The Opioid Epidemic A Generation in Crisis Presented to AASCIF Las - - PowerPoint PPT Presentation

A Generation in Crisis

The Opioid Epidemic

Presented to AASCIF

December 5, 2017

Las Vegas, Nevada

Ø Scope of the Epidemic? Ø What changed? Ø Increase in Heroin use? Ø What changed? Ø Impact on state workers’ compensation systems. Ø Solutions. Ø Legislative Trends. Ø Supplemental Information. Ø Q&A.

Topics to cover

SCOPE OF THE EPIDEMIC?

National Overdose Deaths

52,404 19,447 32,957 10,000 20,000 30,000 40,000 50,000 60,000

Number of Deaths from All Drugs

Total Female Male

Source: CDC Wonder Includes intentional, unintentional and undetermined deaths

National Overdose Deaths

5,000 10,000 15,000 20,000 25,000 30,000 35,000

Number of Deaths from Opioid Drugs

Total Female Male

Source: CDC Wonder

National Overdose Deaths

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000

Number of Deaths from Prescrip8on Opioid Pain Relievers (excluding non-methadone synthe8cs)

Total Female Male

Source: CDC Wonder

National Overdose Deaths

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

Number of Deaths from Benzodiazepines

Total Female Male

Source: CDC Wonder

National Overdose Deaths

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

Total Benzodiazepines and Opioids Benzodiazepines without Opioids

Opioid Involvement in Benzodiazepine Overdose

Scope of the Epidemic?

Ø 80% of global opioid supply is consumed in the United States. Ø Sales of prescription opioids in the US quadrupled from 1999 to 2014, but there was no overall change in the amount of pain Americans report. Ø Pain drugs are the second largest Rx class after cancer medicines.

In 1991 – 76 million pain medication Rxs. In 2011 – 219 million pain medication Rxs. In 2012 – 259 million pain medicine Rxs – enough for every American adult to have one bottle.

Rapid Rise of Pain Medication Rxs

A Bottle for Every American Adult

In 2015 alone, physicians wrote approximately 300 million pain prescriptions = $24 billion market.

Scope of the Epidemic?

Ø Gender specific trends – Since 1999, 400% increase in opioid related deaths for women compared to 265% for men. Ø Estimated 20% of patients – non-cancer pain – receive an opioid Rx. Ø Opioid Rxs per capita increased 7.3% from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice and internal medicine compared with other specialists. Ø Today, primary care physicians account for 50% of opioid Rxs written. Ø Rates of opioid prescribing vary greatly across states in ways that cannot be explained by the underlying health status of the populations. Ø This highlights the lack of consensus among clinicians on how to use

• pioids.

Scope of the Epidemic?

SOURCE: IMS, National Prescription Audit (NPA™), 2012.

In 2016

• verdoses

killed roughly

64,000

people It is estimated that over

2 MILLION

people have an opioid use disorder In 2015

97.5

MILLION

people used prescription

• pioids

Scope of the Epidemic

The Deadliest Crisis in American History The leading cause of death among Americans <50

SOURCE: First governmental account of nationwide drug deaths.

Every day, more than 90 Americans die after overdosing on opioids.1

The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. 2

• 1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–
• 2015. MMWR Morb Mortal Wkly Rep. 2016;65. doi:10.15585/mmwr.mm655051e1.
• 2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in

the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.

Scope of the Epidemic?

Ø In 2013, Louisiana ranked 1st in the US for proportion of opioids prescribed per capita among all 50 states.

Srey Ram Kuy, La. Department of Health.

Ø In one study, Louisiana had the 6th highest opioid prescribing rate in the country.

IMS Institute for Healthcare Infomatics’ Analysis, 2016.

Ø Found there were 102.3 opioid Rxs for every 100 people (new and refills). National average is 69.5 Rxs per 100 people. Ø CDC ranked Louisiana 19th among states – age adjusted opioid

• verdose rate.

WHAT CHANGED?

What Changed?

Ø More liberalized views of pain management and chronic pain.

v In 1995 OxyContin approved by FDA. v “Pain as the 5th vital sign” introduced by the American Pain Society. v Only subjective vital sign that cannot be objectively measured. v VA adopted as part of their national pain management strategy. v Adoption of pain scale use. v Joint Commission began auditing for pain scale use. v Others followed suit.

What Changed?

Ø Patient Satisfaction Surveys.

v CMS shifted focus from pay for volume to pay for value (outcomes). v 30% of score for value based upon patient surveys. v Too much emphasis on score. v Tied to reimbursement. v Pendulum swung all the way to the other side.

INCREASE IN HEROIN USE?

Heroine is an extremely potent and illegal opioid. Heroine usage has risen 58% over the last 10 years in adults of 26+ years

• f age.

Each day 580 people initiate heroine use.

Increase in Heroin use.

Increase in Heroin use.

National Overdose Deaths

12,989 3,108 9,881 2,000 4,000 6,000 8,000 10,000 12,000 14,000

Number of Deaths from Heroin

Total Female Male

Source: CDC Wonder

National Overdose Deaths

5,000 10,000 15,000 20,000 25,000

Number of Deaths from Heroin and Non-Methadone Synthe8cs (captures illicit opioids)

Total Female Male

Source: CDC Wonder

National Overdose Deaths

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000

Number of Deaths from Cocaine

Total Female Male

Source: CDC Wonder

Opioid Involvement in Cocaine Overdose

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000

Total Cocaine and opioids Cocaine without Opioids

East Baton Rouge Parish Heroin Deaths

10 20 30 40 50

2012 2013 2014 2015

5 35 28 41

Deaths Baton Rouge, Louisiana It forms the parish seat of East Baton Rouge Parish and is located on the eastern bank

• f the Mississippi River. As the

capital city, Baton Rouge is the political hub for Louisiana, and is the second-largest city in the state after New Orleans, with an estimated population of 228,590 in 2015.

Ø Why is Heroin use increasing? Perfect Storm.

Adoption of Prescription Monitoring Programs (PDMP) to help curtail “doctor shopping”. Depletion of legal supply = Price increase. Decriminalization of Heroin – non violent criminals. Heroin is cheap and unregulated.

What Changed?

Heroin surge tied to Rx opioids.

What Changed?

ALCOHOL MARIJUANA COCAINE Rx OPIOID PAINKILLERS

are are are are

2x 3x 15x 40x

People who are addicted to… … more likely to be addicted to heroin.

IMPACT ON STATE WORKERS’ COMPENSATION SYSTEMS.

WCRI – most recent multi-state review.

Impact on State Workers’ Compensation Systems

26 states share data with WCRI.

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Workers’ Compensation

Impact on State Workers’ Compensation systems.

Ø 85% of Injured workers with pain medications received opioids. Ø 1 in 6 Injured workers who received opioids were on long-term basis. Ø Louisiana had the highest percentage of workers’ compensation claims with long-term opioid use. Ø Louisiana injured workers received 2x more opioids than median state. Ø Louisiana had highest number of opioids Rx’d per claim. Ø Narcotics account for approximately 25% of Rx spend in workers’

• compensation. NCCI 2016.

Drugs Are Why 1 in 5 Men Drop Out of the Labor Market

Source: The Brookings Institution, Washington, DC

Ø Reduce the supply.

v DEA – 25% reduction of Schedule II narcotics in 2017. v Includes reduction of Oxycodone, Hydrocodone, Fentanyl, Hydromorphone, Morphine, etc. v IE – Hydrocodone supply will decrease by 1/3 of 2016 levels.

Ø Prescription Drug Monitoring Programs (PDMP or PMP)

v Started around 2006 and in all but 1 state. v Every state different, but creates registry. v Helps prevent doctor shopping for drugs.

Ø Change in prescribing habits.

Solutions.

Solutions.

Ø Change in prescribing habits. Ø “The prescription overdose epidemic is doctor-driven. It can be reversed by doctors.” Dr. Tom Frieden, CDC Director. Ø “For the past 20 years, public policies – well-intended but now known to be flawed – compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be much more cautious with how we prescribe opioids.” Dr. Steven Stack, 170th President of the AMA. Ø 4/11/17 – Pharmacy Practice News – Patients report worse outcomes with higher

• pioid doses.

Ø Lawsuits against Big Pharma.

LEGISLATIVE TRENDS.

Ø Mandatory Prescription Drug Monitoring Programs (PDMP)

v Statewide registry v Mandatory participation to include broad group of physicians v Initial, periodic and recurring checks v Audit trail detailing access (or non access) v Prevents doctor shopping

Ø Require more stringent documentation Ø Day limits – 7 days for acute injuries Ø CMEs to include opioid training

Legislative Trends.

Ø Creation of statewide opioids abuse commissions Ø Rx Drug Formularies Ø Accountability

Legislative Trends.

Ø SB 96 – Passed as Act. No. 241, effective 6/14/17.

v Focuses on pharmaceutical cost transparency and marketing. v Requires manufacturers to report annually the wholesale acquisition costs of drugs marketed in La. v Authorizes La. Board of Pharmacy to collect data on Rx drug pricing and disclose via website available to all La. prescribers. v Funded by private grant monies so implementation date based upon time needed to raise funds.

Legislative Trends.

What Does It Mean to Be “Well”?

LWCC PROVIDER CONFERENCE

See the whole picture. Treat the whole patient.

Comprehensive Treatment Approach

Davis MA et al. J Am Board Fam Med. 2017; Arteta J et al. Pain Med. 2016;17:295.

Physiological Psychological Social Return-to-work Rx & non-Rx approaches

END THE EPIDEMIC

ENDING OPIOID ABUSE IN AMERICA

Questions and Answers

Children are the Silent Victims of the Opioid Epidemic.

The Human Toll... A Generation in Crisis.

Paul D. Buffone, J.D.

Senior Vice President / Chief Claims Officer

Louisiana Workers’ Compensation Corp. 2237 South Acadian Thruway Baton Rouge, LA 70808 pbuffone@lwcc.com [o] 225.231.0543 [c] 225.229.1134

Questions? Need More Information?

Feel free to contact us.