Opioid projections frequently make up a significant portion of a Medicare Set Aside (MSA). CMS projects the future drug component of the MSA by looking at the claimant’s current pharmacy usage and treatment records. The existing usage patterns generally account for CMS’ monthly drug projections for life. Given the growing body of evidence-based medicine studies that show the dangers of opioid use for chronic noncancer pain and national attention to the opioid epidemic, a shift in opioid prescribing patterns is likely to occur over the next few years.
According to the Centers for Disease Control and Prevention, opioid overdoses from prescription painkillers and heroin were responsible for approximately 47,000 deaths in 2014. The U. S. Surgeon General Vivek Murthy’s office recently launched a public health campaign to “Turn the Tide RX” in an effort to halt the opioid abuse epidemic. The campaign is focused on changing the opioid prescribing patterns of physicians through meetings with physician groups. In addition, the campaign calls for expanded use of naloxone and Medication-Assisted Treatment (MAT) in the treatment of those with opioid addictions. Naloxone counters the effects of an opioid or heroin overdose.
The opioid issue was also addressed by Congress when it passed the Comprehensive Addiction and Recovery Act of 2016 on July 13, 2016. The Act, expected to be signed by President Obama, calls for expanded availability of naloxone for police and health officials to prevent overdoses. Nurse practitioners and physician assistants would also be allowed to prescribe buprenorphine for opioid addiction, while improved prescription drug monitoring programs (PDMP) would help states monitor drug diversion. Although the final bill does not come with funding, it is expected to be authorized by the end of the year.
States have similarly addressed the opioid epidemic through a variety of policy changes. Recent studies put out by the Workers’ Compensation Research Institute (WCRI) examined the impact of opioid policies on opioid use. In the “Interstate Variation in Use of Opioids” report, (Vennela Thumula, Dongchun Want, Te-Chun Liu) the authors concluded that states that had adopted opioid policies including, in part, enhanced state PDMPs, drug formularies, and chronic pain treatment guidelines with provider education, showed reductions in opioid utilization. The “Longer-Term use of Opioids” report by Dongchun Wang looked at the impact of evidence-based medicine opioid treatment guidelines on opioid use trends. In examining data from 25 states, the author observed that although current opioid treatment guidelines call for random urine drug testing, psychological and psychiatric evaluation, as well as physical therapy, few injured workers actually received these services. In order for the revised opioid treatment
guidelines to have an impact, they must be implemented.
As with all national campaigns, only time will determine its success rate. The drug industry’s active marketing of opioids coupled with patients’ expectation of complete pain relief, and physician prescribing patterns have taken years to develop and will likely take several to undo. In the meantime, consideration should be given to weaning programs for opioid addicted workers prior to preparation of an MSA. Non-opioid alternatives should also be explored as viable options for pain relief.