ASTORIA, Ore. – Oregon está en las garras de lo que los expertos consideran una crisis de salud pública: la adicción a analgésicos, prescritos para tratar el dolor crónico. Un grupo de clínicas de manejo del dolor trabajan para ofrecer opciones a los pacientes.

Una de ellas se encuentra en Astoria y representa el paso más reciente de un esfuerzo estatal para controlar un abuso en el uso de analgésicos, que ya es epidémico en Oregon. El estado ocupa el primer lugar nacional de muertes por sobredosis de medicamentos recetados contra el dolor. Muchas drogas prescritas legalmente para condiciones crónicas llevan a la adicción o son derivadas ilegalmente para otros usos.

La North Coast Pain Clinic (Clínica del Dolor de la Costa Norte) integra la medicina tradicional con terapia física, servicios psicológicos y métodos sin drogas para paliar el dolor crónico. Mark Altenhofen, quien es gerente de proyecto y especialista en dolor, dice que no sólo es una alternativa para los pacientes, sino también para los médicos que son cuidadosos al recetar paliativos del dolor.

“Vemos a médicos que a veces dicen, ‘Bueno, no estoy tratando en absoluto el dolor.’ Y es muy triste, porque la receta es sólo una parte de la herramienta; hasta en cuidados primarios puedes todavía apoyar al paciente incluso si decides no recetar. Hay otras maneras de manejar el problema.”

Un nuevo estudio reporta que entre 2000 y 2012, casi 42 mil oregoneses murieron de sobredosis accidental o indeterminada de fármacos, y más de 15 mil fueron hospitalizados. El documento recomienda la identificación temprana de la gente con problemas de adicción, y una mejor coordinación de la salud conductual y la física.

La Dra. Anne Alftine, directora de estrategia clínica en Jackson County CareConnect (CareConnect del Condado Jackson), dice que las Organizaciones Coordinadas de Cuidados (“CCO” por sus siglas en inglés) – como la Columbia Pacific de la Costa Norte, o Jackson CareConnect en Medford, donde ella trabaja – son un catalizador que integra los diferentes tipos de cuidados. La meta es trabajar más y en colaboración más estrecha con los proveedores de tratamientos contra las adicciones. Asegura que en una gran parte del estado hay desabasto.

“Han faltado fondos durante varios años, y esa es una de las cosas que estamos analizando – y entonces, ¿cómo nos asociamos con ellos de una mejor forma en cuanto a cuidados primarios y servicios para adicciones? ¿Cómo trabajar juntos como socios en ayudar a que esos pacientes tengan los cuidados que necesitan?”

Una investigación nacional sobre el uso de drogas y la salud muestra que sólo una de cada diez personas que necesitan tratamiento contera el abuso de substancias, las obtienen en un lugar especializado. Alftine agrega que eso refuerza la necesidad de un cuidado coordinado.

El Dr. Jim Shames, director médico de Jackson County Health and Human Services (Servicios de Salud y Humanos del Condado Jackson), opina que Oregon está usando enfoques novedosos para evitar que la gente se enganche en los analgésicos –pero agrega que el verdadero progreso necesita un cambio cultural, tanto en los pacientes como en los doctores.

“Realmente queremos cambiar nuestra manera de pensar sobre el manejo del dolor crónico, del dolor en general. Requiere difusión pública, difusión médica. Es un problema grande y profundo, pero las consecuencias de no manejarlo bien son muy severas, sabes? Nos está matando.”


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Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"