Finally, Good News Regarding Opioid Use

Levounis

The number of opioid prescriptions dropped 12% in 2017, the biggest drop in 25 years, according to a new report.

The IQVIA Institute for Human Data Science study, “Medicine Use and Spending in the U.S.: A Review of 2017 and Outlook to 2022,” found that prescription opioid dosage volume, as defined by morphine milligram equivalents (MME), shows that prescription opioid volume had increased annually since 1992, peaking in 2011. Then, a series of regulatory and legislative restrictions combined with tighter clinical prescribing guidelines and greater reimbursement controls resulted in average 4% per year declines from 2012 through 2016.

Overall, prescription opioid volume decreased annually during the past five years across all 50 states. In addition to MME declines, actual dispensed opioid prescriptions decreased 10.2% in 2017, while high doses, those where the patient was prescribed more than 90 MMEs per day and which correlate with higher risk of dependency and overdoses, declined by 16.1% for the same year. 

Petros Levounis, MD, MA, professor and chair, Department of Psychiatry, Rutgers New Jersey Medical School, is encouraged by this report.

“Prescribers are becoming more responsible and regulations that have been put in place to address the opioid epidemic are bringing results,” says Levounis. “What’s also great is that people now take safe and effective medications to treat their opioid use disorder.”

Unfortunately, what is missed amid all this good news is the rise of illicit heroin, fentanyl, and fentanyl analogs, according to Levounis. “People who are already addicted to prescription opioids and do not receive treatment often switch to heroin and other dangerous opioids when they no longer have access to their pills,” he says. “As a healthcare executive, I'm very concerned that we do not have an adequate workforce of primary care clinicians and addiction specialists to keep up with a raging opioid epidemic. Yes, we are happy that prescription opioids are on the decline and treatment is on the rise, but we are far from being out of the woods yet.”

Kleinrock advises executives to make evidence-based business decisions. “In as much as public opinion could shape their business, they should understand how plan designs are being received in the general market, and they should understand if their business decisions have consequences beyond simply profit and loss,” he says.

Effect on spending

The report also looked at medicine use and spending. “Medicine use is shifting due to changing guidelines, regulations, aging population, and attempts to improve adherence,” says Michael Kleinrock, research director of the IQVIA Institute for Human Data Science. “Medicine net spending is flatter than often reported and those dynamics are complicated.”

In addition, says Kleinrock, patient out-of-pocket cost exposure is rising, but final out-of-pocket costs are declining as patients shift to generics, use coupons, or hit deductibles.

“Innovation is reaching the market in large numbers of drugs but many of them are specialty, niche and orphan,” he says. “The way in which managed care attempt to control the trend on drug spend for their plans is influenced in part by their sponsors wishes, and by their expectation of future usage. There are literally dozens of nuggets of information that help to explain/inform those areas of interest.”