4 Reasons Why the Opioid Crisis Still Needs Our Attention

By: | January 29, 2021

Phil Walls is the Chief Clinical Officer for myMatrixx. He joined the company in 2006 and oversees all aspects of myMatrixx’s clinical program including drug utilization review, formulary management, drug regimen reviews and targeted intervention with prescribing physicians. Phil is a clinical pharmacist with over 40 years of experience in pharmacy, healthcare informatics and workers’ compensation.

The COVID-19 pandemic became a primary focus of nearly all aspects of health care in the past year, and rightfully so. Adjusting to an unforeseen crisis requires us to quickly change focus and priorities to ensure optimal care until effective treatment protocols and a vaccine can allow for a return to some degree of normalcy.

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However, latent problems are of course still going to be there when we can return our attention. In many situations, we’re even finding the effects of the pandemic have exacerbated these problems and created new challenges to overcome.

In workers’ compensation pharmaceuticals, the opioid misuse crisis that we’ve spent so much time and effort fighting over the last decade clearly represents this phenomenon.

There’s some evidence that issues related to the pandemic environment, including treatment delays and increased social isolation, may be contributing to an uptick in misuse. But there are other developments in the health care, pharmaceutical and workers’ compensation industries affecting both opioid usage and the parties responsible for paying for it.

We’ve made real strides fighting the opioid crisis over the past five-plus years. myMatrixx clients showed a 10.7% decline in opioid spending in our 2019 Drug Trend Report, but now is not the time to declare victory or forget about this important public health concern.

I’d like to discuss the most significant factors that will keep opioids as an area of focus in 2021 and for years to come.

1) Pandemic-related treatment delays and social isolation

When the 2019 novel coronavirus outbreak was declared a pandemic in March 2020, it caused a cascade of shutdowns, delays and status quo modifications that impacted nearly every part of daily life.

While there is still a lot of uncertainty around the exact relationship between opioid usage and COVID-19, there is reason to believe that the pandemic may have created an environment where risk factors for opioid misuse and abuse were increased.

Surgery delays may have significantly increased opioid usage. One recent study into the impact of surgery delays on chronic pain patients reported a 23.4% increase in pain medication dosage among people informed of a delayed procedure.

Even for pain sufferers not waiting to undergo surgery, the social isolation, uncertainty, stress and lack of productive activity that so many have been facing during the pandemic may result in increased drug use and misuse. Recent data shows an uptick in both prescription and illegal opioid use over the past nine months.

For example, a new research brief from the National Council on Compensation Insurance (NCCI) shows that the share of prescription drug claims inched up in 2020 after previous declines in the last two years. Additionally, according to a study published in the Journal of the American Medical Association, one urban emergency department in Virginia saw a 123% increase in nonfatal opioid-related overdoses over a similar period in 2019.

As of this writing, COVID-19 has claimed over 400,000 lives in the United States, data from the CDC reports, with every indication that this number will continue to climb.

Researchers will spend years trying to discover the extent to which the pandemic was a secondary contributor to other fatalities. There is reason to believe a significant portion of the fatal opioid overdoses in 2020 were related to the pandemic in some way.

2) Telemedicine increases access to needed health services, but also the potential for opioid abuse

While COVID did cause a marked increase in the use of telehealth services in 2020, it was already a growing trend that the pandemic only accelerated. We’re still waiting to see the full effect of the recent DEA relaxation of telephonic requirements for physicians using medication assisted treatment (MAT) for opioid use disorder.

Buprenorphine (brand name Suboxone) is one drug used to treat opioid use disorder. Classified as a partial agonist-antagonist opioid, buprenorphine may be highly beneficial if used properly.

However, there is a risk for it to be used off-label for pain treatment. This in turn opens the door to potential misuse or abuse by patients.

Increased access to health care providers via telemedicine is an enormous benefit, but it’s important for the industry to stay vigilant. With clinical oversight and data analysis, clients may identify potentially dangerous scenarios and take appropriate corrective measures.

3) The ongoing expense of opioids

Despite the broad public awareness of the opioid crisis, pharmaceutical companies continue to find ways to make money from the production of this drug class.

A key reason for this is exploitation of patent protection laws. Patent protection is critical for innovation and fostering creativity in the industry, giving manufacturers an incentive for the enormous investment required in the research and development of new treatments.

However, in the case of opioids, pharmaceutical companies regularly reformulate old drugs, such as morphine and hydrocodone, and sell them at an expensive brand rate. These are drugs that have been on the market for decades, or in the case of morphine, over a century.

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Drugs that have been around as long as opioids should be very inexpensive, but payers are too often still paying a premium price.

In workers’ compensation, there are few categories of drugs that have seen the influx of new so-called “brand only” drugs that opioids have. This has resulted in increased costs in a category that already represents a health risk for injured workers.

4) Drug interactions create new patient management challenges

Drug interactions are a significant concern with use of opioids. Opioids interact with other medications and can increase the likelihood of overdose and deaths. Dealing with drugs this powerful requires a comprehensive patient management program.

Benzodiazepines present a significant interaction risk and have received the FDA’s black box warning. Still, we see doctors prescribe opioids together with benzodiazepines and sometimes powerful muscle relaxants such as Soma (carisoprodol).

The combination of opioids with medical marijuana is another interaction that requires careful monitoring. As more states legalize marijuana, it may be more likely to be used in conjunction with opioids.

The biggest issue we’re currently facing is that legalization of marijuana is occurring at the state level while the federal government continues to classify it as an illegal drug. This means the safeguards that exist for prescription drugs, including state prescription drug monitoring programs (PDMPs), do not exist for marijuana. The state-level legalization has resulted in a powerful and addictive drug bypassing the existing safeguards of a comprehensive clinical pharmacy oversight within the profession of pharmacy today.

Drug interactions that can result from combining drugs with marijuana are not being identified. While more study is needed, we know that marijuana has an interaction with opioids, and it is not recommended to combine the two.

The Importance of Comprehensive Clinical Management

As we move forward into 2021, there will still be a long road ahead in fighting and overcoming the COVID-19 pandemic and returning to whatever the new normal turns out to be.

But it will also be a year for returning needed attention to the many issues and challenges the workers’ compensation industry faces. For patient safety and cost, opioid misuse will continue to be a major focus area.

At myMatrixx, opioid management has stayed on our radar even as we helped clients navigate the complexities of the pandemic environment last year. We’re developing key strategies and partnerships designed to help clients better identify and understand opioid usage patterns among injured workers and help reduce opioid misuse and abuse.

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Behavioral care shows promising results for helping patients overcome opioid use disorder and wean themselves off of medication. Another important consideration from an analytic standpoint is drug testing, which is often needed to bolster prescription data with actual usage statistics. These are two areas that we’re excited to focus on and will be adding to the extensive portfolio of clinical management services we offer.

The opioid misuse crisis continues to negatively impact the lives of patients while costing our health care system billions of dollars. This is why it still deserves our focus and why myMatrixx will continue to keep opioid management as a major priority. &

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