Longwood, FL (WorkersCompensation.com) - According to the Centers for Disease Control and Prevention (CDC), opioids are involved in most fatal overdoses. Although illicit opioids play a role, prescription opioids are a significant factor in the opioid abuse epidemic. Between 1999 and 2010, the amount of prescription opioids distributed to the medical community almost quadrupled.
The wide-spread acceptance of opioids as treatment for chronic non-cancer pain was responsible for this, although evidence-based medicine no longer supports this approach. Of the 42,000 people that overdosed on opioids in 2016, 40% of those deaths were from prescription opioids. The CDC is working with 45 states and Washington D.C. in an Overdose Prevention in States (OPIS) effort intended to provide states with assistance in combatting the opioid epidemic. Three main programs, Prescription Drug Overdose: Prevention for States, Data-Driven Prevention Initiative and Enhanced State Opioid Surveillance make up the effort.
Various states have also taken their own initiative in the prevention of opioid abuse. A 2016 report from the Workers Compensation Research Institute (WCRI), entitled “Interstate Variations in Use of Opioids, 3rd Edition, by Vennela Thumula, Dongchun Wang and Te-Chun Liu, examined data from 25 states to determine the effectiveness of the state reforms in curbing the abuse. State policies and organization interventions such as Prescription Drug Monitoring Programs (PDMPs), drug formularies, guidelines and limits on prescribing and dispensing were expected to have an impact on the prevention of the abuse. In examining Texas' adoption of a drug formulary based on the Official Disability Guidelines (ODG), the authors noted a 60% reduction in the use of non-formulary opioids and a 10% reduction in all opioids.
Oklahoma, Tennessee and California followed suit with similar formularies designed to limit the improper use of opioids. Oklahoma additionally enacted a real time reporting requirement of scheduled opioids in the PDMP as of January 1, 2012. This study further documented the new laws that were passed by states to limit the way opioids can be prescribed. For example, Massachusetts only allows an initial 7 day supply of opioids, with exceptions for chronic pain and cancer. Michigan requires detailed documentation for the ongoing need of opioids after 90 days. Michigan. Tennessee and Florida have also placed restrictions on the dispensation of certain opioids. Additional time will be needed to determine the efficacy of these changes although the initial results are promising.
Since the WCRI report was published, California enacted a new formulary that went into effect on January 1, 2018. It is intended to prevent opioid addiction by weaning when possible. The push to stop opioid abuse remains strong with, as of August of 2017, 24 states passing laws limiting opioid prescription patterns.
It is clear from the CDC guidelines and the various evidence-based medicine studies that opioids in general, should not be used for the treatment of chronic noncancer pain. In light of this, CMS's drug projection methodology when it comes to opioids is all the more egregious. Evidence-based medicine MSA projection models, such as the NuShield certified MSA, are available to provide a more realistic assessment of future treatment. Additional information is available upon request.
(As published in a recent NuQuest newsletter)
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