The health insurance industry: perpetuating the opioid crisis through policies of cost-containment and profitability

Schatman, Michael E; Webster, Lynn R.

doi:10.2147/jpr.s83368

Cited by 24 publications

(20 citation statements)

References 52 publications

(48 reference statements)

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“…These diverse interventions include prescription drug monitoring programmes, clinician and patient education, the introduction of abuse‐deterrent formulations, changes to product labelling and treatment guidelines, and pain clinic and opioid disposal legislation . However, the impact of these interventions on opioid utilization, abuse, and patient and clinician behaviours is uncertain . From a clinical and policy perspective, there is a need for further research into patterns of opioid use and misuse, both at the level of the population and the individual.…”

Section: Discussionmentioning

confidence: 99%

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Karanges

Blanch

Buckley

et al. 2016

Brit J Clinical Pharma

146

154

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Aim The aim of this paper is to investigate 25‐year trends in community use of prescribed opioid analgesics in Australia, and to map these trends against major changes to opioid registration and subsidy. Methods We obtained dispensing data from 1990 to 2014 from two sources: dispensing claims processed under Australia's national drug subsidy programme, the Pharmaceutical Benefits Scheme, including under co‐payment records from 2012; and estimates of non‐subsidized medicine use from a survey of Australian pharmacies (until 2011). Utilization was expressed in defined daily doses (DDD)/1000 population/day. Results Opioid dispensing increased almost four‐fold between 1990 and 2014, from 4.6 to 17.4 DDD/1000 pop/day. In 1990, weak, short‐acting or orally administered opioids accounted for over 90% of utilization. Use of long‐acting opioids increased over 17‐fold between 1990 and 2000, due primarily to the subsidy of long‐acting morphine and increased use of methadone for pain management. Between 2000 and 2011, oxycodone, fentanyl, buprenorphine, tramadol and hydromorphone use increased markedly. Use of strong opioids, long‐acting and transdermal preparations also increased, largely following the subsidy of various opioids for noncancer pain. In 2011, the most dispensed opioids were codeine (41.1% of total opioid use), oxycodone (19.7%) and tramadol (16.1%); long‐acting formulations comprised approximately half, and strong opioids 40%, of opioid dispensing. Conclusions Opioid utilization in Australia is increasing, although these figures remain below levels reported in the US and Canada. The increased use of opioids was largely driven by the subsidy of long‐acting formulations and opioids for the treatment of noncancer pain.

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Section: Discussionmentioning

confidence: 99%

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Karanges

Blanch

Buckley

et al. 2016

Brit J Clinical Pharma

146

154

View full text Add to dashboard Cite

show abstract

“…Many of the interventions we identified, including CE, hold promise, but as with any intervention, it is essential that they be evaluated for their impacts and be informed by science. [17][18][19] Given the complexity of the problem, the challenges associated with measurement, the role of illicit opioids, 20 the multiple private actors, 21,22 the challenge of tracking meaningful patient outcomes, and the sheer number of interventions across the United States, it will be difficult to determine the impact of a singular intervention in isolation or in combination with others. Despite the challenges associated with evaluating policy interventions in general, and CE in particular, [23][24][25][26] we need to better understand how these interventions can positively influence prescriber behavior, reduce the harm associated with prescription drugs, and improve the treatment of pain.…”

Section: Resultsmentioning

confidence: 99%

<p>An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018</p>

Duensing

Twillman²,

Ziegler³

et al. 2020

JPR

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Introduction: Opioid overdose deaths in the United States have climbed sharply over the past two decades. Simultaneously, increased awareness of inadequately treated chronic pain has resulted in increased opioid analgesic prescribing. The correlation between these two phenomena has led policymakers to posit that they are causally linked, and to implement policy changes supporting safe opioid prescribing. Purpose: To evaluate the impact of its Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) program, the US Food and Drug Administration (FDA) requested the opioid manufacturers responsible for implementing that program provide information regarding opioid policy changes from 2016 to 2018. FDA also requested a survey of state requirements for pain and opioid prescribing continuing education (CE), the number of prescribers affected by those requirements, the extent to which a REMS-compliant CE program would meet each state's requirements, and the number of relevant CE programs available. Results: Results indicate that 527 federal and state opioid-related policies (statutes, rules/ regulations, and guidelines) were approved during the 2016-2018 study period. While the largest number of these policies focused on prescription drug monitoring programs, 170 specifically imposed limits on opioid prescribing and an additional 35 specifically referred to, or incorporated, the Centers for Disease Control and Prevention opioid prescribing guideline. We also found that 46 states and the District of Columbia mandated some amount of pain or opioid prescribing CE for prescribers renewing their licenses. These mandates potentially affected as many as 1.7 million prescribers. In 69% of cases, a REMS-compliant CE program would fully meet the state mandates for various types of prescribers. Conclusion: The severity and complexity of the problems of pain management and opioid overdose have led to large-scale intervention by policymakers. Assessing the impact of these changes is difficult, at best, but will be necessary if interventions are to be refined to increase their effectiveness.

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“…Additionally, the insurance industry’s failure to pay for more expensive but effective abuse deterrent formulations of opioids has certainly contributed to the figures that Dr. Marcus recklessly cites. 23 The Doctors Company was developed to allegedly protect the interests of physicians. In the present climate of increasing medical malpractice with opioid prescribing recently identified as the leading cause of medication malpractice claims, Dr. Marcus’s inaccurate and irresponsible presentation of so-called facts can serve only to exacerbate the “chilling effect” on physicians already fearful of prescribing.…”

Section: Two Wrongs Do Not Make a Rightmentioning

confidence: 99%

Fact or fiction: the truth behind the doctors company claims regarding licit and illicit opioids

Dragic

Fudin

Schatman

2018

JPR

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The health insurance industry: perpetuating the opioid crisis through policies of cost-containment and profitability

Cited by 24 publications

References 52 publications

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

<p>An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018</p>

Fact or fiction: the truth behind the doctors company claims regarding licit and illicit opioids

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