A Healthesystems publication

Spring 2012

Opioid Epidemic Update

The good, the bad, and the ugly of our current opioid reality

I open this edition of RxInformer on a topic I was hoping not to write about – and that is the current reality of our opioid epidemic. However, recent developments have compelled me to once again address this long-standing and still incredibly relevant area of concern.

It’s been said that reality is a relative concept, and I can’t help but think how significantly this statement applies to where we currently stand in regard to opioid epidemic.

Here are some positive aspects of our current opioid reality: the workers’ compensation industry has done much, collectively, over the last 15 years to combat the opioid problem. And while the world outside of workers’ comp has been slower to recognize and subsequently act on the opioid threat, it is now being addressed with the urgency it deserves as a public health emergency. State and federal policies are doubling down on initiatives to stem the damage – a notable example being a flood of state-implemented laws limiting the duration and dosage of initial opioid prescriptions. Because of these efforts, as a country we have seen some very real results, with prescribing rates and morphine equivalent dose (MED) levels finally trending lower over the last several years.

Here is the less optimistic view of that reality: “lower” is only relative to the excessive volumes of prescription narcotics that have been prescribed and consumed in our country over the last two decades. In 2016, U.S. doctors wrote 66.5 opioid prescriptions per 100 people. This reflects marginal progress over the last decade when compared with 2006, when doctors wrote 72.4 prescriptions per 100 persons. Still, slow progress is better than no progress at all.

Then, of course, there is the downright ugly version of reality, in which national opioid overdose rates continue to rise – steeply. The CDC released provisional data in August that estimates more than 53,000 opioid-related deaths occurred in 2016. If final statistics land near that number, this would mark an increase of 20,000 deaths, reflecting the sharpest increase observed over a one-year period to date.  This trend is in large part driven by illicit use of fentanyl; however, the provisional data also demonstrate an increase in deaths related to natural and semi-synthetic opioids such as oxycodone and hydrocodone.

Continued Efforts & Education

While some may be tempted to dismiss fentanyl as a concern outside of workers’ comp and focus on the positive progress we’ve made as an industry, it would be highly remiss. Right now, opioid management remains more important than ever. Not only from a claims cost management perspective, but to ensure we aren’t sending patients down an initial path of prescription opioids that will continue to feed the subsequent reality of illicit opioid use and related overdose deaths. 

Thus, as much as it pains me to revisit this conversation year after year, we must persist in pursuing dialogue and education about problematic opioid use, as well as strategies for addressing it. In this edition of RxInformer, we bring attention to state initiatives being undertaken against opioids in “State of the Nation: States Take on Opioid Epidemic” (see page 38). In “Reality Check: New FDA Initiatives Re-Examine Opioid Policies” (page 26), we report on recent FDA activity as this federal governing body makes steps to realign its policies regarding opioids to better address the public health concerns presented by prescription opioid medications. And in “New Pathways in Pain Management: Novel Non-Opioid Medications” (page 12), we explore some of the non-opioid medications currently in development for the treatment of chronic pain. 

Evolving Specialty Conversation

Even as we continue to bring much-needed insight to the long-standing opioid challenge in workers’ compensation and beyond, it’s equally as critical to appropriately manage newer and developing trends.

Specialty has been an area of focus for the last several years in workers’ compensation, primarily due to the slow but steady increase in specialty drugs prescribed to injured workers, and the resulting impact on pharmacy costs. However, while drug prices have been a prevailing conversation around specialty medications, it’s important to also consider critical care decision points that impact disease and overall medical cost management, such as the potential for improved health outcomes, the need for timely access to care, and patient factors that greatly influence the effectiveness of specialty drugs, including medication adherence. In “6 Specialty Trends Impacting Workers’ Comp Right Now” (page 16), we discuss six chronic conditions impacting workers’ compensation claims, highlighting important considerations when managing these patient populations as they relate to specialty medications.

I hope you enjoy this edition of RxInformer as we continue to highlight both current and evolving important areas of focus in the healthcare and workers’ compensation industry. As a final thought, I urge us all – whether thought leaders and influencers, clinicians, decision-makers, or claims staff – to keep doing our part to evolve the current status of the opioid epidemic into a more positive reality.  

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