Study: Use of short-acting opioids decrease, long-acting opioids increase

Claims for short-acting opioids decreased while long-acting opioid claims increased resulting in an overall slight decrease in opioid claims, according to new findings presented at the Academy of Managed Care Pharmacy (AMCP) Nexus on October 4, in National Harbor, Maryland.

Death from drug overdoses in the United States was highest in 2014 and 61% of drug overdose deaths involved some type of opioid, including heroin, according to the CDC. Opioid abuse and misuse is a serious public health problem. The development of opioids formulated to deter abuse may help create safer opioid analgesics. The FDA considers the development of abuse-deterrent products a high public health priority.

Prime Therapeutics analyzed pharmacy claims for both short- and long-acting opioids, including an evaluation of long-acting opioids with and without abuse-deterrent properties. Researchers studied administrative pharmacy claims from 15 million commercially insured members from January 1, 2014 through March 31, 2016.

In this time period, there were 20.5 million opioid claims. For this analysis, opioids were grouped into four categories: non-abuse-deterrent short acting, non-abuse-deterrent long acting, abuse-deterrent with the FDA validation, and abuse-deterrent without the FDA validation.

The FDA has validated seven long-acting opioids and approved abuse-deterrent study information in their labels. An additional six products have data suggesting they may have abuse-deterrent properties, but they have not been validated by the FDA to include abuse-deterrent study data in their label.

The study found that, overall, opioid utilization decreased 3.9% from 2014 to 2015. Short-acting opioid claims represented 92% of all opioid claims and short- acting claims declined over the 27-month analysis period. All long-acting opioids accounted for approximately one in 12 opioid claims, yet accounted for nearly half of the opioid cost. Long-acting opioid claims increased 11.3% over the analysis period.

“Insurers need to understand their own utilization patterns to help forecast utilization and expenditures associated with new and existing abuse-deterrent opioid legislation,” Cathy Starner, PharmD, principal health outcomes researcher at Prime, told Managed Healthcare Executive. “Managed care executives should increase their own awareness in the category and ensure prescribers are aware of CDC guidelines for opioid prescribing and the prescription drug monitoring programs.”

The study also found that long-acting opioids accounted for only 8% of the total claims and 46% of total paid.

“It is also interesting to note that in the time of an opioid epidemic we are still seeing opioid claims increase over time,” Starner said. “While short-acting opioid claims did decrease, the long-acting abuse-deterrent opioids increased. This is concerning because prescribers may be assuming these abuse-deterrent products actually prevent abuse which is not true. Opioids with abuse-deterrent properties are not proven to eliminate abuse.”

According to MultiState Associates Inc., in August 2014, Massachusetts became the first state to pass abuse-deterrent opioid legislation requiring the FDA validated abuse-deterrent medications to be covered by insurers and put limits on cost-sharing requirements for patients.

In 2015, Maryland and Maine passed similar abuse-deterrent opioid legislation. Florida and West Virginia passed abuse-deterrent opioid legislation in 2016.

Approximately 30 bills relating to abuse-deterrent opioid drugs have been introduced in about 20 states across the country during this 2016 session.

The FDA has validated label changes for seven extended-release/long-acting (ER/LA) opioids with abuse-deterrent properties consistent with the FDA’s Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling. The products are: OxyContin, Targiniq ER, Embeda, Hysingla ER, MorphaBond, Xtampza ER and Troxyca ER.

“An additional six products have data suggesting they may have abuse-deterrent properties, however they have not been validated by the FDA to make any label changes,” Starner said.