Co-authored by Neil Welch, Julie Mantzouranis-Barthuly, Ian Kea, Kiley Ward and Tam Briggs
2021 Opioid Epidemic Report
According to the American Medical Association (AMA), 44.4 % of opioid prescribing decreased in the last ten years.1 Access to Prescription Drug Monitoring Programs (PDMP) continues to help with availability now in all 50 states after Missouri recently commenced its statewide program last year. Unfortunately, despite opioids being prescribed less, The Centers for Disease Control (CDC) reports that as a nation, there is an upward trend of overdoses related to fentanyl, methamphetamine, and schedule I stimulants.2,3 Although most overdoses statistically are attributed to illicit opioids, cautionary tools for prescribers can mitigate misuse of any prescription opioids.7
AMA-Manatt Health 2022 State Policy Toolkit
The AMA is encouraging interventions within healthcare settings that affect communities at every care level. That includes access to evidence-based, affordable therapies to treat and screen for substance use disorder. Since 2017, 70,000 prescribers have become authorized to prescribe treatments for opioid use disorder. However, the AMA says 90% of patients still don’t receive treatment.3 A greater focus on better understanding harm reduction to improve pain management guidelines by the CDC is highly recommended.2
CDC Pain Treatment Guidelines
The 2022 CDC opioid guidelines suggest that opioid naïve patients should begin with the lowest dosage opioid as tolerated to treat acute, subacute, and chronic pain. Before prescribing controlled substance therapies, clinicians are encouraged to consider toxicology testing to screen for substance use disorder. Opioid prescribers are advised to use immediate-release opioids instead of previously suggested extended-release/long-acting options.5 It is suggested that clinicians review signs of dependence, tolerance, or adverse effects while; not abruptly discontinuing or rapidly increasing dosages, if not necessary. Patients on chronic opioid therapies, defined as longer than three months, are likely to better tolerate slow taper of no more than a 10% reduction per month.4,5
Prescription Drug Monitoring Program Increase & State Formularies
The PDMP remains an excellent tool for healthcare providers in monitoring prescription drugs. All 50 states track in their own unique way based on the prescribing circumstances of their state. While there has been a tremendous increase in the use of PDMP within the United States, each state’s method of overseeing prescriptions varies with some states tracking only a certain class of prescriptions compared to others who may be more comprehensive with tracking prescriptions of difference classes. This lack of uniform standard may be something that needs to be addressed down the line.
Formularies are another method for providers to prevent possible misuse. These formularies comprise of a list of prescription medications, both brand and generic, that are usually categorized as pre-approved, not approved, or requiring an exception. This system utilizes evidence-based research in deciding which medications should be a preferred drug for first-line treatment for injured workers. 17 states currently have a formulary in place which can help organize medication preferences, improve tracking, control certain costs, and better identify treatment options. However, in recent years less states have shown interest in formularies with data confliction and concerns about setup. Both PDMP’s and formularies have created positive effects but are just one piece of the solution concerning the prevention of opioid abuse and opioid-related deaths.
Further expansion of insurance coverage for medications to help treat substance use disorder, such as methadone, buprenorphine, and naltrexone, should be considered. This policy should also include the elimination of prior authorization for such medications and removing barriers to fast-track treatment programs.1,6 As innovative methods continue to evolve to combat opioid abuse; federal, state, local and private partners should look to work in collaborative fashion to establish more uniform standards.
References1. Report shows decreases in opioid prescribing, increase in overdoses. https://www.ama-assn.org/press-center/press-releases/report-shows-decreases-opioid-prescribing-increase-overdoses. Accessed April 6, 2022.
2. AMA report finds nearly 40% decline in opioid prescriptions. https://www.fiercehealthcare.com/practices/ama-report-finds-nearly-40-decline-opioid-prescriptions-but-overdose-deaths-continue-to. Accessed April 6, 2022.
3. State Toolkit to End the Nation’s Drug Overdose Epidemic: Leading-Edge Actions and Strategies to Remove Barriers to Evidence-Based Patient Care.; 2022. Accessed April 7, 2022. https://end-overdose-epidemic.org/wp-content/uploads/2022/02/AMA-Manatt-Health-Toolkit-Resources-January-2022_f_FOR-WEB-FINAL.pdf
4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1
5. Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids–United States, 2022.
6. Opioid use falls, but issues remain | Business Insurance. https://www.businessinsurance.com/article/20220401/NEWS08/912348724/Opioid-use-falls,-but-issues-remain. Accessed April 6, 2022.
7. AMA Urges Change After Dramatic Increase in Illicit Opioid Fatalities. medscape.com/viewarticle/934548. Accessed April 25, 2022.