ASTORIA, Ore. - A new pain-management clinic in Astoria is the latest step in a statewide effort to curb an epidemic of pain medication abuse in Oregon.

The state is ranked first in the nation in deaths from pain prescription overdoses. Many drugs prescribed legally for chronic conditions lead to addiction or are diverted to other users illegally.

The North Coast Pain Clinic integrates traditional medicine with physical therapy, psychological services and non-drug methods of easing chronic pain. Mark Altenhofen, project manager, said it's an alternative not only for patients but for doctors wary of prescribing painkillers.

"We're seeing docs say, 'Well, I'm not treating pain at all,' in some cases," he said. "And it's really sad, because the prescription is just one part of the tool. Even in primary care, you can still support that patient even if you decide not to prescribe. There are other ways to help address the issue."

From 2000 to 2012, according to a state report, almost 4,200 Oregonians died of an unintentional or undetermined drug overdose, and more than 15,000 were hospitalized. It recommended early identification of people with addiction problems, and better coordination of behavioral and physical health care.

Dr. Anne Alftine said Coordinated Care Organizations such as Columbia Pacific on the North Coast or Jackson CareConnect in Medford, where she works as director of clinical strategy, are serving as catalysts to integrate the different types of care. One goal is to work more closely with addiction treatment providers. In much of the state, Alftine said, they're in short supply.

"It's been under-funded for a number of years," she said, "and that's one of the things we're looking at: How do we partner with them in better ways, in connecting primary care and addiction services? How do we work together as partners, in helping these patients get the care that they need?"

According to a national survey on drug use and health, only about one in 10 people who need specialized substance abuse treatment get it from a specialized facility. Alftine said that's more proof of the need for coordinated care.

Dr. Jim Shames, medical director for Jackson County Health and Human Services, said Oregon is taking other innovative approaches to keep people from becoming hooked on painkillers - but real progress requires a cultural shift, for patients and doctors.

"We really have to change the way we think about the management of chronic pain - of pain in general," he said. "It requires public messaging, physician messaging. It's a big issue and it runs deep, but the consequences of not getting it right are pretty severe. It's killing us."


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.