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Nov
20

The Anti-Opioid Movement is gaining speed and traction

The pushback on opioids has accelerated dramatically; every day there’s at least one major announcement about states, the Feds, or other entities taking major steps to attack the overuse of opioids.

We are starting to see some progress.  Perhaps most noticeably, a few weeks ago the CDC published draft guidelines re the use of opioids for treating chronic pain.

Unsurprisingly, the pain industry wasn’t happy. They’ve penned letters to CDC officials and Congress, with one complaining: “a lobbying organization that seeks to reduce the prescribing of opioids appears to have played a significant role in developing the guidelines.”

Allow me a moment to pick my jaw off the floor.  This is the height of hypocrisy.

This is coming from an industry that has used the billions it has made from selling opioids to:

  • lobby state and federal elected officials and regulators,
  • pack ostensibly unbiased review panels with drug company shills,
  • fund “research organizations” that published biased research supporting opioids, and
  • brilliantly and effectively promote the use of this incredibly dangerous and damaging drug.

I’m just stunned at the unmitigated gall of these people.

CompPharma (the work comp PBM advocacy organization of which I am president) has joined with the National Safety Council, Physicians for Responsible Opioid Prescribing, American Society of Addiction Medicine, National Coalition Against Prescription Drug Abuse and several other groups to support the DC guidelines.

The human cost of opioids is a constant and terrible reminder of the impact the opioid promotion industry has on each of us.

Yesterday the estimable Steve Feinberg MD sent one of his periodic emails re interesting issues related to work comp and the delivery of care in comp.. This one was a column by Bob Beckel, an editorialist who recounted how he had to check himself into rehab after a mere eight weeks post-op care involving OxyContin and Percocet had addicted him to the stuff.

Truly frightening.  And very common.

A truly awful side effect of the rampant overprescribing of prescription opioids has been the explosive growth in heroin use.  When patients can’t get prescription opioids, those addicted or dependent may well turn to illicit versions of opiates, namely heroin.

myMatrixx’ Phil Walls RPh has written an excellent synopsis of the history and current status of heroin. Detailed, thorough, readable; download and read on your next flight.

Perhaps the most trenchant observation appeared a couple weeks ago in an editorial in the New York Times entitled “How Doctors Helped Drive the Addiction Crisis”.  Here’s Dr Richard Friedman’s concluding paragraphs:

WHAT is really needed is a sea change within the medical profession itself. We should be educating and training our medical students and residents about the risks and limited benefits of opioids in treating pain. All medical professional organizations should back mandated education about safe opioid treatment as a prerequisite for licensure and prescribing. At present, the American Academy of Family Physicians opposes such a measure because it could limit patient access to pain treatment with opioids, which I think is misguided. Don’t we want family doctors, who are significant prescribers of opioids, to learn about their limitations and dangers?

It is physicians who, in large part, unleashed the current opioid epidemic with their promiscuous use of these drugs; we have a large responsibility to end it. [emphasis added]

Kudos to Gov Charlie Baker (R) of Massachusetts.  Gov Baker is calling for a strict limit on initial opioid prescriptions throughout his state.  Of course several docs are protesting this, noting problems of access for patients who need the medications.  It would be even better if these docs noted the problems inherent in opioid prescribing; perhaps they did but the reporter didn’t publish those comments… (thanks to Jake for the tip!)

Finally, there are many, many pieces and parts to ACA, including significant funding for clinical research, patient outcomes research, and research into improving the delivery of care. The Patient-Centered Outcomes Research Institute just closed it’s request for proposals for research into Clinical Strategies for Managing and Reducing Long-Term Opioid Use for Chronic Pain.

There’s nothing more important in the work comp world than this issue. 


6 thoughts on “The Anti-Opioid Movement is gaining speed and traction”

  1. UCLA has a great program called Re:claim for Prescription opioid dependence. Contact me for more information

  2. Joe,
    Excellent blog! This problem is ever-growing despite the efforts of all stakeholders including PBM’s like IPS. We are making some progress but I’m sure you would agree we have a long tough road ahead to really reverse this epidemic. I could not agree more that Physicians are primary to the explosion and until Payers and law makers unite to allow for the narrowing of approved treating physician networks that enable payers to restrict access to claimants from bad actor physicians we will have a tough time changing physician prescribing patterns. Frankly, this type of network narrowing should also include the large chain pharmacies that increasingly want to pillage the comp industry with higher drug prices compared to a group health claim. We all know that it does not cost a pharmacy a dime more to dispense a drug to a work comp claimant than it does to dispense the same drug to a group health patient. The payer industry needs a good education as to the difference from the PBM side with respect to managing a comp claim vs. a group claim and the significant difference and therefore need for higher pricing or admin fees to cover the extensive oversight and utilization management and reporting on a comp claim. The PBM deserves more to administer a comp claim but a pharmacy does not deserve more to dispense a drug to a comp claimant. What are your thoughts?

    Respectfully, Greg Todd
    PS. Happy Thanksgiving

    1. Hi Todd – thanks for the comment.

      I appreciate your comments and perspective. Regarding the cost to the retail pharmacy, I’d suggest there is a good deal more work inherent in dispensing to the comp patient, and more risk as well. As WC only pays for non-controverted scripts that are related to the occupational injury, it is critical that the pharmacy manage that risk – either proactively or retrospectively via a third party biller. Either way, it is more costly.

      For initial fills, the patient often has no idea who their work comp insurer is, much less the PBM. Thus the pharmacy has to do this legwork if it wants to get paid.

      Once the claim is accepted, the pharmacy still has to ensure the meds it is dispensing are related to the occ injury or it won’t get paid.

      I certainly agree that a key solution is for payers to be much more diligent about which docs they use.

  3. My understanding is that for any claim that is work comp, but the injured worker lacks an ID card with the PBM data on it, the pharmacies process these scripts and then sell them to third party billers like Stone River – and Stone River does all the tracking down and accepts the risk.

    What work does the pharmacy do here?

    1. Hi Randy – thanks for the comment and question.

      The injured worker has to fill out extensive paperwork re the claim, employer, demographic details etc.

      Stone River does not accept all scripts. It may reject scripts for any number of reasons, which leaves the pharmacy holding the proverbial bag.

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Joe Paduda is the principal of Health Strategy Associates

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