Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.
Dr. Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.
She committed this past summer to a two-year project consisting of occasional visits to medical providers in California’s most rural areas, where opioid deaths and prescribing rates are high.
“I view it as peer education,” Meengs said. “They don’t have to attend a lecture half an hour away. I’m doing it at [their] convenience.”
“There is some poetic justice in the fact that these programs are using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using … to disseminate less helpful and occasionally distorted information.”
The total budget for the detailing project in California is less than $2 million. The state’s Department of Public Health oversees it, but the money comes from the federal Centers for Disease Control and Prevention (CDC) through a program called “Prevention for States,” which provides funding for 29 states to help combat prescription drug overdoses.
The California doctors and pharmacists who conduct the detailing conversations are focusing on their peers in the three counties hardest hit by opioid addiction: Lake, Shasta, and Humboldt.
They arrive armed with binders full of facts and figures from the CDC to help inform their fellow providers about easing patients off prescription painkillers, treating addiction with medication and writing more prescriptions for naloxone, a drug that reverses the toxic effects of an overdose.
In an earlier effort, Coffin said, his department conducted detailing sessions with 40 San Francisco doctors who have since increased their prescriptions of naloxone elevenfold.
“One-on-one time with the providers, even if it was just three or four minutes, was hugely beneficial,” Coffin said. He noted that the discussions usually focused on specific patients, which is “way more helpful” than talking generally about prescription practices.
One recent afternoon, Dr. Meengs paid a visit during the lunch hour to Fortuna Family Medical Group in Fortuna, a town of about 12,000 people in Humboldt County.
“Anybody here ever known somebody, a patient, who passed away from an overdose?” Dr. Meengs asked the group, a physician, two nurses and a physician assistant.
“I think we all do,” replied the physician, Dr. Ruben Brinckhaus.
Brinckhaus said about half the patients at the practice have a prescription for an opioid, anti-anxiety drug, or other controlled substance. Some of them had been introduced to the drugs years ago by other prescribers.
Dr. Meengs’ main goal was to discuss ways in which the Fortuna group could wean its patients off opioids. But she was not there to scold or lecture them. She asked the providers what their challenges were, so she could help them overcome them.
Dr. Meengs will keep making office calls until August 2019 in the hope that changes in the prescribing behavior of doctors will eventually help tame the addiction crisis.
“It’s a big ship to turn around,” said Meengs. “It takes time.”