How Does Doctor Shopping Impact The Opioid Epidemic?

Surprisingly, the non-medical prescription of drugs, including opioids, continues, with only states holding legislation against this dubious practice smothering the flames helping stoke the opioid addiction fire. Since 1999, deaths from prescription opioids have quadrupled, alongside opioid sales of painkillers such as oxycodone (Oxycontin) and hydrocodone (Vicodin). But this hasn’t stopped opioid abusing patients from trying to nab a couple of extra pills by ‘doctor shopping,’ the practice of hopping from physician to physician and playing the numbers until finding a doctor who will meet the patient’s desire for a few extra pills. Luckily states nationwide, alongside the insurance and healthcare community, are becoming increasingly aware of these issues, and are attempting to stem this contributing facet of the epidemic through the use of prescription drug monitoring programs (PDMPs). And a new study has shown them astonishingly successful.

An Easy-to-Use, Effective Means of Curbing ‘Doctor Shopping’

Physicians utilizing these state-run electronic prescription databases, mandatory in some states and voluntary in others, offers them access to each patients prescription history, and the opportunity to see drug types and quantities prescribed to patients before breaking out the prescription pad. In addition to thwarting potentially deadly drug interactions and excessive dosages, a recent study has shown that these programs are highly effective for reducing the non-medical prescription of drugs, boasting a whopping 80% reduction in the odds two (or more) doctors would dole out pain relievers for non-medical reasons to a single patient in states with mandatory PDMP use, and slashing the odds 56% in states with voluntary participation. Every state except Missouri now has one of these programs. Other studies have also shown states tracking a wider range of potentially addictive medications and updating databases weekly witnessed the biggest reduction in overdose deaths.

Won’t Patients Turn to Illicit Substances?

Public health advocates have had this worry for quite some time, but the current study pointing to the massive, 80% reduction in non-medical prescription of opioids in those states with mandatory programs also uncovered some reassuring news. PDMPs did not, in fact, lead to an increase in doctor shopping individuals turning to heroin. This offers hope for the promise of PDMPs as part-and-parcel of a multifaceted, comprehensive strategy toward fighting the nation’s opioid epidemic, which steals the lives of 91 Americans each day.


About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.


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Opioids Still the Top Prescribed Drug in California

Using data derived from the 10.8 million workers comp prescriptions dispensed between January 2005 and December 2014, a recently released report by the California Workers’ Compensation Institute identified opioids as the number one prescribed drug in California’s workers’ compensation system.

Report findings indicate that opioid prescriptions accounted for 27.2% of total prescribed pharmaceuticals. In addition, the average cost of opioid prescriptions rose by 85% from $61 to $113. In comparison, other prescription drugs within the same time frame experienced only a 39% increase, from $94 to $131. The report also indicated the proportion of injured workers prescribed opioids within the first 24 months following injury increased from 22.4% in 2005, to 27.9% in 2010.

Some positive trends were revealed however - in 2014, opioids dispensed to injured workers in the state dropped to 27.2%, from a 2009 peak of 31.9%. Also, the impending implementation of a statewide formulary is expected to contribute to reduced opioid use.

At the end of the day however, opioid use is still excessive. While prescription drug monitoring programs have been a focus of California state regulators, other California Workers’ Compensation Institute studies of utilization review have shown that medical management resources in California have been disproportionately directed to the review of requests for opioids and pain management drugs.

In workers’ compensation pain management, opioids continue to be prescribed in situations where their use may not be entirely appropriate, increasing the patient’s risk of addiction or overdose. ANS’s pharmacotherapy review program has been highly successful in uncovering overprescribing and ineffective management of patient treatment plans not just in California but across the country. The work of our legal nurse experts lays the ground work for pain treatment regimens that reduce the financial costs of large loss claims, while improving quality of care and life for injured workers.

To learn more about are success rate in California, contact ANS Solutions today.

This content was originally posted at http://ans-solutions.com/opioids-still-the-top-prescribed-drug-in-california/

Sources:

Hayes, Steve, Swedlow, Alex. “California Workers’ Compensation Institute: Trends in The USE of Opioids in California’s Workers’ Compensation System,” May 2016.

CDC Opioid Guidelines Sheds Light on Conflicting Expert Opinions

The CDCs latest opioid prescribing guidelines, released this March, were created with the goal of achieving balance between the analgesic and addictive properties of opioid analgesics, to uphold the safety as well as meet the pain management needs of the public at large. Unfortunately, the controversy surrounding these guidelines points to a detrimental issue at the crux of their implementation: A fractured field – two expert, yet conflicting, schools of thought on the current opioid policy.

• Treating chronic pain with a wider range of treatments, as opposed to relying mainly on opioid regimens.
• Avoiding the use of high dose prescriptions, as well as the combined prescription of opioids and benzodiazepines, to reduce the risk of overdose.
• Providing addiction treatment when necessary (methadone, buprenorphine).

There are two conflicting schools of thought regarding treatment approaches to opioids…

1. Reduce Pain and Suffering.
   This paradigm stems from an aggressive movement in the 1990s wherein physicians trained in pain management and palliative care were instructed to be sympathetic to pain. Enforced by the belief that those in true pain would not become addicted and reinforced by pharmaceutical companies and federal agencies pointing to pain as “the fifth vital sign,” this movement missed the boat on understanding the serious risks of opioid addiction.
2. Prevent and Treat Addiction.
   Driven by addiction specialists, who lacked an understanding of the seriousness of debilitating and chronic pain and whose priorities were vastly different than pain and palliative care physicians, practitioners of this model had a more thorough understanding of the addictive risks of opioid regimens. They watched the sales of opioid prescriptions quadruple from 1999-2010 - alongside the rate of overdose deaths. Though the need for a rapid public health response remained apparent, insufficient evidence on safe stoppage procedures for opioid regimens existed. Dissention among experts as to the seriousness of the problem and how to address also further muddied the waters.

The Fulcrum between Analgesia and Addiction

Though the CDC’s recently released guidelines are as strong as they can currently be, opioid pain treatment regimens – and addiction treatments – continue to be a work in progress. The fractured nature of this field reflects the reason changes were such a long time coming. A multidisciplinary approach will be as essential to working out the kinks as they were to the development of the CDC’s recently released guidelines, as all parties involved strive to save lives and ensure quality of care.

Are you looking for more advanced and comprehensive medical cost containment strategies that protect patient outcomes while also reducing the costs associated with pain management in workers compensation claims? ANS Solutions’ pharmacotherapy review program can help.

This content was originally posted at http://ans-solutions.com/cdc-opioid-guidelines-sheds-light-on-conflicting-expert-opinions/

Prescription Drug Abuse Knows No Bounds

Earlier this month, the American public was shocked by the untimely death of iconic pop legend Prince. Though autopsy results remain unreported, media coverage alleges that Prince was struggling with a prescription pill addiction to Percocet, receiving treatment for an opioid overdose just days before his death.

This post is not to re-hash celebrity news from various gossip reports but rather to point out the depth and breadth of the prescription drug epidemic. In the past decade, Whitney Houston, Heath Ledger, Brittany Murphy, Anna Nicole Smith and Michael Jackson were just a few other celebrities to overdose on legally prescribed medication. These very public deaths reflect a larger wave of prescription drug abuse across the United States, something ANS has touched on frequently in our blog posts.

A Proactive Approach to Patient Care

There seems to be a false sense of security that accompanies the use of doctor prescribed pain killers- the risk of addiction may not be stated clearly enough or is just not taken seriously.

At the end of the day opioid addiction knows no boundaries, spanning all races, ages, genders and income levels.

When it comes to chronic pain treatment, a focus on the education of well-being of the injured worker is crucial. That is why ANS developed pharmacotherapy review – not only as a medical cost containment strategy for payers, but as a proactive approach to minimizing inappropriate, duplicate or unnecessary treatment regimens, as is often seen with opioid based prescription pain killer treatment regimens.

Through in-depth reviews of each patient’s medical history alongside the assessment of the practices of prescribing physicians, our legal nurse experts are able to uncover underlying illnesses, behaviors and risks, and then implement actionable recommendations to existing treatment plans, addressing potential issues before they can lead to serious adverse events.

Concerned about the growing opioid epidemic and how it’s contributing to treatment outcomes and your large loss workman’s comp claims? We can help, contact ANS today at www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/prescription-drug-abuse-knows-no-bounds/

FDA Focuses on Opioid Policy

The FDA has recently acknowledged its own need to establish a “far-reaching action plan to reassess the agency’s approach to opioid medications” in order to reduce the trend, deemed by the U.S. Department of Health and Human Services as “a serious public health issue.” Now the leading cause of accidental death in the U.S., more Americans currently die from drug overdoses annually than motor vehicle crashes, the majority of which can be linked back to opioid prescription medications such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.

National Attention

In addition to spurring the FDA to action, Health and Human Services Secretary Sylvia Burwell identified the boundlessness of the epidemic, citing the importance of both state and federal leaders coming together to form “a coordinated and comprehensive approach to address this crisis.” President Obama has also taken part in multiple efforts to curb the issue, including his 2010 National Drug Control Strategy to address opioid use disorders and overdose, as well as an October 2015 Memorandum to Federal Departments and Agencies calling for improved prescriber training and improved access to treatment for those addicted.

Recent Court Cases Press the Issue

The limelight on opioids has also triggered debate in the political arena, as well as even deeper scrutiny by the medical and workers’ comp communities, particularly following an array of eye-opening court cases in which doctors are being held liable for opioid prescribing practices. The most recent? February 2016’s Tseng Conviction, in which a California general practitioner was sentenced 30 years to life for the prescription of unnecessary painkillers which contributed to the fatal overdose of three patients.

The FDA Proposal to Combat the Epidemic

In response to the crisis, the FDA “has developed a comprehensive action plan to take concrete steps toward reducing the impact of opioid abuse on American families and communities.” Among the steps being taken…

• Advisory committees to review new drug applications, especially for opioids without abuse-deterrent properties.
• New warnings and safety labels to help doctors better understand risks and safe prescription practices.
• Upholding new requirements for drug companies to provide new data on the long-term impact of opioid drugs.
• Improved and updated CME training, including proven uses for opioids and safe prescribing practices, to decrease inappropriate prescriptions.
• Creating/expanding access to abuse-deterrent opioid formulations (ADF) to discourage abuse by spurring innovation, as well as generic formulations, of ADF products.
• A re-examination of the risk-benefit paradigm for opioids to include consideration of the widespread public health effects of drugs.

ANS Pharmacotherapy Review

Our approach to pharma review and intervention is the only face-to-face program of its kind offering evidence-based and actionable treatment recommendations that reduce pharma spend while offering improved quality of care for the injured worker with reduced risk of overdose and addiction. Contact http://www.ans-solutions.com to learn more about our comprehensive pharma review and intervention programs today.

This content was originally posted at http://ans-solutions.com/fda-focuses-on-opioid-policy/

SOURCES:

http://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/

http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

https://www.whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector

http://www.hhs.gov/about/news/2015/09/17/hhs-hosts-50-state-convening-focused-preventing-opioid-overdose-and-opioid-use-disorder.html#

http://www.fda.gov/NewsEvents/Newsroom/FactSheets/ucm484714.htm

http://nationalpainreport.com/commentary-the-debate-over-opioids-should-be-much-more-than-it-is-8829446.html

http://www.consumerreports.org/cro/magazine/2014/09/the-dangers-of-painkillers/index.htm

No Proven Benefit for the Use of Opioids in Chronic Pain

Millions are addicted to or dependent on prescription opioids. Worse than the dependency, over 200,000 deaths are attributable to prescription opioids, as well as hundreds of thousands of overdoses. What’s the biggest contributor to the epidemic, you ask? Most commonly, it’s the inappropriate prescription of opioids for the treatment of issues like musculoskeletal disorders, chronic low back pain, headaches, and other issues.

Insights from a Leading Pain Expert

A recent study conducted by leading pain expert Gary Franklin, MD, MPH, V.P. of Physicians for Responsible Opioid Prescribing, provides substantial evidence that prescribing opioids for chronic pain offers no real benefit. Franklin has been striving to shed light on this issue which is believed to be contributing in large part to the prescription opioid abuse epidemic sweeping the nation. Opioids such as hydrocodone and oxycodone have increased in prescription from around 76 million in 1991 to nearly 207 million in 2013, making the U.S. the biggest global consumer for these products at nearly 100% of word consumption for hydrocodone, 81% for oxy. Most notably, Dr. Franklin’s research found clear evidence of dose-dependent risk for serious harm:

• A dramatic increase in death with opioids administered at a dose of 100mg MED (morphine equivalent dose).
• A risk of overdose 2-5 times higher when the above MED runs between 50-99mg.
• Doses lower than 100mg MED still result in overdose – even without long-term therapy.
• Opioids administered in combination with benzodiazepines, sedative-hypnotics, or muscle relaxants dramatically increase the risk for harm.
• Double the risk of remaining on disability 1 year for those treated with opioids for at least 7 days (cumulative dose: 150mg MED).

Reversing the Trend

Believed to be the direct result of poor research and outdated teaching practices, the most important step toward reversing the opioid epidemic is simple- putting a stop to improperly prescribed opioids particularly for chronic pain. To aid this effort, t­he American Academy of Neurology and a number of states have produced product guidelines advising against the use of opioids for the treatment of musculoskeletal conditions, headache, or fibromyalgia, and additionally advising physicians to proceed with caution when initiating opioid therapy for pain or long-term use. (Since released, the guidelines created as a result of the drug utilization review have effected a 30% sustained decline in overdose deaths and a substantial decline in injured workers on chronic opioids in Washington State.)

Evidence-based Alternatives

Opioid therapy is not necessarily the only answer to treating chronic pain. Drug utilization review programs such as ANS Pharmacotherapy Review can provide alternative therapy recommendations. ANS deploys an exceptionally credentialed network of nurse experts to deliver recommendations in face-to-face meetings with treating physicians. These recommended treatment options are equally, if not more effective than opioids. Better still, they offer improved quality of care and quality of life for the injured worker.

If the pitfalls of opioid therapies are taking over your workers’ comp claim settlements, the proven drug utilization review protocols at ANS Solutions can show you a better path. Optimized outcomes for the injured worker are possible. Contact ANS today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/no-proven-benefit-for-the-use-of-opioids-in-chronic-pain/