Opioids are a public health problem in the U.S. The rate of overdose deaths involving opioids quadrupled since 1999, according to the Department of Health and Human Services. The overdoses include heroin but also prescription pain relievers.
Not to minimize heroin use, but the prescription aspect is the one the healthcare industry needs to consider because it is the mechanism that makes it possible. More than 650,000 opioid prescriptions are dispensed on average every day, while 3,900 people start non-medical use of prescription opioids. The volume of legally prescribed opiates helps fuel misuse by ensuring an abundant supply and raises the question of whether the medicines might be over prescribed.
Many doctors have begun to examine whether patients need as high a dosage as they have received. One driving factor has been pressure from outside.
Payers have also begun to restrict opioid use. Some of the methods they use include “prior authorization on certain formulations/products, quantity limits, dose limits, controlled substance ‘lock-in’ programs, and restrictions on the use of multiple short-acting or multiple long-acting opioids,” as Managed Healthcare Executive learned from Tyson Thompson, PharmD, clinical consultant pharmacist, University of Massachusetts Medical School.
As pressure increases for limits on opioid prescriptions, providers and healthcare organizations need new effective ways to manage pain, particularly with an aging large segment of the population. It is a difficult balance to find and the enforced preventative measures can be ineffective. Patients can shop for multiple doctors and pay out of pocket, avoiding payer restrictions. They might even do so not for their own use, but to sell to addicts. Information systems may lack the sophistication to recognize people who have acquired multiple prescriptions across broad networks of doctors and pharmacies.
Simple solutions are unlikely to work because people’s circumstances differ. What might be possible with office workers in their 30s might fail for middle aged people who do physical work, need the continued income, and yet become disabled by pain.
Many doctors are shifting from opioids to offering anti-inflammatories, physical therapy, or even anti-depressants. Some see acupuncture and counseling as possible tools, as well as mind-body approaches to chronic pain.
According to Thompson, the University of Massachusetts Medical School brings together “the University of Massachusetts Medical School medical director (a practicing internist), the clinical pharmacy manager for University of Massachusetts Medical School Medicaid client, a board-certified psychopharmacology pharmacist, an operations pharmacist and two clinical consultant pharmacists” as a team. The group will review particularly complicated cases and develop individualized plans to address pain management.
Addressing opioid over-prescription is a complicated process and one that ultimately must involve management and executives to see how innovation can help patients and reduce potential legal liabilities.
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