Editor's note: The Opioid Monthly is compiled by OptumLabs. The Daily Briefing is published by Advisory Board, a division of Optum, which also owns OptumLabs. Optum is a wholly owned subsidiary of UnitedHealth Group, which separately owns UnitedHealthcare.
From the literature
Patient safety: Patients who undergo major surgeries are commonly prescribed opioids—putting them at risk for opioid-related adverse drug events (ORADEs), according to a recent publication in JAMA Surgery. The study found that among adult patients who underwent surgery or endoscopy in a hospital from 2013-2015, 10.6% (14,386) of the 88% (135,379) who received opioids had at least one ORADE (most of which were moderate to severe). The ORADEs studied included respiratory, gastrointestinal, and central nervous system issues, such as acute respiratory failure, constipation, and delirium. Findings reveal that many patients experience harm from opioids administered in hospitals (an understudied area) and these cases should be carefully monitored and reported to inform strategies that can improve patient safety.
From the media
Community impact: A newly released STAT documentary, "Runnin," takes us inside Somerville, Massachusetts, with a story of how pain pills and heroin have devastated the lives of more than a dozen friends and their families. You can the documentary online at STAT with a $9.99 donation. The publication will donate 25% of the proceeds to the Alex Foster Foundation, which supports people with addiction and their loved ones. The film has already won a National Headliner Award and the audience award for best short documentary at the GlobeDocs Film Festival.
Criminal justice and opioid-use disorder: Jail time as punishment for relapse is counterproductive for those on probation who have opioid use disorder (OUD), as mounting evidence shows addiction is more effectively treated as a disease, rather than a choice. A recent New York Times article shares the story of Julie Eldred, who was randomly drug screened as part of her probation program shortly after relapsing and reinitiating Suboxone, a form of medication-assisted treatment (MAT). Despite being back in treatment, she was sent to jail because she tested positive for remaining traces of fentanyl. Experts such as Kelly Mitchell from Minnesota Law School suggest that, rather than interrupting treatment with jail time, people on probation should be evaluated for OUD and required to get treatment, with the condition that failure to do so would be viewed as a violation of probation.
Maternal and child health: A baby is born every 15 minutes with an opioid-withdrawal condition known as neonatal abstinence syndrome (NAS), which can be expected when nearly 90% of women with opioid-used disorder (OUD) who become pregnant did not plan for it—including Alicia and Elizabeth, two women who shared their stories in the New York Times. Depending on where they live, women who use illegal substances while pregnant face various levels of criminal persecution including the loss of child custody—which can sometimes provide the necessary motivation to seek treatment and get better for their new family. Paired with the right support, mothers with OUD and their babies who may be born with NAS can go on to live healthy lives.
Maternal and child health: New programs provide child care services while mothers with opioid-use disorder (OUD) get treatment and build parenting skills, as seen at Horizons at University of North Carolina Medical Center. Children born to mothers with OUD who use opioids during pregnancy often suffer from neonatal abstinence syndrome (NAS), or opioid withdrawal at birth. These NC programs enable close monitoring of children who were born with NAS and may be at risk for complications—such as delays in learning—and an opportunity to address them.
Medication-assisted treatment access: Some stakeholders are arguing that prior-authorization requirements for medication-assisted treatment (MAT) drug coverage are at odds with mental health parity regulations, which require that evidence-based medications for mental health—such as MAT—be covered without barriers when evidence-based medications for chronic conditions are covered without barriers on the medical side. This was the problem Mandy experienced: Because her insurer (Blue Cross and Blue Shield of Illinois) decided not to cover a buprenorphine prescription after review, she must either pay nearly $2,900 a year or go through a long appeals process to get coverage. "I never paid a dime for my opioids. Those were always covered," Mandy said. "But I'm paying all this money for the treatment."
Medication-assisted treatment access: Across the United States, only about a third of people in treatment for opioid-use disorder (OUD) do so with evidence-based medications, and there is continued erroneous prejudice that medication-assisted treatment (MAT)—the evidence-based treatment approach to OUD—means "substituting one drug addiction for another." These solutions aren't perfect, yet about half of people with OUD relapse after six months on MAT compared with the 90% to 95% of people who relapse after six months without it. You can visualize the rates of MAT across the United States, and how different forms of MAT work, at the Boston Globe.
From the economists
Labor force trends: Nearly 20% of the decline in male participation in the workforce could be attributed to opioid-use disorder (OUD), according to a 2017 Princeton report—a prime example of how the opioid crisis has negative affect on many parts of society, including America's economy. It's a situation that has become all too common, with a recent report from the Federal Reserve finding that one in five Americans knew someone who suffered from OUD, and that they were more likely to rate the nation's economy poorly if they knew someone who misused opioids. Read more from NPR.
Opioid-use disorder telemedicine: Four new telehealth bills are in motion to expand opioid-use disorder (OUD) treatment for Medicaid members, aiming to reach more people with quality treatment and improve adherence and outcomes. The bills include:
- Expanding Telehealth Response to Ensure Addiction Treatment (eTREAT) Act: The bill would remove site restrictions so that telehealth can be provided not only from hospitals and clinics, but also from community centers, doctor's offices, or even homes;
- Medicaid Substance Use Disorder Treatment via Telehealth Act: The bill would require HHS guidance for reimbursing state Medicaid programs that use telehealth for substance use disorder treatment;
- Telehealth for Children's Access to Services and Treatment (TeleCAST) Act: The bill would require the evaluation of substance abuse disorder treatment programs for children and CMS reporting on how to reduce barriers for children on Medicaid to access telehealth treatment; and
- Opioid Addiction Treatment Programs Enhancement Act: The bill would require HHS to publish data on total Medicaid members with substance use disorders and the treatment provided to them.
Sen. Mark Warner (D-Va.), who introduced the bills, said of the measures, "Expanding access to telehealth services could not only save lives but equip rural and underserved communities with better tools to fight this epidemic." Project Echo offers free online opioid addiction treatment training to providers to help build the resources that will be needed to meet the demand that will come with expanded use of telemedicine.
OptumLabs' Opioid Key Performance Indicators (KPIs) are live for use via the Advisory Board Opioid Profiler tool. The Opioid Profiler is an interactive analytic tool that enables Advisory Board members to set up geography-specific views of county-level KPIs and get rapid insight into opportunities to address the opioid crisis in their local markets.
July 12 webconference: Learn 15 steps to rein in unwarranted opioid prescribing
Although recent evidence suggests that opioid prescribing volumes are on the decline, experts agree that we are still vastly overprescribing. Join the webconference on Thursday, July 12 to learn 15 best practices for reducing unwarranted opioid prescribing.