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Tag: JAMA

  • Could Alcohol Use Screenings Become More Common For Adults?

    Could Alcohol Use Screenings Become More Common For Adults?

    One task force suggests that if an adult reports drinking more than recommended amounts, doctors should take steps to help them cut back.

    Alcohol use screenings while seeing a physician may become more common for all adults, due to a new recommendation from the United States Preventive Services Task Force. 

    The recent recommendation, according to CNN, was accompanied by a statement Tuesday (Nov. 13) in the journal JAMA. The statement advises that if an adult reports drinking more than recommended amounts, doctors should take steps to help them cut back. 

    Recommended amounts, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), are different for men and women and across age ranges. Men 21 to 64 years old should not surpass four drinks daily or 14 drinks weekly.

    For women and men over 64, that changes to three drinks daily and seven drinks weekly. For women who are pregnant, no level of alcohol consumption is safe. 

    The task force has made similar recommendations before, and this is simply the latest update to the version from 2013. Among the changes is removing the phrase “alcohol misuse” and replacing it with “unhealthy alcohol use.”

    The task force has recommended since 1996 that doctors screen adult patients and provide counsel if need be. Prior to that, in 1989, the task force suggested that doctors should have their patients describe their alcohol use. 

    However, in an editorial accompanying the recommendation, Boston University School of Public Health officials Angela Bazzi and Dr. Richard Saitz wrote that not enough doctors are doing so.

    “Yet implementation of screening and brief intervention still remains quite low,” the editorial read. “For example, in the United States, 1 in 6 patients reports having discussed alcohol with their physician; rates in Europe are similarly low.”

    The authors go on to state that addressing unhealthy drinking in adults could be difficult for various reasons.

    “First, screening may be met with reluctance if unhealthy alcohol use is viewed as less ‘medical’ than other conditions,” they wrote. “The stigma surrounding heavy alcohol use and blame that may be placed on patients make this challenge difficult to address, possibly requiring a shift in thinking, additional training, and acceptance of broader, more contemporary views of disease and prevention.”

    Difficulty could also be due to the brevity of doctor visits, as well as the normalization of drinking in today’s culture, Bazzi and Saitz wrote. 

    The pair went on to note that the way alcohol is viewed in society must change in order to make forward progress.

    “The societal context must change, as recommended by the World Health Organization, to limit the influence of the alcohol industry and make the message unequivocal that less use of a toxin and carcinogen (even at very low levels) is better for health,” the two concluded. 

    View the original article at thefix.com

  • Are Health Insurers Driving The Opioid Crisis?

    Are Health Insurers Driving The Opioid Crisis?

    While the brunt of the negative attention has focused on drug suppliers and prescribers, experts are now examining the role that insurers have played in the epidemic.

    Health insurers could be stoking the opioid epidemic, according to a new study published Friday in the journal JAMA Network Open.

    “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology.

    That’s based on a 2017 analysis of 15 Medicaid plans, 15 Medicare plans and 20 private insurers, which revealed that many aren’t applying evidence-based “utilization management” rules that could cut down on opioid overuse.

    “Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander said. 

    The study comes even as a long-term uptick in opioid-related deaths has pushed dozens of states, counties, and cities to launch lawsuits against drug companies and distributors that make and provide the addictive prescription painkillers fueling the overdose crisis. 

    For the most part, the brunt of the negative attention has focused on drug suppliers and prescribers rather than on insurers, but the new findings by the Johns Hopkins Bloomberg School of Public Health probes what roles insurance plans could play in the epidemic.

    The researchers identified specific utilization management tools that insurers may not be relying on enough, such as restricting the quantity of drugs doctors can prescribe, requiring prior authorization or mandating that providers begin with less risky drug alternatives. 

    Quantity limits are commonly used for opioids—but those limits might still be higher than they should be, the researchers found. Generally, insurers capped scripts at a 30-day supply instead of the shorter limit recommended by the CDC. 

    Across all the plans studied in Medicare, Medicaid and commercial insurers, doctors typically weren’t required to start with less addictive alternatives like over-the-counter NSAIDs before doling out more powerful opioids.

    A median of just 9% of the covered opioids in Medicaid plans required doctors to start with something less risky first, the researchers found. For commercial plans, the median number was around 4%. Medicare plans typically had almost no so-called “step therapy” requirement. 

    The majority of opioid prescriptions didn’t require prior authorization, which is when the prescriber has to call the insurer for approval before writing the prescription. Some insurers, however, have begun putting such policies in place for patients with chronic, non-cancer pain. 

    “Insurers can either be part of the problem, or part of the solution,” Alexander said. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go.”

    The analysis comes on the heels of a 2017 deep-dive by the New York Times and ProPublica, which found that many insurers limited access to less addictive —but more expensive—alternatives. 

    “This is not a hypothetical problem,” Rep. Elijah Cummings (D-Maryland), later wrote in a letter to insurance companies. “In my home state of Maryland, 550 people died of an overdose in the first three months of 2017 alone. Synthetic opioids like fentanyl are driving up the epidemic’s death toll, but prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses.”

    View the original article at thefix.com