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Tag: opioid prescribing

  • Opioid Prescribing Varies Widely By Region, Study Shows

    Opioid Prescribing Varies Widely By Region, Study Shows

    In some states, patients were up to three times more likely to be prescribed opioids.

    Whether or not patients are prescribed opioids in the emergency room and how many of the pills they get varies widely by region, according to a new study, suggesting that despite increased awareness about the dangers of opioids there is still plenty of room to cut down on unnecessary prescribing. 

    According to Science Daily, researchers from the University of Pennsylvania School of Medicine examined insurance claims to see how patients presenting with sprained ankles were treated for pain.

    In some states, patients were up to three times more likely to be prescribed opioids. Researchers also found that people who received more opioid pills were five times more likely to fill an additional opioid prescription over the following six months. 

    “Although opioids are not—and should not—be the first-line of treatment for an ankle sprain, our study shows that opioid prescribing for these minor injuries is still common and far too variable,” said M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn who led the study. 

    “Given that we cannot explain this variation after adjusting for differences in patient characteristics, this study highlights opportunities to reduce the number of people exposed to prescription opioids for the first time and also to reduce the exposure to riskier high-intensity prescriptions,” Delgado said. 

    The study examined more than 30,000 patient records and found that 25% were given opioids. 

    “Although prescribing is decreasing overall, in 2015 nearly [25%] of patients who presented with an ankle sprain were still given an opioid, a modest decrease from 28% in 2011,” Delgado said. “By drilling down on specific common indications as we did with ankle sprains, we can better develop indicators to monitor efforts to reduce excessive prescribing for acute pain.”

    Researchers found that there was a huge variation between states in the percentage of patients given opioids. For example, only 3% of patients received an opioid prescription in North Dakota, compared to 40% in Arkansas. If states with above-average prescribing were reduced to the average amount, 18,000 fewer opioids pills would be prescribed each year. 

    In addition, if all patients were given the smallest supply of opioids, usually 10-12 pills, there would be a significant reduction in the number of pills distributed. 

    “Simply making these amounts the default setting electronic medical record orders could go a long way in reducing excessive prescribing as our previous work has shown,” Delgado said, noting that the concept could be expanded to other areas of care.

    “It would be great to see analyses such as ours replicated in other settings, such as post-operative prescribing, where prescriptions are higher intensity. In these settings there may be greater opportunities to decrease transitions to prolonged opioid use by reducing excessive prescribing.”

    View the original article at thefix.com

  • Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    Healthcare Pros Talk Unintended Consequences Of Addressing Opioid Crisis

    “Doctors just say, ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” said one health expert.

    The opioid epidemic has drawn more political and media attention than any other public health crisis in recent memory, but healthcare professionals say that the focus on preventing opioid-related deaths is having unintended consequences for patients dealing with other conditions including cancer, chronic pain and other forms of substance use disorder. 

    One of the biggest concerns is that patients are being taken off their opioids too quickly, which can increase physical symptoms of withdrawal and leave patients feeling overwhelmed by the idea of quitting. 

    “Some people will be tapered too quickly or in a way that is intolerable to them,” Elinore McCance-Katz, the Health and Human Services assistant secretary for mental health and substance use, told Politico. 

    Sally Satel, a psychiatrist and Yale University School of Medicine lecturer, said that some doctors are less understanding of slowly tapering patients because they’re concerned about their own liability. 

    “I’ve seen patients where doctors just say ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” she said.

    Although policies have shifted to focus on non-opioid pain relief, these options are still less likely to be covered by insurance, leaving patients with chronic pain with few options.

    The Department of Veterans Affairs and the Defense Department have begun paying for alternative care, but “beyond that it’s pretty much just been lip service and it’s a little challenging how to craft legislation that affects what private payers are able to offer in this arena,” said Bob Twillman, executive director of the Academy of Integrative Pain Management. 

    “It’s one thing for an insurer to cover [an opioid alternative]. It’s another thing to cover it at a co-pay that the patient can afford,” said Cindy Reilly, who recently left the Pew Charitable Trust, where she focused on issues around opioid use and access to effective pain management. “We need to stop making opioids the easy decision—in terms of writing prescriptions and patient access. Higher co-pays will stand in the way.”

    Sean Morrison, chairman of the geriatrics and palliative medicine department at the Icahn School of Medicine at Mount Sinai, said that he is increasingly seeing hospice patients unable to get the opioid drugs needed to make their end of life more bearable. 

    “Almost every patient I have prescribed for recently has either a) run into pharmacies that no longer carry common opioids; b) cannot receive a full supply; and c) worst of all had their mail order pharmacy refuse to fill or have had arbitrary and non-science based dose or pill limits imposed,” he said. 

    Joe Rotella, the chief medical officer for the American Academy of Hospice and Palliative Medicine, agreed. 

    “Even with exemptions for hospice care, prescription limits are still having an impact,” he said. “Patients have a tougher time getting these medications and it’s a lot more hassle for providers.”

    Cancer patients are also being affected as hospitals experience a shortage of IV fentanyl and morphine. 

    Finally, the focus on funding interventions for people abusing opioids has deflected money from other drug-intervention programs. This is especially problematic in areas like the Southwest, where overdose deaths from methamphetamine are rising sharply. 

    “We treat drug epidemics like ‘whack a mole,’” said West Virginia Public Health Commissioner Rahul Gupta. “We get one under control, another pops up.”

    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