The increase in individuals diagnosed with an opioid misuse disorder over the past seven years has significantly outpaced the rate at which patients receive the standard medication-assisted treatment, according to a report by the Blue Cross Blue Shield Association (BCBSA) released last week.
For the report, BCBSA analyzed pharmacy and medical claims for more than 30 million individuals with BCBS commercial insurance from 2010 through 2016. The researchers looked at the number of members diagnosed with an opioid misuse disorder and the number of prescriptions for medication-assisted therapy. The analysis included all eligible members under age 65.
The analysis found the number of BCBS members with an opioid misuse disorder diagnosis surged 493 percent, while the number of individuals using medication-assisted therapy to treat their diagnoses rose by 65 percent. This means the rate of diagnoses grew nearly eight times as quickly as the rate of medication-assisted therapy use, according to Vox.
The analysis found access to treatment varied across the country, with opioid misuse patients more likely to receive medication-assisted therapy in New England than in the South and parts of the Midwest. The researchers said states that saw the highest growth in the use of medication-assisted therapy were not necessarily the areas most affected by opioid misuse disorders.
The analysis also found a correlation between opioid misuse disorders and the strength and length of opioid prescriptions. For instance, patients who were given high-dosage opioid prescriptions for a short timeframe were 40 times more likely to be diagnosed with an opioid misuse disorder than those who were given a low-dose prescription for a short timeframe. The risk of opioid misuse was seven times higher when patients were prescribed a high dose for a long duration than when they were prescribed a low dose for a long duration.
Further, the researchers found women ages 45 and older had higher rates of opioid misuse than men in the same age range. But men younger than 45 had a higher rate of opioid misuse than women in the same age group. Across all age groups, the researchers found, women filled more opioid prescriptions than men.
Kim Holland, vice president for state affairs at BCBSA, said the findings indicate "there's work to do" because "not everyone is getting the treatment they need." Holland said the infrastructure to effectively help individuals with an opioid misuse disorders is lacking, but BCBS companies "are already undertaking initiatives to help families and communities address opioid use disorder by forging partnerships with the medical community to promote best practices in prescribing and providing critical education to the public to raise awareness of the risks of opioid use."
John Kelly, an associate professor at Harvard Medical School who was not involved in the study, said the analysis shows "we are now at the public health equivalent of 'DEFCON 5' with this opioid crisis." He continued, "High-dose, long-duration prescribing practices, which can drive up rates of opioid-use disorder, are still too common," adding, "This needs much closer attention and monitoring to curb the onset of new cases of opioid-use disorder."
David Pizza, managing director of strategy and data analytics at BCBSA, said, "You have to be concerned not just how long the script goes but how high a dose you're prescribing." He added, "The way in which they're provided is key to addressing the dependency issue."
Andrew Kolodny of Brandeis University said stemming the opioid misuse epidemic might require a two-pronged approach, similar to one used in New York City that looks to combat high use of tobacco. Under that approach, officials looked to make tobacco products less accessible while also increasing access to tobacco alternatives, such as certain tobacco cessation tools. Likewise, Kolodny said he would address the opioid misuse epidemic by making opioids less accessible and opioid misuse treatments more accessible (Steele, Wall Street Journal, 6/29; Livingston, Modern Healthcare, 6/29; Lopez, Vox, 6/29; Zimmerman, Becker's Hospital Review, 6/29).
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Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties, and providers typically intervene only after the patient has shown signs of misuse and addiction.
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