Recognition of the research-based links among tobacco use, chronic pain, and problem opioid use has led progressive, evidence-based programs to begin making tobacco cessation services a key component of addressing the opioid crisis(5,7)

In the context of an opioid crisis continuing to claim lives, how effectively are business-model controllers of public healthcare funds, like Columbia Pacific CCO, providing evidence-based services to vulnerable Americans trapped in the epidemic?

Here’s what it looks like in hard-hit rural coastal Oregon

I    Columbia Pacific CCO has failed to support clinical practices that would support patient use of Marijuana to assist, as supported by research, in managing pain without opioids while tapering off prescribed opioids, instead recommending clinical policy that would abruptly end prescription of opioids if a urine drug test is positive for THC, leaving patients – who generally were provided the opioids in medical settings overseen by Columbia Pacific CCO – at risk of turning to illicit opioids – “on the street”. Clinic chronic pain and opioid prescription policies, as guided by the CCO, ignored the established role of tobacco in worsening chronic pain and risk of problem opioid use.

II    Columbia Pacific CCO uses public healthcare funds to exclusively support Treatment as Usual (TAU) for substance use problems, TAU established by decades of research to predict no benefit or harm for problem substance use and to increase risk of tobacco use.

For example, TAU is wedded to and incorporates 12-Step programming -a set of religious prescriptions completely unrelated to treatment for substance use disorders – and encourages or requires participation in meetings of the religious subcultures (like Alcoholics Anonymous and Narcotics Anonymous) identified with 12-Step practices. At those meetings, addictive use of tobacco – arguably the most lethal and addictive substance among public health threats –is encouraged in a variety of ways. At meetings, tobacco use is:

– socially reinforced – used to connect socially, feel accepted

– ritualized – a reliable, structured part of the experience, a habit

– normalized – ignored as an “addiction”, accepted as something different

– sometimes rationalized – Don’t worry about smoking, focus on your alcohol use

– and rewarded – each time smokers are celebrated for being “clean and sober” while remaining dependent on tobacco

III    Columbia Pacific CCO uses public healthcare funds to support New Age remedies with no support by research for effectiveness in treating a life-threatening substance use disorder -tobacco use.  Creating the belief in smokers that the practices without evidence of effectiveness are treatment for their lethal compulsive behaviors – and billing Medicaid funds for the group sessions – causes harm and looks a lot like abuse of public funds.

IV  Columbia Pacific disseminated clinical practice advice to healthcare programs for tobacco cessation practices, by employees presented by Columbia Pacific as “experts” in the required areas of interpretation of research, substance use problems, and evidence-based practices for substance use. But none of the “experts” had competence or expert background in those areas, neglected to review the current research, and disseminated inaccurate information – recommending use of nicotine replacement products to help stop smoking, when current research points to no benefit from that approach.