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July 22, 2019

Is the US making progress on the opioid epidemic?

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    The United States over the past few weeks got some big, positive news regarding the opioid epidemic. First, research indicated that more Medicare beneficiaries are accessing medication-assisted treatment (MAT) for opioid use disorders. Second, preliminary CDC data estimated that fatal drug-related overdoses decreased by 5.1% from 2017 to 2018, potentially marking the first significant drop in U.S. drug overdose deaths since the 1990s.

    Your top resources for combatting the opioid epidemic in one place

    While those developments certainly are worth celebrating, observers are urging caution, noting that looming funding lapses and other issues could jeopardize the country's progress in combating the epidemic.

    More Medicare beneficiaries are accessing MATs

    MATs have become a key tool in public health officials' plans to combat opioid misuse. The treatment combines behavioral therapy with medications that reduce an individual's cravings for opioids and withdrawal symptoms. FDA has approved three such drugs for use in the United States: buprenorphine, methadone, and naltrexone.

    HHS has made increasing access to MATs a top priority, and a report released last week by HHS' Office of Inspector General found that Medicare-covered prescriptions for buprenorphine and naltrexone increased from 2016 to 2018, with approximately 174,000 Medicare beneficiaries receiving such a medication last year. Further, the report noted that Medicare-covered prescriptions for naloxone, which can reduce the effects of an opioid-drug related overdose, rose by 501% from 2016 to 2018.

    The report also noted that opioid prescriptions covered by Medicare Part D decreased by 11% from 2016 to 2018, and the percentage of beneficiaries considered at high risk for opioid misuse or overdose declined by 46%.

    Further, CMS in April 2018 announced a policy to increase access to buprenorphine by limiting prior authorizations for the drug under Medicare Part D to once a year, and research suggests more beneficiaries accessed MATs after the policy took effect.

    For instance, a research letter published last week in JAMA found fewer Part D and Medicare Advantage prescription drug plans required prior authorization for the brand-name form of buprenorphine-naloxone, dropping from 87.5% in 2017 to 3.5% in 2019. The decline for generic equivalents of the drug was even steeper, falling 95.8% to 0.1%. In addition, the percentage of plans requiring prior authorization for buprenorphine without naloxone fell from 86.9% in 2017 to 58% in 2019.

    Tami Mark, the research letter's lead author and senior director of behavioral health financing and quality measurement at RTI International, told Modern Healthcare's Harris Meyer that the reductions in prior authorization requirements likely mean 30% more beneficiaries would receive MATs, which could reduce overdose deaths by at least 50%.

    Preliminary data show drop in drug overdose deaths

    And it appears those and other efforts are translating into fewer drug-related overdose deaths, according to the preliminary CDC data released recently.

    The Washington Post's Christopher Ingraham writes that the data indicate "that declines in deaths related to prescription painkillers" might have driven a 5.1% decline in overall drug-related overdose deaths from 2017 to 2018. Specifically, CDC estimates there were 12,757 overdose deaths involving prescription drugs in 2018, down from 14,495 in 2017. "That's the biggest decline among the drug categories tracked in the CDC's provisional data," Ingraham writes.

    4 reasons why it might be too early to celebrate those numbers

    But there's still a lot of progress to be made—and some factors could hinder the United States' progress against the opioid epidemic, observers warn.

    First, Vox's German Lopez notes that CDC's data are preliminary, meaning "[o]verdose deaths could end up higher or lower than the data says right now." He explains, "The preliminary estimate for 2017 was off by roughly 2,000 overdose deaths," so "[w]e are just a margin of error from these numbers looking very different."

    Second, Axios' Sam Baker writes that although the 5% decline in drug-related overdose deaths is notable, "overdose deaths rose by roughly 316% between 1999 and 2017," meaning, "[t]here's still a long way to go, and more than 68,000 Americans still died of overdoses last year."

    Third, CDC projects that overdose deaths involving synthetic opioids, including fentanyl, were tied to 32,000 overdose deaths in 2018, up from 29,000 in 2017. Further, deaths related to cocaine and methamphetamine increased substantially from 2017 to 2018.

    And fourth, federal funding to help states with efforts to address the opioid epidemic are running out, putting those efforts in jeopardy, the New York Times' Abby Goodnough writes.

    For its part, the Trump administration has signaled its commitment to continuing the fight against substance use disorders and the opioid epidemic.

    "While the declining trend of overdose deaths is an encouraging sign, by no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades and it will not be solved overnight," HHS Secretary Alex Azar said, adding, "President Trump and HHS will continue to provide the resources and support communities, families, and individuals in our collective efforts to prevent and treat addiction."

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