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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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.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.