Drug overdose deaths and opioid-involved deaths continue to climb, according to the CDC. Ninety-one Americans die every day from an opioid overdose—that includes prescription opioids and heroin. Most drug overdose deaths (more than six out of 10) involve an opioid.
“The opioid epidemic, and the corresponding issue of overdose deaths, represents the largest public health crisis this nation has seen during most of the population’s lifetime—the swine flu outbreak about a century ago was the last epidemic to reach a similar scale,” says Capt. Michael Colston, USN, Office of Health Services Policy & Oversight, Department of Defense Health Affairs. The overdose epidemic caused more deaths in 2016, approximately 60,000, than HIV/AIDS, gun violence, suicide, or automobile accidents ever did at their corresponding peaks. Overdoses from the strongest synthetic opioids, such as fentanyl, have tripled, says Colston. Here are four programs that are making a difference:
1. Partnership HealthPlan of California’s managing pain safely (MPS) initiative
“The opioid epidemic has created a significant strain on the health of our communities as valuable resources are being shifted to address overdose and other health issues arising from unsafe prescribing,” says Robert Moore, MD, medical director of the managed care plan, which serves more than 570,000 individuals. “For us, we felt the severity of the issue necessitated that we act and take the first step in helping communities address the issue,” he says.
The MPS is firmly grounded in community involvement, says Moore. “The success of our plan has always been built on the relationships—partnerships—we have in the community with members, physicians, health centers, community organizations, and more. As we know, the opioid epidemic cannot be solved by a single entity,” he says.
The program includes cross-sector representation including providers and medical associations, law enforcement, and educational entities. “While this cross-sector approach is becoming more common in this opioid work, it was relatively new at the time of formation,” says Moore. “As we implemented our MPS program, we saw that the community coalitions that were the most successful had the most wide-ranging representations. Additionally, this comprehensive strategy has helped shift knowledge and norms within the prescribing community, and is working to do the same at the community level.”
Health plans are in the unique position to directly impact and guide provider prescribing habits, says Moore. “We leveraged changes in our formulary to help facilitate safer prescribing for our members,” he says, adding that they also updated prescriber guidelines. “MPS started with a goal to prevent escalating doses of opioids for patients already on high doses,” says Moore. “This has morphed into supporting clinicians in our network to think critically when prescribing opioids at any dose, and to support safe and appropriate prescribing.”
Since the initiative started, the organization experienced a 68% decrease in total opioid prescriptions from January 2014 to June 2017.