The abuse of and addiction to opioid analgesics is a serious and challenging public health crisis in the United States. Deaths from drug overdose have risen steadily for the past two decades and are now one of the leading causes of injury death in our country. Prescription medications, notably opioid analgesics such as hydrocodone, oxycodone, morphine and methadone used to treat acute and chronic pain, have been increasingly implicated in drug overdose deaths over the last decade. National statistics show that from 1999 to 2013, the rate for drug poisoning deaths involving opioid analgesics nearly quadrupled. As a result, the U.S. Department of Health and Human Services (HHS) has taken several steps to address opioid analgesic misuse and abuse1. Earlier this month, HHS Secretary Sylvia M. Burwell announced changes in an effort to further address this challenge. The actions, which were announced2 on July 6, 2016, include:
- Medication Assisted Treatment (MAT): Buprenorphine Final Rules
The announcement states that “expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT.” As a result, rules finalized by the Substance Abuse and Mental Health Services Administration (SAMHSA) allow “practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more to now obtain a waiver to treat up to 275 patients.” The announcement makes it clear that “practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.”
- Pain Management Survey Scores No Longer Tie to Medicare Payments to Hospitals
Regarding pain management survey scores, the announcement also indicates that many clinicians felt pressure to overprescribe opioid analgesics because scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey pain management questions are tied to Medicare payments to hospitals. However, those payments have a very limited connection to the pain management questions on the HCAHPS survey. As a result, “in order to mitigate even the perception that there is financial pressure to overprescribe opioid analgesics, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation.” Thus, the announcement makes it clear that hospitals will continue to use the questions to survey patients about their in-patient pain management experience, but will not affect the level of payment hospitals receive.
- Indian Health Services Prescribers and Pharmacists Required to Check Database
While many Indian Health Service (IHS) clinicians already utilize Prescription Drug Monitoring Program (PDMP) databases, IHS will now require its opioid analgesic prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid analgesic for more than seven days. Effective immediately, the new policy applies to more than 1,200 IHS clinicians working in federally operated IHS facilities currently authorized to prescribe opioid analgesics. Additionally as a part of this work, “IHS will train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.”
- New Research and Scientific Studies on Opioid Misuse and Pain Treatment
Secretary Burwell’s statement reaffirms that research on opioid analgesics conducted and funded by HHS helps the department better track and understand the epidemic, support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid analgesic misuse and overdose, and improve opioid analgesic use disorder treatment. These areas of research are critical to our national response to the opioid epidemic. As a result, HHS will launch more than a dozen new scientific studies on opioid analgesic misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report3 and inventory4 on the “opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area.”
- Prescriber Training Request for Information
In the announcement HHS confirms that it is actively working to curb the overprescribing of opioid analgesics in a number of ways. This includes providing prescribers with access to the tools and education they need to make informed decisions. In particular, HHS has developed a number of activities that support opioid analgesic prescriber education. As a result, HHS seeks comment on its current prescriber education and training programs as well as proposals that would augment ongoing HHS activities. The department released an infographic5 and fact sheet6 on actions HHS has taken and plans to take to address the opioid epidemic.
Whether stemming from a workers’ compensation injury, auto accident or a slip and fall, a therapy plan often includes an opioid analgesic. It is therefore important for stakeholders know, keep up with and understand the various changes being implemented to mitigate situations of opioid analgesic misuse and abuse. As always, we will continue to monitor such changes and report on the same.