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Opioid Prescriptions Drop Sharply Among State Workers

The recent efforts by the CDC and public media have initiated important advances in the crusade against opioid addiction.

The agency that manages health care for California’s massive state workforce is reporting a major reduction in opioid prescriptions, reflecting a national trend of physicians cutting back on the addictive drugs.

Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools and their families. CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.
Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to new CalPERS data.

The CalPERS data represents a cross-section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

This rapid change in prescribing habits indicates how quickly physicians reacted to the data as furnished by DEA and other regulatory bodies.

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the American Medical Association, the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention revealed a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, as recommended by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Pain management courses are being emphasized in medical school curricula, as well as continuing medical education courses.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will 

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About 50 million Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”

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