Amid a national epidemic of prescription opioid abuse, urgent care clinics in Los Angeles County have been slow to adopt guidelines designed to combat over-prescription and abuse of the powerful pain medications.
Last summer, officials with the L.A. County Department of Public Health announced that 80 urgent care clinics had adopted the guidelines. Despite a campaign to increase that number, only 11 more clinics signed on over the past year, according to Dr. Joel Hyatt, one of the leaders of the effort, a collaboration of the county, health insurers and medical providers called Safe Med LA.
There are 281 urgent care clinics in the county, Hyatt says.
It's important to get urgent care clinics on board, he says, especially because all 74 emergency departments in the county adopted the guidelines.
"The concern is, where do these doctor-shopping patients go next?" Hyatt says. "One of those places is often urgent care clinics."
The guidelines, established by the American Academy of Emergency Medicine, advise clinicians to try to address pain with non-opioid treatments first. If there is a clear need for opioid medication, then they should start by prescribing the lowest effective dose of opioids and for no more than three days, the guidelines say.
Doctors are advised to consider screening patients for opioid misuse or addiction, and to refrain from replacing lost opioid prescriptions or refilling opioid prescriptions for chronic pain.
The 80 urgent care clinics that first supported the effort are owned and operated by medical groups or health systems, says Hyatt. The collaborative worked with health plans, which reached out to the clinics they contract with, to sign up the next 11, he adds.
But the effort to reach the remaining urgent care clinics has been hampered by the lack of a statewide association representing them, says Hyatt.
"It has created a more difficult scenario in trying to recruit them," he says.
The operators of a number of independent clinics haven't returned calls or emails, says Hyatt, adding that others have said they don't prescribe opioids and aren't interested in participating.
"We're going to have to make cold calls or go door-to-door to many of these mom-and-pop or independent urgent care clinics to try to have that conversation," says Hyatt.
The Safe Med LA collaborative hopes to get at least half of the urgent care clinics in the county – about 140 – participating in the effort by next summer.
This story has been updated to reflect the number of urgent care clinics in Los Angeles County, according to the county's Department of Health Services.