames: "I feel bad about it. I feel like I in a sense kind of pushed opiates on a number of people that would have much been better off without them."

Next, we’ll talk with an addiction expert about why opioids are so easy to get hooked on, why they’re so hard to kick and why effective treatment is so important.

Copyright 2015 Jefferson Public Radio