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America’s opioid epidemic: A public health emergency

Part 1: The numbers are staggering, but we see signs for hope.

Cathy Starner, PharmD, BCPS | October 30, 2017

 


On Thursday, Oct. 26, President Trump declared the opioid crisis a public health emergency.1

This designation will support hiring of staff at the federal level to address the emergency and expanded work with the Drug Enforcement Administration to make telemedicine more available for treating addiction and possible use grant money to combat the epidemic.1

How deadly is this emergency?

Deadlier than car crashes.2 More lethal than gun violence.3 And available right down the street at the local pharmacy. Use crosses geographic boundaries, socio-economic status and gender, causing more than 100 deaths a day.



Who’s using opioids?

We are. The United States, which represents just 5 percent of the global population, consumes 80 percent of the world’s prescription opioids.5

Most countries limit opioid use to acute hospitalization and trauma. Here, opioids are commonly prescribed to manage chronic non-cancer pain, to the tune of 250 million prescriptions per year.5

What is Prime doing?

Prime recently announced its “Controlled Substance Management Program,” which identifies members who are at risk of controlled substance misuse. It gets them into programs that can help reduce their risk. Prime combines existing and new offerings into a multi-layered program to help address the national epidemic.

I was proud to see these results: Our current program has contributed to a 16 percent decrease in opioid claims over the past five years for Prime’s commercial book of business, comparing the first half of 2012 to the first half of 2017.6  The new program will build on that success.



Most countries limit opioid use to acute hospitalization and trauma. Here, opioids are commonly prescribed to manage chronic non-cancer pain, to the tune of 250 million prescriptions per year.5

What else can help curb this trend?

Every one of us in the health care system has a role to play.

  • Legislators need to continue to pass bills that help curb opioid abuse, while averting legislation that could drive up overall health system costs. (We’ll talk more about this in part 4.)
  • Plan sponsors should focus on evidence-based strategies, such as utilization management.
  • Pharmacy benefit managers and pharmacies need to:
    • Improve management and oversight of at-risk individuals,
    • Support single pharmacies and take-back programs,
    • Improve monitoring of pharmacies, providers and members, and
    • Incentivize e-prescribing.
  • Health care professionals need to change the standard of care by:
    • Following the CDC’s new prescribing guidelines,
    • Consulting the prescription drug monitoring program (PDMP) database,
    • Applying pharmacy home programs, when possible, and
    • Providing patient education.

What else do you need to know?

As we continue to explore this critical topic, we will be asking:

  • Can we accurately measure opioid misuse/abuse?
  • Can we predict misuse?
  • Which pharmacy benefit management strategies help to curb the problem?
  • How do political action and advocacy make an impact?
  • What’s in the future for opioid management?

Be sure to take a look at the next in our five-part series -- Part 2: Take action, but make it count

You may also want to look at Thought leadership / Controlled Substances, where you can find more of Prime's work in this area. 


1.  “Donald Trump declares public health emergency over opioid crisis. Here’s what that means.” by Miriam Valverde, Oct, 30, 2017. PolitiFact. Accessed at: http://www.politifact.com/truth-o-meter/article/2017/oct/30/opioid-epidemic-united-states-and-trump-administra/

2.  Increases in drug and opioid overdose deaths — United States, 2000–2014. (Jan. 1, 2016). Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

3.  Past summary ledgers. (n.d.) Gun Violence Archive.  http://www.gunviolencearchive.org/past-tolls

4.  Overdose death rates. (Dec. 2015). National Institute on Drug Abuse. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

5.  Americans consume vast majority of world's opioids. (April 27, 2016) CNBC. http://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html