The number of deaths due to opioids has shown no signs of diminishing—drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017 (see National Rate of Opioid-Related Inpatient Stays Increased 79% Since 2008, D.C., Florida & Pennsylvania Had The Highest Rate Of Increase In Opioid-Related Deaths In 2016, 70,000+ Drug Overdose Deaths Reported In 2017, Up 9.6% From 2016, and Overdose Death Rates). This crisis has also strained the health care system, most notably at the emergency room level, where opioid overdoses increasing 30% between 2016 and 2017 (see Emergency Department Data Show Rapid Increases in Opioid Overdoses, Opioid-Related Emergency Department Visits By Older Adults Rose 217% Between 2006 & 2014, and Women Have 374.8 Opioid-Related Hospital Stays Per 100,000 Population.)
This has led to massive new federal spending to address opioid addiction and changes in federal policy (see CMS Announces New Medicaid Payment Model For Maternal Opioid Abuse Treatment and HHS Planning Policies To Allow Telemedicine-Based Prescription Of Medication Assisted Treatment). State policies and practices have also changed in response to the wave of more opioid abuse—Kentucky Medicaid To Cover Methadone Treatment Services, Philadelphia To Invest $36 Million In Resilience Project To Increase MAT Access, Alaska DHSS Issues RFP For Medication Assisted Treatment Services In 6 Regions, and Massachusetts Jail Ordered To Give Inmate Methadone For Opioid Addiction.
So, you may be wondering why the Centers for Disease Control and Prevention (CDC) issued new guidelines on February 29, 2019 that expand the recommended use of opioids for chronic pain, palliative care, and end-of-life care (see CDC Clarifies Opioid Prescribing Guidelines For Chronic Pain). The reason is concern about inappropriate withdrawal of pain-relieving opioid medications for these consumers. A group of physicians called Health Professionals for Patients in Pain (HP3) have claimed that health plans, provider organizations, and physicians misapplied the Centers for Disease Control and Prevention (CDC) opioid prescribing guidelines—leading to health care consumers with unnecessary pain due to dose reduction. These actions have pushed some consumers to start using illicit substances and considering suicide due to uncontrolled pain. (For more on the work of HP3, see Health Professionals Call On The CDC To Address Misapplication Of Its Guideline On Opioids For Chronic Pain Through Public Clarification And Impact Evaluation.)
The push for the guideline clarification was in reaction to the many policy responses to the wave of opioid abuse that restricted access to opioid medications—and caused unintended consequences for consumers with chronic pain (see CDC’s Opioid Guideline For Chronic Pain Often Misapplied and HHS Draft Report Recommends Biosocial, Multi-Modal, Multidisciplinary Approach For Pain Management). To put this on a personal level, last month, I had an interesting discussion with someone suffering from severe pain due to a skeletal condition. He said that he was reduced to asking friends for any “leftover” opioids because his physicians of many years refused to prescribe more due to the new guidelines. His comment—”a handful of physicians nationwide are now willing to prescribe opioids for pain—and people with legitimate needs are driving hundreds of miles to see them.”
The obvious answer to the question of when opioid medications are appropriate for a consumer is “it depends.” And that presents a challenge for both health plan and provider organization executives. There needs to be some middle ground between preventing unnecessary prescriptions for opioids and assuring access for appropriate uses. The challenge for provider organization management teams is in developing decision support tools for clinical professionals responsible for prescribing—and in having analytics to monitor appropriate and inappropriate prescription patterns (see Checklist For Prescribing Opioids For Chronic Pain, Guideline for Prescribing Opioids for Chronic Pain: Recommendations, and Prescription Drug Monitoring Programs).
But, there are opportunities in change—and management teams should look at the many services where demand will increase, including community-based medication assisted treatment (MAT) programs, programming for children with opioid addictions, addiction recovery programs for the criminal justice system, new pain management programming, and specialized health care coordination models (see New CDC Opioid Guidelines Present New Opportunities).
For more resources on substance abuse disorder and the opioid epidemic, check out these resources in the OPEN MINDS Industry Library:
- Health Plan Strategy Meets The Opioid Crisis
- A Mosaic Solution To The Opioid Challenge
- Opioid Addiction By The Numbers
- The Stigma Of Addiction Treatment Medication
- For Addiction Treatment, Medication & Beyond
- The State ‘Crazy Quilt’ Of Opioid Treatment Policy
- How Far Does $3.3 Billion Go?
- The Privacy Rule For Addiction Treatment Is Final
- Residential Addiction Treatment-The Opportunity In Changing Medicaid Policy
- Untangling The Access Issues For Addiction Treatment
For more, join me on June 5 at The 2019 OPEN MINDS Strategy & Innovation Institute for the session, “Addressing The Opioid Crisis: An Opportunity For Innovation In Serving High-Risk Consumers”, featuring John Talbot, Ph.D., Vice President, Corporate Strategy, Jefferson Center for Mental Health, & Advisory Board Member, OPEN MINDS; Devin A. Reaves, MSW, Co-Founder & Executive Director, Pennsylvania Harm Reduction Coalition; and Paul Bacharach, President & Chief Executive Officer, Gateway Rehab.