Readers Write: Remember the Opioid Crisis?

Remember the Opioid Crisis?
By  Peter J. Plantes, MD

Peter J. Plantes, MD is physician executive with HC1 of Indianapolis, IN.

The last few years have ushered in significant progress on the opioid crisis containment front. Acknowledging decades-long misinformation shortfalls, negligence, and improper prescribing patterns, the healthcare industry took important steps on national and state levels to get out in front of devastating statistics.

A March 2020 report suggested the needle was finally pointing in the right direction. The Centers for Disease Control and Prevention (CDC) reported a 13.5% decrease in opioid overdose deaths from 2017 to 2018.

Unfortunately, that report was quickly overshadowed by the global pandemic that brought the nation to its knees. Opioid misuse, like many other critical healthcare priorities, took a back seat to COVID-19. The fallout is notable. A recent analysis points to a spike in opioid overdose cases by 18% since the start of the pandemic.

It’s not just overdose rates that have many across the industry concerned about the current state of the opioid epidemic. Public health officials also report a surge in relapse rates due to limited access to treatment.

The reality is that 2020 has delivered a perfect storm of factors that are contributing to a problematic front for opioid misuse, including mass unemployment and the isolation created by stay-at-home orders that interrupted existing care plans and contributed to an increase in mental health issues. In addition, studies reveal that opioid prescription rates for procedures such as hip and knee replacements continue to rise. Prescription rule changes aimed at helping patients during the pandemic may also have had negative effects by opening the door to increased fraud and “doctor shopping.”

Amid alarming trends, today’s providers face a complicated front at the intersection of increased addiction and appropriate opioid prescribing. Within what is now a highly regulated framework, healthcare organizations must ensure that they are optimizing patient safety by following prescribing guidelines and adhering to ongoing monitoring processes to detect misuse.

This is especially true for patients covered under a population management program of health insurance (ACOs, Medicare Advantage, and HMOs.) Neglecting this opioid substance abuse patient population can result in poor financial performance as well as regulatory scrutiny. NCQA issued additional opioid abuse management measures that are required to be reported as part of HEDIS 2020 standards. These will encourage both:

• Timely “Follow-up After High-Intensity Care for Substance Use Disorder” (FUI), and
• Sustaining “Pharmacotherapy for Opioid Use Disorder” (POD) patients.

In late 2020 and heading into 2021, there is much at stake with the opioid crisis. Healthcare organizations should reprioritize efforts now and increase their engagement to get the opioid trajectory moving in the right direction. It will not be easy, as accessing the right data and complying with guidance remains complex for the average resource-strapped provider.

At a minimum, healthcare organizations need to address the problem by:

1. Taking into account the public health emergency declared by HHS Secretary Alex Azar. This move on January 31, 2020 subsequently lead to the March 18, 2020 clarification from the US Department of Justice Drug Enforcement Agency (DEA) that healthcare professionals can now prescribe a controlled substance to a patient using telehealth technology.
2. Improving leadership through opioid stewardship committees. The Joint Commission mandated that all healthcare facilities implement leadership teams and performance improvement processes in 2018 to address safe opioid prescribing. Opioid stewardship committees can advance best practices by identifying existing gaps and implementing processes that meet best-practice guidelines that include risk assessment, using state implemented Prescription Drug Monitoring Program (PDMP) data, laboratory testing, and patient education. 
3. Conducting optimal patient risk assessments, monitoring, and education. Comprehensive risk assessments seek answers to the following questions: 1) Was a patient assessed for potential risk of misuse prior to a procedure or prescription? 2) Did the provider and patient have an open and honest discussion about whether opioids were the right choice? 3) Did a patient receive monitoring during follow-up care to ensure appropriate use of opioids? 4) Was a patient counseled on proper procedures for disposing unused opioids? These risk assessment standards should especially be part of telehealth-based opioid prescribing.
4. Accessing the right data in the most efficient way possible. Access to PDMP data is a critical first step, but it doesn’t always provide the full picture, especially in cases where patients are doctor-shopping across state lines. Healthcare organizations can extend the value of this data by combining it with dispensing records from multiple states and intelligent drug consistency assessment via laboratory testing to support precision prescribing.

Smart prescribing and oversight of opioid risk is more important than ever, as is equipping providers with easy access to the right patient data for monitoring. Technology that efficiently brings together the right data and delivers it in an actionable way to providers is improving this outlook. Technology that does not hinder the doctor-patient encounter is especially important for effective delivery of safe opioid prescribing practices. The technology must assist the physician in rapidly and completely engaging all required regulatory expectations without creating an administrative bottleneck in the daily practice setting.