Opioid-related deaths have never been higher. Here's how the government is stepping in.
This week, the White House announced President Obama will request in his fiscal 2017 budget plan $1.1 billion to build efforts to curb prescription opioid and heroin misuse. In response to the opioid abuse epidemic, the FDA also announced this week it will shake-up its policies on the class of drugs.
The Centers for Prevention and Disease Centers states individuals most at risk for heroin addiction are men, non-Hispanic white, 18 to 25 years old, living in a large metropolitan area, and addicted to prescription opioid painkillers. Additionally, there was a 100% increase in heroin use among females from the combined years 2002-2004 and 2011-2013 and an 114% increase in heroin use among non-Hispanic whites during the same time period.
According to CDC data, here are the realities of the problem:
- In 2014, opioids contributed to 28,648 deaths in the U.S., a record year.
- Healthcare providers wrote 259 million prescriptions for opioid pain relievers in 2012. This is enough for every American adult to have such a bottle of pills.
- Since 1999, prescription opioid sales have increased 300% in the U.S. yet the amount of Americans self-reporting pain has remained relatively stable.
- Forty-five percent of people who used heroin were also addicted to prescription opioid painkillers.
Federal policy plans set the stage for more action, scrutiny
“Agencies from across [HHS] and throughout the federal government are united in aggressively addressing this public health crisis,” HHS Secretary Sylvia M. Burwell recently stated.
Using a multi-pronged approach, the FDA stated some of its changes will be to improve access to naloxone and medication-assisted treatment options for patients with opioid use disorders as well as support better pain management options, including alternative treatments.
The Wall Street Journal reported the FDA stated it would require new versions of opioids receive tougher scrutiny and manufacturers present evidence about the effects of the drugs after being introduced to the market.
Greater federal involvement will likely impact providers as well as drugmakers' professional lives. The FDA and Obama’s statements comes a little after a month the CDC floated draft opioid prescription guidelines to address the issue. This week at a panel at the National Health Policy Conference in Washington, DC on initiatives and strategies to reduce opioid misuse, Grant Baldwin, PhD, MPH, director of the division of unintentional injury prevention at the National Center for Injury Prevention from the CDC noted the final guidelines will be released this year.
Baldwin said overall drug overdose rates have never been higher but we “haven’t hit the tip” of the curve yet. He stated HHS has earmarked three priority areas to tackle the crisis:
- Providing training and educational resources to assist health professionals making informed prescribing decisions;
- Increasing use of naloxone; and
- Expanding the use of medication-assisted treatment.
Related to the first priority area, CMS has posted an opioid drug prescription heat map to drill down into prescribing habits for areas down to the zip code level.
CDC, through its draft guidelines, is pressing to restrict physicians who prescribe these drugs to patients. The guidelines suggest doctors opt for shorter-acting, lower dosages and try to prescribe three days worth (or fewer) of the drugs, apart from cases related to major surgery. Additionally, the agency recommends doctors should conduct urine drug tests before prescribing opioids to check if patients are already abusing painkillers.
In addition to releasing the final guidelines later this year, Baldwin noted CDC is attempting to improve data quality to generate near real-time surveillance of ED visits related to drug overdoses and improve surveillance of EMS transports related to drug overdoses. He stated such efforts are being done in hopes to better understand the changing demographic patterns of drug overdoses to better target prevention efforts. This is part of CDC’s plan that policy/program structural changes will help influence the behaviors of providers, patients, and insurers which will help drive towards better health outcomes.
How Ohio is seeing returns on its hard work to curb opioid misuse
The magnitude and the demographics of the epidemic have seen multiple states create efforts to curb opioid overprescribing. This week alone, GOP lawmakers in Iowa introduced a bill to encourage using prescribing tamper-proof pills and lawmakers in Virginia advanced a measure that would require prescribers to check the state’s Prescription Monitoring Program before an opioid prescription for over two weeks is written.
Well-coordinated efforts can work. Just take Ohio for example. The state went from 24th to 2nd in the nation in drug-related overdoses. In 2011, Ohio Governor John Kasich convened the Governor’s Cabinet Opiate Action Team (GCOAT). Andrea K. Boxill, MA, deputy director of the cabinet at the Ohio Department of Mental Health and Addiction Services, told Healthcare Dive one of the first things the committee looked at was opioid prescribing guidelines, starting out in the ED. GCOAT noticed people who were becoming addicted to prescription pain medications then transitioning over to illicit drugs. “I think doctors were doing the best they can with the information that was in front of them and often those who have the disease of addiction can create an information package that looks desperate and in need of pain medication and care,” Boxill said.
She notes that addicts can use trigger words or catch phrases that prescribers can respond to accordingly, phrases such as “the pain is sharp. It’s dull. It’s acute. I’m having a difficult time focusing or functioning.”
To help cease inappropriate prescribing, guidelines were put in place so the providers can look at a patient holistically through the Ohio Automated Rx Reporting System (OARRS). Through the one-button system, a provider can look at the patient’s complete prescription history. “In OARRS, you can see how many scripts were filled within 2 years and where they were filled at a county-by-county level,” Boxill noted, adding Ohio is the first in the U.S. to integrate prescription drug monitoring program into the EHR.
“When the physician looks at a client holistically they have a better regard of what will work for that person,” Boxill stated at the National Health Policy Conference. “We can’t continue to say [addiction] is a disease and then continue to have these backhanded passive comments that would suggest it’s tied to morality.”
In Ohio, patients used to be able to twist an ankle, visit the ER, and receive a 30-day opioid prescription. Today, such patients receive 3-5 days worth of pills and must follow up with a physician for more pills. In addition, physicians and pharmacists are being trained how to conduct screenings and refer more appropriate treatment with compassion and care just as if a patient was reporting to the ED.
The work has paid off. The number of opiate prescriptions dispensed to Ohio patients in 2014 decreased by more than 40 million doses compared to 2013 and the number of individuals “doctor shopping” for controlled substances including opiates as identified through OARRS decreased from more than 3,100 in 2009 to approximately 960 in 2014.
In addition, patients receiving opioid prescriptions for pain treatment at doses greater than an 80 mg morphine equivalent dose decreased by 10.8% from Q4 2013, when Ohio’s opiate prescribing guidelines were first announced, to Q2 2015.
Obama's $1.1 billion plan earmarks $500 million to build ongoing federal efforts such as expanding state-level prescription drug overdose prevention strategies and improving access to naloxone. His plan also tackles upping treatment programs. Boxill states increasing capacity and research with regard to best treatments and evidence-based practices is a step in the right direction. "We not only feel [the weight of this epidemic] in the state but we also feel it across the nation."
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