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/

Key Takeaways from a Recent National Safety Council Survey

Subsequent to the CDC’s new guidelines regarding the treatment of chronic pain, The National Safety Council (NSC) released its latest survey regarding doctor prescribing practices. Summarized below, the statistics:

CDC Guidelines: Use non-opioid therapies first.
NSC Stats: 74% of doctors erroneously believe opioids (morphine, oxycodone) are the most effective way to treat pain.

The Missing Link: Research shows OTC pain meds (ibuprofen, acetaminophen) offer the most effective relief for acute pain.

CDC Guidelines: Do not use opioids for the routine treatment of chronic pain.
NSC Stats: 67% of doctors base there prescribing practices – in part – on patient expectations.

The Missing Link: Patients are often unaware – and doctors wary to inform them – of the effectiveness of alternative treatments for pain. 50% of those patients would return to those prescribers offering alternative treatment.

CDC Guidelines: No longer than 3 days of opioid treatment, beginning with the lowest effective dose.
NSC Stats: 99% of doctors are prescribing these highly addictive drugs for longer than the CDCs recommended time frame – 23% for at least a month.
The Missing Link: Though doctors have the best interests of patients at heart, additional education and training on effective pain management are integral to curbing the rising opioid epidemic.

CDC Guidelines: Address harms of opioid use and assess risk for abuse prior to opioid therapy.
NSC Stats: 84% screen for abuse.
The Missing Link: Only 32% screen for a family history of addiction – a strong indicator.

CDC Guidelines: Re-evaluate risks of continued therapy regularly.
NSC Stats: 99% of doctors have seen a pill-seeking patient – only 32% refer pill-seekers to treatment.
The Missing Link(s): 88% of doctors find referrals overly difficult due to patient unwillingness to cooperate, lack of insurance coverage for such treatments, long wait lists, or lack of providers.

Actionable Treatment Recommendations

ANS's Pharmacotherapy Review Program employs a three staged approach to ensure economically balanced and appropriate treatment options for injured workers. Our legal nurse experts are able to present actionable treatment modification recommendations in a written proposal to treating physicians. Key items of interest covered through the recommendations include:

• Consolidation and coordination of drug therapies between multiple prescribers.
• Consideration of alternate therapies.
• Specification of weaning programs for over-prescribed narcotics.
• Use of generics where applicable.

The end result is a cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. To find out more contact ANS today.

This content was originally posted at http://ans-solutions.com/key-takeaways-from-a-recent-national-safety-council-survey/

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/

Effective Pharma Management Can Help Offset Increases in Prescription Costs

2015 saw rising drug prices contributing to the growth in pharmacy spending for American workers’ compensation payers. Meanwhile, opioid and compound drug cost management continues to be an Achilles heel. An effective pharma cost management program can offset these costs by aiming to improve pain treatment regimens for injured workers.

Pharmacotherapy Review Can Reduce Opioid Spend

Opioids continue to be the costliest class of medications for occupational injuries. To combat the rise in opioid utilization in chronic pain treatment of injured workers, ANS introduced a face-to-face and highly proactive approach to addressing pain physician prescribing practices.  Known as Pharmacotherapy review, it starts with an extensive review of the injured workers’ medical history along with their existing pain treatment regimen and historical physician treatment practices. An ANS Legal Nurse expert with intimate case familiarity visits the doctor in person at their office and negotiates an evidence supported pharmacy regime in a face-to-face and collaborative interaction. The treatment recommendations agreed to during this process not only contribute to reduced opioid prescriptions but often enhance the quality of care and life for injured workers with more risk averse and often more appropriate treatment alternatives.

Combating Rising Compounded Medication Costs

In 2015, the average cost for payers of compounded medications per prescription hovered around $2,000. The cost is high and so are the risks to patients:

• Compounded drugs are not federally regulated and product quality assessments are lacking unlike their FDA-approved counterparts.
• Compounded drugs are not clinically evaluated for safety or efficacy.
• Compounded preparations do not have standard product labeling or prescribing information with instructions for safe use.
• Compounding pharmacies are not required to report adverse events to the FDA
• Potential errors in the preparation of compounded drugs can and have caused adverse effects on patients.

Due to the unnecessary risks compounded drugs pose to patients these products are not considered first-line therapies in the treatment of injured workers. ANS Solutions leads the way in providing medical cost containment strategies that help our clients ensure that pain treatment therapies are appropriate, safe and economically responsibly. By managing compounded medications, clients can reduce unnecessary costs and mitigate the potential harmful effects to patient safety caused by pain physician prescribing habits.

Optimized Financial and Patient Outcomes

ANS medical cost containment programs work uniquely to address these and other legal issues that ensure the most rapid and cost reduced settlement of claims in the industry. Our proven strategies are so effective we offer a 1 million dollar pilot program performance guarantee, completely risk free.  To learn more contact us today or visit www.ans-solutions.com.

 

This content was originally published at http://ans-solutions.com/effective-pharma-management-can-help-offset-increases-in-prescription-costs/

2016 WCRI Annual Issues & Research Conference

ANS recently attended the 2016 WCRI Annual Issues & Research Conference. The independent, not-for-profit institute studies and delivers objective information pertaining to public policy issues involving the workers’ comp system.

Conference Panel Highlights:

• Opioid Prescribing in Workers’ Comp
  • Overview:
    Opioids are a societal problem – not just a workers’ comp issue, and it will take a decade to dig ourselves out. Guidelines are necessary to combat the growing trend.
  • Positive Trends:
    Prescription frequency varies widely by state, leading to revised prescribing guidelines in medical/workers’ comp communities. Retail pharmacies are no longer simply filling, but verifying diagnosis/necessity. The DEA/FDA are also reclassifying some medications to reflect abuse potential, and activist groups supporting change are emerging.
  • Negative Trends:
    A major problem in the workers’ comp arena, the need for early intervention/monitoring is being overlooked by employers, and subsequently programs. Conflicting guidelines also cause confusion. Additionally, use of heroin, the cheaper alternative to prescription opioids, is on the rise.
  • Goals:
    Curtail chronic opioid use and ensure appropriate prescribing of opioids to injured workers and avoid unintended results by boosting awareness of the issue.
• Opioid Dispensing and Use
  • Overview:
    Yet-to-be published studies reveal the impact of pricing reforms for opioid dispensing physicians.
  • Physician Dispensing:
    Following reforms, prices decreased in most states, with fewer prescriptions dispensed. In IL and FL prices substantially increased – because physicians switched to formulations not covered in fee schedules. Price/amounts of pharmacy-dispensed products remained constant.
  • Variations in Use:
    Three-of-four injured workers nationwide receive opioids for pain. LA, NY, and PA dispense significantly higher amounts; NY and PA higher dosages. Patients who received opioids also received benzodiazepines in WI, MI, CT and MA. Per claim amounts decreased from 2012-2014, and frequency of drug testing increased significantly.

As an industry leader in large loss workers compensation claim management, ANS is setting the pace for drug utilization review with our proprietary Pharmacotherapy Review, helping fight the trend of the over-prescription of narcotics. Contact http://www.ans-solutions.com today.

This blog was originally posted at http://ans-solutions.com/2016-wcri-annual-issues-research-conference/

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

Potential Workers Compensation Cost Drivers- Private Label Topicals

We are seeing a trend in which doctors are increasingly prescribing private label topical drugs for the treatment of chronic pain. Awareness of these expensive and clinically unproven products is becoming increasingly important due to their potential safety and cost implications.

What are they?

Differing from custom compounds, private label topicals are similar to over-the-counter (OTC) topical products, with varying formulations that are not clinically tested for either safety or efficacy. Private-label topical analgesics are not recommended according to evidence-based guidelines and they are not approved by the FDA.

From a clinical perspective, private-label topicals offer no greater benefit to the patient than over-the-counter (OTC) alternatives found in national retail chains and in most cases they are significantly more expensive. The potential cost per prescription is disproportionately high with prices points upwards of several hundred dollars yet these drugs being dispensed by physicians and small, independent pharmacies for the treatment of pain when comparable OTC alternatives such as IcyHot® or BenGay typically retail for less than $10.

Curbing the Issue

When recommending any topical product, whether prescription or OTC, physicians must consider patient safety and evidence-based guidelines. More appropriate, less costly alternative treatment strategies may be available for the effective treatment of pain.  ANS Pharmacotherapy Review can help uncover and address private label drug prescription practices. For more information contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/potential-workers-compensation-cost-drivers-private-label-topicals/