Preventing New Opioid Addictions
Posted on April 24, 2019
Health New England Pharmacy Department Teams Up with Western New England University Researcher to Analyze Program Effectiveness
In 2014, Massachusetts Governor Charlie Baker declared a public health emergency over the opioid epidemic. In 2016, Massachusetts confirmed 1,821 overdose-related deaths – more than twice the national average according to the National Institute of Drug Abuse. Preliminary data from the Massachusetts Department of Health estimates over 2,000 opioid-related deaths occurred in 2018.
In response to the crisis, Health New England and our Pharmacy team have been working on ways to help reduce the number of new cases of opioid use disorder. As part of our partnership with Western New England University’s (WNEU) Pharmacy program, in 2018, Gary Tereso, PharmD, Manager of Innovative Pharmacy Solutions at Health New England, teamed up with Natalia Shcherbakova, PhD, Associate Professor of Pharmacoeconomics at WNEU, to evaluate the effectiveness of our newly implemented short-acting prescription Opioid Access Program.
The Opioid Access Program imposed a seven-day quantity limit for all new prescriptions for short-acting agents in any one fill for all new non-cancer/non-palliative care members. Essentially, the program halts members filling a new short-acting opioid prescription in quantities exceeding a 7-day supply at the pharmacy counter and subsequently motivates physicians to reevaluate their processes around prescribing short-acting opioids.
“The interest in the project stemmed from the sheer magnitude of the epidemic, both in the state of Massachusetts and nationwide. The volume of tablets that gets into patients’ medicine cabinets was overwhelming. It amounts to over one hundred and fifty tablets, on average, of short-acting opioids (oxycodone, hydrocodone, etc.) for each Health New England member who has filled any short-acting prescription opioid in a given year,” says Shcherbakova.
The driving forces behind the opioid use crisis are certainly complex, spanning social and socioeconomic boundaries. One piece, however, remains constant among those overusing opioids – ease of access.
“Since the epidemic was facilitated to a great extent by easy availability of prescription opioids through frequent and excessive prescribing practices, it can arguably be contained via the same route – reducing access,” Shcherbakova notes. The Opioid Access Program targets just that, the accessibility of short-acting opioids to its members and the communities we serve that have been enveloped by this epidemic.
Since program implementation in 2017, the proportion of members with short-term supply of prescription opioids (7 days or less) rose 9.6% and 8.4% among commercial and Medicaid member groups, respectively. Accordingly, the proportion of members filling short-acting opioids for quantities exceeding seven days’ supply has decreased. At the same time, the proportion of members filling any short-acting agent dropped 13.5% and 11.6% among commercial and Medicaid covered populations, respectively. On November 13, 2018, Drs. Shcherbakova and Tereso presented their study findings at the International Society for Pharmacoeconomics and Outcomes Research European Congress in Barcelona, Spain.
“Dr. Shcherbakova’s analyses have shown that our program is effective in reducing the number of members filling short-acting opioids and decreasing the likelihood of potential dependence,” says Tereso.
Seeing positive results from the Opioid Access Program, Health New England recently refined its access criteria. The program now requires prior authorization for additional fills for cough syrups containing opioids after the initial fill.
From a managed care perspective, we believe that outside of the context of cancer and palliative care, we need to help patients who rely on prescription opioids to find alternative ways of pain management, including non-pharmacological methods.
“We’ve taken additional steps and have reduced restrictions on alternative pain therapies,” adds Tereso. “We’ve removed prior authorizations on certain prescriptions, like the lidocaine patch, for example.”
Health New England and Dr. Shcherbakova continue to monitor program data and make improvements. These incremental changes may seem minor compared to the scale of the opioid crisis, yet the results show we are moving in the right direction in reducing new cases of opioid use disorder.
Sources:
NIDA, National Institute of Drug Abuse. (Source: https://www.drugabuse.gov/).
CDC, Centers for Disease Control and Prevention. (Source: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm)
Massachusetts Department of Health. (Source: https://www.mass.gov/lists/current-opioid-statistics)
Sage Journals, Annals of Pharmacotherapy. (Source: https://journals.sagepub.com/doi/10.1177/1060028017751913)
Comments are currently closed.