Keeping you updated on the latest Medicare and Part D news

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Opioid prescription patterns linked to likelihood of long-term use

A recent study has found that opioid days supply and the number of prescriptions in the first episode of opioid use can greatly affect the likelihood a patient will become an opioid chronic user.  The study examined a random sample of opioid-naive adults without cancer that received a prescription for opioid pain relievers.  Starting with the third day, the risk of becoming a chronic opioid user grows with each day additional day supply provided to patients.  Prescribing opioids is increasingly becoming a complicated decision for doctors to make.

FIGURE 1. One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply* of the first opioid prescription — United States, 2006–2015

	The figure above is a line chart showing 1- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply of the first opioid prescription in the United States during 2006–2015.

* Days’ supply of the first prescription is expressed in days (1–40) in 1-day increments. If a patient had multiple prescriptions on the first day, the prescription with the longest days’ supply was considered the first prescription.


FIGURE 2. One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of prescriptions* in the first episode of opioid use — United States, 2006–2015

	The figure above is a line chart showing 1- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of prescriptions in the first episode of opioid use, in the United States during 2006–2015.

* Number of prescriptions is expressed as 1–15, in increments of one prescription.



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15 maps and charts visualizing the opioid epidemic in the United States has compiled 15 maps, charts, and graphs that visually depict the opioid epidemic that affects millions of Americans annually. Highlights and a link to the source below:

Chart showing that the number of days an opioid is prescribed matters for curtailing continued use

Chart showing that the number of Americans reporting chronic pain has increased from 1998 to 2010.

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Risk of chronic opioid use in elderly impacted by prescribing doctor

A recent study has found a link between chronic opioid use in Medicare beneficiaries and “high-intensity” prescribers, doctors that prescribe opioids for one in four patients they treat.  Beneficiaries with a high-intensity prescriber were 30% more likely to become a long-time opioid user.  Study authors conclude that their results are indicate that a single opioid prescription can affect the chances of long-term use and additional adverse health outcomes among elderly patients though additional research is needed.

The New England Journal of Medicine

New York Times


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The Opioid Epidemic and Medicare Beneficiaries

CMS recently outlined it’s strategy for combating the opioid epidemic that is impacting a large numbers of Medicare and Medicaid beneficiaries and their families.  CMS identified the following areas as priorities to reduce opioid overuse and misuse in Medicare and Medicaid:

  • Implement more effective person-centered and population-based strategies to reduce the risk of opioid use disorders, overdoses, inappropriate prescribing, and drug diversion
  • Expand naloxone use, distribution, and access
  • Expand screening, diagnosis, and treatment of opioid use disorders, with an emphasis on increasing access to medication-assisted treatment
  • Increase the use of evidence-based practices for acute and chronic pain management

The success of CMS’ strategy relies on successful coordination and cooperation between Medicare and Medicaid beneficiaries, their families and caregivers, health care providers, health insurance plans, and states.  Acumen’s work on the Overutilization Monitoring System (OMS) is described as one example of the work CMS already does with health insurance plans to improve how opioids are prescribed by providers and used by beneficiaries.

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Widespread Use Of Prescription Drugs Provides Ample Supply For Abuse

A federal survey published Thursday found that about 45 percent of the individuals 12 and over take prescription psycho-therapeutic drugs, amounting to 119 million Americans. Misuse of prescription psycho-therapeutic drugs is second only to marijuana as the nation’s most prevalent illicit drug use issue.

Organizations, such as the CDC and SAMHSA, are working on two main solutions: (1) creating better prescribing practices to lessen the availability of the drugs; and (2) expanding substance abuse treatments to increase affordability and accessibility.

The widespread availability of these drugs poses issues with the misuse of these drugs. Only 5 percent of survey respondents bought drugs from a dealer or stranger, the vast majority misused their own prescriptions or obtained drugs from family or friends. This misuse amounts 16 percent of all prescription drug use, a result of a prescribing system that promotes overuse and abuse.

A secondary issue is the lack of affordable and accessible treatment options. Many of these psycho-therapeutic drugs have addictive properties. Only 8.3 percent of individuals need substance abuse treatment, but only 1- percent of these individuals people receive the treatment that can help them to recover.

NPR Article


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Heroin-related Overdose Deaths Quadruple Since 2002

A new CDC Vital Signs report released last week found that heroin use has increased in the U.S. among men and women, most age groups, and all income levels.  Surprisingly, some of the greatest increases in heroin use were among demographic groups that have historically low rates of use: women, the privately-insured, and people with high incomes. Heroin use doubled among women and young adults, while use more than doubled among non-Hispanic whites. The increases in heroin use have led to increased heroin-related overdose deaths. Between 2002-2013, the rate of heroin-related overdose deaths nearly quadrupled, with more than 8,200 people dying in 2013.

Referring to the reasons for the increase in heroin use, CDC director Dr. Thomas Freiden told CNN: “First, more and more people are susceptible to heroin because they have been prescribed prescription opiates, like OxyContin. And the second reason is that heroin itself seems to be cheaper and more widely available.” The CDC report finds that more than 9 in 10 people that used heroin used at least one other drug, with those addicted to opioid painkillers to be 40 times more likely to be addicted to heroin. Additionally, 45% of heroin users were also addicted to prescription opioid painkillers.

There are signs that the U.S. is making progress in curbing opioid painkiller abuse, but it remains the strongest risk factor for heroin addiction. The CDC report calls for increased education and monitoring efforts by state governments and local health care providers.  Other suggestions from the CDC include increased access to substance abuse treatment services through the Affordable Care Act, expanded use of Medication-Assisted Treatment, and supported developments of pain medications that are less prone to abuse.


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DEA Reclassifies Hydrocodone Combination Products As Schedule II Drugs

The Drug Enforcement Agency released a new rule reclassifying hydrocodone combination products as Schedule II drugs. Previously, only pure hydrocodone drugs were considered Schedule II, while hydrocodone combination products were classified as Schedule III because it was believed that mixing hydrocodone with non-narcotic painkillers such as acetaminophen would reduce their potential for abuse. The policy change will take effect in 45 days, and will place stricter rules on how doctors can prescribe hydrocodone combination products.