Dive Brief:
- Many policies aimed at curbing the opioid epidemic in Massachusetts proved to be largely ineffective, a New England Journal of Medicine paper says, raising new questions about private and government stakeholders’ efforts to prevent overdose deaths.
- The paper found that the state's effort to email confidential reports to all controlled-substance prescribers with data on how their opioid prescription history in the past year compared to other doctors in the same specialty showed no evidence of reducing opioid prescribing among high-volume prescribers.
- “Other well-intentioned policies,” such as limiting the supply of opioids dispensed at one time and making so-called doctor shopping illegal, were found to have no meaningful effect, according to the researchers.
Dive Insight:
The paper comes days after several industry players weigh in on measures to combat the crisis.
For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) released a new plank of expanded policy proposals Tuesday it argued would help save lives.
PhRMA’s ideas include: limiting the supply of opioid medications to 7-days for acute pain, mandating prescriber training, expanding access to treatment and overdose reversal agents, further implementing the use of prescription drug monitoring programs, developing non-opioid and non-addictive treatments for pain and expanding law enforcement’s ability to shut down sources of diversion.
Another new effort announced Monday by Aetna aims to reduce overdose deaths by waiving the co-pay for Narcan for fully insurer members starting January 1. The insurer previously ended pre-authorization requirements for buprenorphine products in March for commercial members.
But the new NEJM paper calls into doubt if such efforts are enough: the researchers found that PDMPs and efforts to reformulate certain opioids as examples of policies that have had a mixed effect.
“Rigorous studies are showing that PDMPs are most effective when they have robust design features, such as weekly updates, or when legislation mandates their use. When such features aren’t included and use is optional, clinician adoption is disappointingly low and valuable data are neglected,” the paper states.
One good piece of news is that opioid misuse among teens has dropped to historical lows, according to a National Institutes of Health survey also out this week. In the past year, misuse of Oxycontin stood at 2.7% among high school seniors, a drop from a peak of 5.5% in 2005. National Institute on Drug Abuse Director Nora Volkow said the drop may suggest that some public health programs are working.
“The bottom line is that because there is no silver bullet that can solve this problem overnight, we have to pursue a comprehensive, holistic approach that targets the many different drivers contributing to the crisis,” PhRMA spokesperson Caitlin Carroll told Healthcare Dive.
A House Energy & Commerce Committee GOP spokesperson agreed, telling Healthcare Dive that the committee is focused on “many small, meaningful things we can do to stem the tide,” pointing to efforts to oversee implementation of Comprehensive Addiction and Recovery Act and the 21 Century Cures Act.
But the spokesperson sidestepped a question if more funding is needed to effectively respond to the crisis.
President Trump declared the epidemic a public health emergency, but has not allocated new funding that advocates say is urgently needed.