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Sonoma County Adopts Opioid Prescribing Guidelines

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Sonoma County Adopts Opioid Prescribing Guidelines

The Committee for Healthcare Improvement, a coalition of healthcare providers that is part of Sonoma County Health Action, announced health care organizations across Sonoma County are implementing common guidelines for safe pain management. The purpose of adopting standardized practices across all emergency departments and most primary care providers is to ensure that clinicians follow best practices for addressing pain while simultaneously curbing the nationwide opioid epidemic.

“As leaders, we aim to make our county the healthiest in California. Today in Sonoma County emergency departments, visits for accidental opioid overdose have gone up 73% over about a four year period, and our rate is significantly higher than California overall. I’m proud that our medical community is leading the effort to address the issues of overuse and misuse head-on” said Sonoma County Board of Supervisors Chairwoman Shirlee Zane.

“In 2014, about one quarter of Sonoma County residents filled an opioid prescription. Such a high number is contributing to the epidemic,” said Dr. Karen Milman, Sonoma County Health Officer. “There are clear risks when using an opioid that the public needs to be aware of, including the possibility of misuse or negative long-term health risks. Opioids should only be used when necessary, and usually only for short periods of time.”

Uniform guidelines help update physicians about evolving best practices, alternatives for treating pain effectively, and avoidance of combinations of medicine considered particularly dangerous. Guidelines also recommend writing prescriptions for shorter durations and closely monitoring patients and their progress. In addition, the guidelines provide better ways to talk with patients about pain management options. 

“As medical providers, we are learning about the grave risks of long-term opioid use as well as how we have over-estimated the benefits,” conveyed Dr. Lisa Ward. “It is our imperative to partner with our patients to share this information so that together we use the safest and most effective strategies for the many patients we care for living with chronic pain.” Dr. Ward is the Chief Medical Officer for Santa Rosa Community Health Centers and co-led the efforts to create the guidelines.

The guidelines were created by Health Action’s Committee for Healthcare Improvement (CHI), which is charged with optimizing healthcare delivery and improving health in Sonoma County.


To learn more, here is Sonoma County's informational website for Public Education where you will also find RESOURCES for Health Care Providers:



What is an Opioid?

Opioids are pain relieving medications, such as codeine, morphine and oxycodone.  They are also commonly known by their brand names, for example, Vicodin and OxyContin.

They are: 

  • Most often used for new, acute pain, such as after surgery, an accident, or a fall
  • Come in many forms, including tablets, capsules or liquid

Opioid medications are to be used with caution and always under a medical provider’s close supervision because these medications have many serious side effects such as reducing or stopping your breathing. Continued use can lead to physical and/or psychological dependence. People who use opioids, even for as little as a few weeks, may experience withdrawal symptoms when the drug is discontinued or not taken consistently.  Some examples of withdrawal symptoms include increased pain, sweating, feelings of anxiety and diarrhea.

Know the Risks

Talk to your health care provider about the risks and side effects of prescription opioids.

Opioid medications can:

  • Cause your breathing to slow or stop, which can lead to death
  • Cause dizziness and increase your risk for falling
  • Lead to hormonal changes and reduced testosterone levels

Every year there are, on average, 44 deaths in Sonoma County due to accidental drug overdose.

Annually on average, there are 476 emergency department visits for accidental drug overdose among Sonoma County residents. 

As many as 1 in 4 people who are taking a prescription opioid long term obtained from their primary care provider struggle with physical and/or psychological dependence.

If You Are Taking Opioids

  • Take pain medication as prescribed by your health care provider and don’t increase the dose without first consulting your provider.
  • Don’t drink alcohol, take sleep aides or other medicines or drugs that make you sleepy.
  • Don’t drive or operate heavy machinery while taking opioids.
  • Never share with other people, and store them in a secure/locked place to keep away from youth and children.
  • Make sure to dispose of leftover and unused medication by returning to a designated safe medicine disposal site. For more information visit:
  • If you think you are experiencing physical and/or psychological dependence to opioids, call (707) 565-7450 for substance use disorder treatment assessment and referral.
  • Talk to your health care provider about whether there is a need for you to be prescribed a medication to reverse the effects of an opioid overdose like Naloxone.

Alternative Treatment Options

Chronic pain can greatly impact quality of life. Safe and effective pain management is the main goal. 

Talk to your health care provider about the safest ways to manage your pain, especially treatments that don’t involve prescription opioids. Some of these options may actually work better and have fewer risks and side effects.  

Treatment options may include:

  • Acetaminophen (Tylenol) or ibuprofen (Advil)
  • Cognitive behavioral therapy
  • Physical therapy and exercise
  • Medications for depression or seizures
  • Interventional therapies (injections) by a pain specialist
  • Complementary and alternative options including acupuncture, massage therapy, mindfulness-based stress reduction, osteopathic manipulation, spinal manipulation, tai chi, yoga, and other relaxation techniques

Resources for Health Care Providers

For more information on safe opioid prescribing visit: Sonoma County Health Action.

Sonoma County Opioid Prescribing Guidelines:

Toolkit for Clinical Providers