The Crux of the Opioid Epidemic

As the country works through finding medically responsible solutions to eradicate the opioid epidemic, a blame-game has ensued and is making the crux of the issue cloudy. The opioid crisis is the result of unchecked, inappropriate prescribing habits.

Are opioids the only inappropriately prescribed drugs?

This year’s National Rx Drug Abuse and Heroin Summit hosted a panel discussing “Problematic Patterns: Overlapping Opioid/Benzodiazepine Prescriptions”. Panelist Gery Guy, PhD, MPH, Senior Health Economist for the Centers for Disease Control and Prevention shared findings from a study on overlapping prescriptions in 9 states.

Contrary to clinical practice guidelines which recommend avoiding the prescription of opioid pain medication and benzodiazepines concurrently whenever possible, the study found that opioids and benzodiazepines are actually being prescribed together more frequently.

In California, Delaware, Florida, Idaho, Kentucky, Maine, Ohio, Virginia, and West Virginia overlapping prescriptions occurred as much as 29.7% of the time in patients (22.4% on average). This means that in the more problematic areas, nearly 1 out of every 3 patients received overlapping prescriptions against clinical practice guidelines. Dr. Guy’s presentation download is available here with an Rx Drug Summit-issued password.

The practice of overlapping prescriptions is a dangerous affair. A 2017 study from The BMJ concluded that concurrent benzodiazepine/opioid use has sharply increased in a large sample of privately insured patients in the US. The notable increase has significantly contributed to the overall population risk of opioid overdose.

To paraphrase recent commentary from Virginia Representative, and Ranking Member in the Federal House Committee on Education and the Workforce, Bobby Scott (D):  How does a prescription get filled without someone along the line certifying that the drug being prescribed is actually medically necessary?

Excellent question Representative Scott.

Are narrow legislative bills enough to keep patients safe?

The State of Massachusetts recently passed a modified version of Governor Charlie Baker’s House Bill 4033 requiring the Department of Industrial Accidents to create a drug formulary for workers’ compensation. The latest version of the text, included in House Bill 4470, narrows the focus of the drug formulary to opioid prescriptions only. Judging by stakeholder commentary, a compromise on Governor Baker’s original bill was the only path for some form of the legislation to be passed.

Earlier this year, both chambers in the State of Pennsylvania’s legislature, the House and Senate, struggled to get Senate Bill 936, requiring the adoption of an evidence-based drug formulary, to Governor Tom Wolf’s desk for consideration. Governor Wolf vetoed the bill providing what many in Pennsylvania considered to be a hollow commitment to enact standards to curb the inappropriate prescription of these dangerous drugs (read my blog post about SB 936 and Governor Wolf’s veto letter here).

Considering the fate of Pennsylvania’s SB 936, the compromise in Massachusetts may prove to be a great first step. Still, one has to wonder if the passage of such a narrow bill will be effective in keeping injured workers safe with prescribers having little prescribing standards to consider. Is Massachusetts swapping one pharmacy problem for another? Only time and the measurement of health outcomes will tell.

For now, the crux of the opioid epidemic continues to elude some influencers in the legal and medical communities across the country. Lacking comprehensive evidence-based prescribing standards, today’s opioid issue has the potential to evolve into another prescription drug crisis tomorrow.

Categories: Evidence-Based Medicine (EBM), Healthcare, Managed Care, Opioids, State Government, State Workers' Compensation Standards

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