Six Ways to Effectively Manage Pain During an Opioid Epidemic

Calabrese

Taking the life of a U.S. citizen every 13 minutes, the opioid epidemic continues to devastate our country and overwhelm our communities, neighbors, coworkers, friends, and family members. This national health crisis places an undue burden on the entire healthcare system, negatively impacting health outcomes and causing significant financial strain.

While it’s well-documented that these medications remain overprescribed, opioids represent very effective options for managing pain for select chronic medical conditions like cancer and end-of-life care, and in short-term treatment of more severe acute pain where alternative therapy may not be suitable. Despite the attention drawn to the epidemic and the excess supply of these medications on the market today, we must also remain conscientious of the large numbers of patients with chronic, debilitating pain who rely on opioids to improve their quality of life and overall function, and ensure appropriate access to viable, effective, non-opioid treatment alternatives.

Opioids are powerful medications with highly addictive potential, and anyone taking them, regardless of predisposition to addiction, can find themselves struggling with reliance and dependence. An estimated 2.1 million Americans suffer from ‘documented’ opioid use disorder, according to the Substance Abuse and Mental Health Services Administration. Further, data shows the economic cost of the opioid crisis, including treatment, was $504 billion in 2015.

Given the depth and breadth of this crisis, virtually all constituents of the healthcare system hold some level of responsibility in utilizing tools and resources at their disposal to help address this epidemic. To be successful, solutions must be multidimensional, mixing evidence-based clinical programming, educational outreach, and aggressive intervention in order to curb overuse, misuse and abuse, and to protect the safety of those requiring opioid therapy. Efforts must address every step of the process and target all stakeholders including patients, pharmacists/pharmacies and physicians. The most effective actions will address the contributing factors at the epidemic’s core, with tactics spanning several components, such as:

• Prevention and education. Despite the prevalence of this issue, many don’t realize how closely tied this problem is to an inclination to overprescribe, over-demand and over-consume opioid medications. Appropriate use of opioids is achieved when pharmacists, physicians, caregivers and patients are fully informed about the risks, proper dosage, drug storage, and potential side effects.
• Minimizing early exposure. Since features of physical dependency can begin to occur within as little as a few days of initiating opioid therapy, safer non-opioid alternatives should always be considered for treating chronic and acute pain. When opioids are used, physicians and other healthcare providers who prescribe these medications should do so consistent with CDC guidelines for both dosing and length of therapy.
• Reducing inappropriate supply. Despite growing concerns regarding the epidemic, physicians and other healthcare providers issued nearly 215 million opioid prescriptions in the United States in 2016, equating to nearly one full 30-day supply for every adult U.S. citizen. By reducing the initial supply of opioids in patients newly exposed to an opioid to an acceptable amount based on a patient’s condition, physicians and prescribers can better monitor usage, and patients are less likely to abuse treatment. Applying evidence-based utilization management protocols, limiting unnecessary therapy extension, monitoring for abuse and diversion, and decreasing exposure to harmful drug interactions through routine medication screenings can help limit the inappropriate volume of opioids prescribed.

Related: Four Ways Health Execs Can Help Patients Recover from Addiction

• Treating at-risk and high-risk members. Certain patients are at a higher risk for opioid dependency/misuse based on daily dosage, drug combinations, doctor or pharmacy shopping, and/or previous history of substance abuse issues. Progression to chronic opioid use, defined as regular use with signs of dependency, can be averted by developing programs that prevent fraudulent dispensing, as well as adopting prescription monitoring and auditing programs that use data to find at-risk patients in real-time. For members at the highest levels of risk for opioid abuse and overdose, intensive, personalized management by fully informed care professionals may be required.
• Supporting chronic populations and recovery. Identifying and guiding patients with current or previous histories of overdose or misuse are critical long-terms solutions to the epidemic. Effective treatment options such as the proactive promotion of medication-assisted therapy (MAT), monitoring adherence to such therapy, monitoring for patient relapse, and offering long-term support are proven strategies in improving healthcare outcomes.
• Safe disposal of excess supply after treatment. According to national study, approximately 60% of Americans retain leftover opioid medications in the home, often in unsecured locations. Additional data supports the fact that many of those who misuse, abuse and divert opioid medications are commonly obtaining them by borrowing, stealing or buying leftover opioids from friends, family, or other acquaintances. Rather than disposing of unused opioids in the trash where they can be retrieved and potentially abused, or flushing excess pills which can contaminate water supply, a safe, convenient, and effective method of disposal should be used such as a Deterra kit. The Deterra kit is a simple-to-use means of deactivating the opioid medication so it can be properly disposed of and not misused. Organized collections like National Drug Take Back Day also represent an opportunity for safe drug disposal.

A plan in action

As a pharmacy care services company, OptumRx is focused on improving health outcomes and lowering total healthcare costs. Through implementing tools such as advanced data analytics, prior authorization requirements, and fraud monitoring strategies, OptumRx has achieved a significant degree of success through its Opioid Risk Management Program. For example, health plans and employer clients who have adopted the program saw significant reductions in opioid prescriptions and average daily opioid dosing, facilitating greater compliance by physicians and other prescribers with opioid prescribing standards set by the CDC. Positive results since the program’s launch include a 31% reduction in opioids prescribed, and a 34% reduction in total doses dispensed. Most importantly, in a recent analysis conducted by OptumRx and Optum Labs, clients who deployed such programming witnessed a 50% lower likelihood of patients progressing from short-term acute use to longer-term chronic opioid use.

As an industry and a country, we’re collectively taking steps in the right direction and the results we’ve seen have been encouraging. The current administration has passed new legislation that would help reduce the supply of highly addictive substances, like fentanyl, while creating incentives for using non-opioid pain treatments to improve quality of outcomes. A recent

from the American Medical Association shows the number of opioid prescriptions decreased by more than 22% between 2013 and 2017, with a 9% decrease between 2016 and 2017 alone.

While progress continues to be made, ending the opioid epidemic is a process, and will require collaborative action amongst multiple stakeholders across the health care continuum and beyond-including care providers, pharmacists, governments, clients, individual consumers, and community organizations-with the ultimate goal of protecting our citizens, while still preserving the highest quality in health outcomes for all.

David Calabrese, RPh, MHP, is senior vice president and chief pharmacy officer of OptumRx. He also is an editorial advisor for Managed Healthcare Executive.