Recently I attended a seminar on what has become the nation’s number one health care crisis: opioid use. It was a wake-up call to some astonishing information. Our industry has begun to feel the devastating effects and so far there is no end in sight. The statistics were alarming:
- Every 16 minutes, there is a death from opioid overdose
- 1,375 percent increase in opioid treatment spending over five years
- 4.5 million Americans estimated to have a substance use disorder associated with prescription painkillers
- $78.5 billion estimated cost of America’s opioid epidemic
According to Center for Disease Control and Prevention mortality data, death rates for young adults ages 25 to 44 has increased from 139.8 per 100,000 in 2010 to 151.3 per 100,000 in 2015, an increase of 8.2 percent in 5 years. In our own backyard (Ohio, Kentucky, Indiana, West Virginia, and Pennsylvania), those increases were 20 percent or more. This is concerning data when you factor in the costs associated and the number of lives destroyed.
In 2016, it is estimated that 59,000 to 65,000 lives were taken from drug overdoses in the U.S. These estimates are conservative, considering unreported or misreported overdose deaths. Compare that with peak car crash death rates in 1972 of 54,589 and peak H.I.V. deaths in 1995 of 50,887.
As opioid use continues to rise, drug overdoses are expected to be the leading cause of death in the U.S. for Americans under age 50. Synthetic opioids, such as Fentanyl and its closely related counterparts, play a major role in driving overdose death numbers to exponential levels. Resources and budgets are strained by the rise in numbers. Increased police, medical care, foster care, and additional administrative burdens have all combined to quickly exceed state and federal budgets.
Many may ask how we arrived at such outrageous numbers. Some thought-provoking background:
From the mid-1980s through the 2000s
- First publication suggesting safety of extended opioid use in non-cancer pain
- MS Contin approval
- OxyContin approval
- APS launches “Pain as the Fifth Vital Sign” campaign
- Purdue launches $200 million marketing campaign
- Multiple new opioid brands and key generics flood market
- Opioid Rx volume and death toll skyrocket
- Government investigations ensue
- Purdue pays $600 million in fines for false promotion
- 2012: 259 million opiate Rxs were issued in the U.S.
The opioid use disorder (OUD) epidemic has been driven by the U.S. health care system’s unintentional widespread prescribing of opioid painkillers without realizing the consequences.
- 80 percent of the world’s supply of all Rx opioids are consumed in the U.S.
- 92 units is the average number of tablets per Rx. Opioid dependence can start in just a few days. Risk of chronic opioid use increases with each additional day of opioid supplied starting with the third day.
- 91 percent of patients who experience opioid overdose receive another opioid Rx within 10 months.
- 80 percent of heroin users report starting on Rx opioids prior to transitioning to heroin.
- 53 percent of users received opioids free from a friend/relative, while another 16.6 percent took or bought them from a friend/relative.
The CDC publishes guidelines for prescribing opioids which include, but are not limited to:
- Opioids are not to be the first line therapy for chronic pain.
- Short duration of acute pain.
- Three days of therapy should be sufficient, more than seven days is rarely needed.
- The lowest effective dose is recommended to start.
Interestingly, 44.7 percent of first-fill opioid prescriptions are NOT in compliance with CDC recommendations.
From an insurer’s perspective, the focus is on methods of treatment and the education of providers. Determining the most effective approach to care in order to provide sustained long-term results is critical. Approaching OUD as a long-term chronic condition, instead of relying solely on short-term interventions, is essential. Each patient is unique and needs dedicated appropriate resources and guidance.
Pairing counseling and cognitive behavioral therapy with approved FDA medication to treat substance abuse disorders and prevent opioid overdose are more effective than behavioral interventions or medication alone. Studies suggest that with this medication-assisted treatment, the chances of remission within a year are significantly greater, up to 50 percent compared to 10 percent with traditional treatment. Along with these figures, this type of treatment costs up to 75 percent less than residential treatment. Education of physicians for this treatment protocol is critical and will take time. However, insurance carriers are responding to the needs rapidly and are developing methods to educate both the providers and the public.
In March of 2017, President Trump created a commission to study the crisis and their interim report has made a number of initial recommendations. As of October 2017, the Trump administration declared the opioid crisis a public health emergency.
As we, together, begin to recognize the scale of this crisis, it is critical that we acknowledge that OUD is an epidemic that does not discriminate. Be it the athlete who is prescribed pain medications for an injury and becomes addicted, or a relative who is recovering from surgery, or any one of the many circumstances in which victims lives are taken, let’s not be so quick to judge. Taking a “moral” perspective will not effect change. Instead, we need to come together to find a solution.