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A health plan tackles opioid addiction


Blue Cross Blue Shield of Massachusetts has taken big steps to curb the growing opioid addiction problem.

At least one health plan has taken big steps to curb the growing opioid addiction problem in the U.S. as reflected in a recent report by the National Center for Health Statistics (NCHS).

The NCHS report, released in late February, found that 6.9% of adults over 20 years of age in 2011 to 2012 reported using a prescription opioid analgesic in the past 30 days, up from 5% in 1999 to 2002. It also found that opioid analgesic users who reported using an analgesic stronger than morphine increased from 17% in 1999 to 2002 to 37% in 2011 to 2012. In addition, opioid analgesic sales quadrupled from 1999 to 2010, and opioid-related deaths more than tripled from 1999 to 2010.

A program by

Blue Cross Blue Shield of Massachusetts

(BCBSMA) is one of the first in the nation from a health plan to tackle the trend and its burden on the healthcare system. The health plan released data on its Pain Medication Safety Program, started in July of 2012, as a managed cared initiative between physicians, pharmacists and pain management experts to reduce prescription pain medicine abuse and addiction.

It requires physicians and pharmacists to follow a three-step checklist to ensure that patients aren’t receiving too much pain medication that could lead to abuse or addiction. Included in the program are: limits on amount of opioids prescribed to patients based on best practices, prior authorizations on opioid prescriptions, and checks and balances between physicians and pharmacists to identify patients who receive prescriptions from multiple providers.

“Federal agencies, including the Centers for Disease Control, have called for health plans to respond to the epidemic of painkiller abuse and misuse. Our program has resulted in an estimated 9.6 million fewer doses of opioid-based medications in the community, proving that health plans can make a difference,” says Jenna McPhee, spokesperson for BCBSMA.

Since implementing the program two years ago, BCBSMA has seen a 25% drop in claims for Vicodin and Percocet, a 50% drop in claims for OxyContin, and an increase in patients being referred to pain management experts and more care coordination around patients dealing with chronic pain.

NEXT: "Putting hurdles in place is a good idea"


“We’ve reduced the risk of addiction and misuse of prescription painkillers while protecting vulnerable patients,” McPhee says, adding that in 2012, BCBSMA identified that the state was wrangling a growing opioid abuse and addiction problem. “More than 30,000 of our members received prescriptions for more than a 30-day supply of powerful painkillers such as Vicodin and Percocet. Many experts believe prolonged use of these medications increases the risk of addiction. Thousands of our members were receiving opioid-based prescriptions combined with acetaminophen at levels that could be harmful.”

Andrew Kolodny, M.D., director of Physicians for Responsible Opioid Prescribing, says that the model that BCBSMA created can and should be replicated by other health plans and hospitals.

“Putting hurdles in place is a good idea,” Kolodny says of requiring prior authorizations for opioid prescriptions. “Doctors don’t like it, but it keeps them from the possibility of exposing patients to long-term opioids for chronic pain, and they should have to justify that. It’s a dangerous and questionable practice.”

Related:AMCP: High-risk opioid users spend three times more

Data on the increasing number of people addicted to opioids further the need for more implementation of more managed care practices. More than 30% of Medicare Part D patients who are prescribed opioids have prescriptions from multiple providers. These patients are more likely to be hospitalized due to opioid-related issues, according to the British Medical Journal.

Prescription painkillers were involved in 68% of opioid-related overdoses in 2010, costing $1.4 billion, according to JAMA Internal Medicine. Overdoses from opioid drugs cause more deaths than firearms and car accidents in people from 35 to 54 years old, according to an October 2014 report by the American Academy of Neurology.

Kolodny says that emergency departments in hospitals are on the front lines of managing patients who are addicted to prescribed opioid drugs. Fifty-five percent of patients who come to emergency departments due to prescribed opioid overdose are admitted to the hospital, according to JAMA Internal Medicine. Those patients spend an average of 3.8 days in the hospital at a cost of nearly $30,000.

“Emergency room doctors are in a very awkward place, because on one hand they are being told to treat pain aggressively, and being encouraged by hospital administrators to treat pain aggressively. But they are also seeing lots of patients coming in who are addicted, coming in complaining of pain,” Kolodny says. “Guidelines on prescribing in the emergency room are very important.”


NEXT: How states are managing opioid abuse


States manage opioid abuse

Most states are attempting to manage opioid abuse and addiction, as well. In 2011, Florida passed legislation that banned physicians from dispensing opioids--only pharmacists can dispense the pain medications. New York City released guidelines too for prescribing opioids in emergency departments in 2013, to address what city leaders call an epidemic. Many already have or are planning to launch drug databases so that providers must track the opioid drugs that they prescribe.

Increasing technology surrounding databases and electronic health records can be a helpful tool as health plans begin managing prescribed opioids as well, Kolodny says.

“In preventing new cases of addiction and linking people to addiction treatment, there’s an important role for big data, e-prescribing and prescription monitoring. That data can help us identify doctors who are prescribing aggressively, who may need an educational intervention. If you see that your doctors are mainly treating back pain with opioids, that’s a bad idea,” he says.

Related:Docs slow to e-prescribe controlled substances

Patients with lower back pain who received physical therapy early in their treatment as a referral from a primary care physician, reduced subsequent treatments, including opioid use, and reduced healthcare costs by nearly $3,000, according to a 2012 study published in Spine.

Health plans must begin making it easier for patients to utilize alternative pain management methods and physical therapy in order to manage chronic pain. This has been problematic in the past, Kolodny says.

“If you speak to people in the pain management field, some will say that healthcare didn’t want to pay for non-pharmacological treatment. To get someone out of the office with just a prescription was a short visit and didn’t cost much. I don’t know if that’s true or an excuse,” Kolodny says. “Physical therapy is going to be absolutely a better option to many with chronic pain. But many believe that payers are a barrier to non-pharmacological pain intervention.”

Donna Marbury is a freelance writer in Columbus, Ohio.

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