Change in Medicare can help stem abuse of opioids

Posted: February 04, 2016

By Cynthia Reilly

In a political climate in which the two major parties don't always see eye to eye, one issue is bringing them together: Republicans and Democrats agree that we must address the tragedy of prescription drug abuse.

With 44 people dying every day from overdoses of oxycodone, hydrocodone, and similar opioid pain relievers, there is growing awareness that misuse of these drugs can affect almost anyone.

Presidential hopefuls on both sides of the aisle have told personal stories about the terrible toll this epidemic has taken on family, friends, and colleagues, and some have proposed detailed policies to address prevention and treatment of abuse. And Congress is considering a number of legislative proposals to augment existing prevention and treatment strategies.

What other steps can we take now to save lives by preventing substance abuse before it starts?

Opioid abuse frequently begins when patients with pain seek relief from multiple prescribers and pharmacies at the same time. Because providers often don't know that the people they're treating are seeking - or have already sought - help elsewhere, patients may obtain and take unsafe amounts of prescription pain relievers, putting them at increased risk for addiction and overdose.

But there are tools that can help lower the risk of abuse and protect patients from harm. Many health plans use patient review and restriction (PRR) programs to identify patients receiving opioids from multiple prescribers. These drug-management programs can lower the risk of overdose by providing coordinated care from designated doctors and pharmacies while ensuring that patients have access to the pain relief they need. (People who need high doses of pain medication, such as those with cancer or in hospice, are exempt from PRR programs.) Patients can still choose their doctors and pharmacies.

PRRs have the potential to save lives and lower health-care costs. In Oklahoma, for example, Medicaid patients in a PRR program used fewer narcotic medications, decreased their visits to multiple pharmacies and physicians, and made fewer trips to emergency departments. In Ohio, opioid doses were reduced by 40 percent among patients enrolled in the state's Medicaid PRR program.

But even though PRRs work for Medicaid and private insurance plans, federal law prohibits their use for Medicare recipients - even though these patients are at risk of harm from overuse or misuse of prescription pain relievers. In 2011, nearly a quarter of a million Medicare beneficiaries took potentially life-threatening doses of opioids for 90 or more consecutive days.

Fortunately, support for PRRs in Medicare is gaining ground. The House of Representatives already overwhelmingly voted to lift the restriction on PRRs in Medicare as part of a larger health-care measure; similar bipartisan legislation has been introduced in the Senate. Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, said these drug management programs would be very helpful in stemming abuse. President Obama signaled his support for these drug-management programs when he proposed establishing PRRs in Medicare as part of his 2016 budget request to Congress.

PRRs are a proven strategy that can help prescribers and pharmacists provide better care for their Medicare patients and stem the troubling trend of overdose deaths. And because protecting patients from harm is an idea we can all agree on, it's time for Congress to pass legislation granting Medicare the authority to use PRRs.

Cynthia Reilly directs the Pew Charitable Trusts' prescription drug abuse project. creilly@pewtrusts.org

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