This week I want to share two articles about prescription opioids and their deep impact. The first is a comparison of Work Comp opioids in two different states. The second is a robust report on how we can begin to approach the opioid problem in the United States with science and technology. Below are these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
A Tale of Two States regarding opioids
These thoughts originated with two different stories published on the same day by WorkCompCentral (subscription required). It relays a story of how two states, California and Louisiana, are addressing the use of opioids in Work Comp. California’s use has decreased significantly while Louisiana has not gotten any better. The difference is the culture and how that impacted the tools selected and their success (or relative lack thereof).
WorkCompCentral this morning (Dec 2) tells the tale of two states and their experience with Work Comp and Rx opioids…
- “Attorneys Say Workers Need Alternative Treatments as Opioids Continue to Decline” (subscription required) – California has dramatically reduced the use of Rx opioids ($6.5B in savings over 10 years, lower per-capita death rates). For additional context read “Kudos to California!” (9/5/15) and “A CURES for the Disease” (7/11/16). However, there’s concern about what happens next: “Hopefully, the savings will allow for an investment in successful return-to-work programs and not fighting alternative modalities of medical care for workers.”
- “Reports on Drug Costs, Opioid Use Could Amplify Calls for Formulary” (subscription required) – Louisiana continues an opposite trajectory. “The number of opioid prescriptions per comp claim in Louisiana was 6.2, more than double the U.S. average…The average morphine-equivalent dose also was second highest in the country, more than triple the median state’s dosage.” For additional context read “The Louisiana Trifecta” (5/10/17).
If you would like more info about Louisiana, read the summary and the details of a December 4 report from the Louisiana Legislative Auditor. While there appears to be another push for a drug formulary coming in 2020, the usual people are pushing back. I understand the opioid epidemic is now about illicit rather than prescription opioids, and some of the data used by NCCI and this audit are as much as two years old, and that Louisiana has several “hazardous occupations,” and that claim severity is increasing while frequency is declining. But the numbers are the numbers and Louisiana continues to be an outlier compared to other states. The reasons for being an outlier are manifold—many of them political and judicial and unique to Louisiana. Drug formularies in Work Comp have been proven in other states to be part of the solution in conjunction with other tools and tactics (both in Work Comp and in general healthcare / society). Continuing to reject a drug formulary as one of the tools to help encourage clinically appropriate opioid prescribing (remember, “Appropriate, Not Zero, Opioids“) puts the onus to fix it squarely on those who reject it.
This report dives into how technology and science are key aspects to approaching a solution for the opioid crisis. It provides recommendations from scientists and healthcare committees about drug addiction and how we can begin to combat the problem in the United States.
A National Roadmap to Stem the Opioid Crisis is dense but important reading. This Oct 2019 publication by the smartest scientists in the US, with input from a wide range of stakeholders, is full of great observations and ideas. My summary follows:
- Biology and Chemistry of Pain and Opioid Addiction: Scientific understanding is increasing but research needs to be more collaborative
- Non-Biological Contributors to Opioid Addiction: ACE is an important predictor of use/misuse/abuse but not the only contributor to a predisposition
- Pain Management: More education about and accessibility to non-pharma options is needed
- Prevention of Opioid Addiction: Reducing supply and demand are equally important, but data is THE most important
- Treatment of Opioid Addiction and Sustaining Recovery: “there is no ‘one size fits all’ approach”
- Overdose Prevention and Reversal: Naloxone saves lives but comprehensive treatment after an overdose reversal keeps them alive
- Community Consequences of Opioid Addiction: The impact on communities is broad and deep and expose structural flaws that further complicate a response
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-december-9-mark-rxprofessor-pew/
Until Next Week,