Doctors are prescribing fewer opioids, but progress is uneven

The total number of opioid medications prescribed to people with commercial insurance from a Blue Cross and Blue Shield plan has fallen 29 percent since 2013.

Prescriptions played a role in the growth of the U.S. opioid crisis. Now doctors are changing their prescribing habits to combat epidemic rates of opioid misuse and overdose, according to a new report from the Blue Cross and Blue Shield Association.

Doctors are prescribing fewer opioids, and their prescriptions for the powerful painkillers are now more likely to fall within recent government guidelines, according to the Association’s analysis of claims for commercially insured Blue Cross and Blue Shield members.

“It all starts with the physician’s pen,” Dr. Matthew Fontana, divisional senior vice president and chief medical officer for pharmacy at Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas, previously told Making the Health Care System Work.

Experts believe overprescribing of opioid painkillers in the late 1990s contributed to widespread misuse of the drugs. Overdose deaths from prescription and nonprescription opioids were five times higher in 2016 than in 1999, according to the Centers for Disease Control and Prevention (CDC).

The Blue Cross and Blue Shield Association’s newest Health of America Report, “The Opioid Epidemic in America: An Update,” shows those prescribing patterns are improving.

The total number of opioid medications prescribed to people with commercial insurance from a Blue Cross and Blue Shield plan has fallen 29 percent since 2013.

Prescription drug monitoring programs may be one explanation for this decline. These monitoring programs involve state-level electronic databases that track prescriptions of controlled substances like opioids. They are intended to reveal inappropriate prescribing and help providers identify patients at risk of addiction.

The CDC calls the monitoring programs one of “the most promising state-level interventions to improve opioid prescribing, inform clinical practice and protect patients at risk.”

Uneven progress

Some states are making progress faster than others, according to the Health of America Report. Opioid prescription rates dropped fastest in Massachusetts (down 51 percent), Rhode Island (46 percent) and Mississippi (43 percent). The rates fell much more slowly in other states, such as Kansas (15 percent), Missouri (19 percent) and Florida (20 percent).

Many states started prescription drug monitoring programs in 2012 and 2013. However, the details of the programs vary from state to state. Missouri, the only state without a monitoring program, saw the second lowest decline in opioid prescriptions, the BCBSA report found.

Government guidelines

While opioids are risky, some people need them to control pain. In 2016, the CDC released opioid prescription guidelines to help prescribers make decisions that help their patients who are in pain.

The government recommends opioid prescriptions should last seven days or less and be under 50 morphine milligram equivalents per dose.

In 2017, 45 percent of BCBS members’ opioid use were within the recommended doses and duration guidelines — a six-point improvement over 2013. For members filling their first opioid prescription, that number jumps to 67 percent.

More work needed to lower addiction rates

These changes in prescribing patterns seem to be having a positive influence on the opioid epidemic. The rate of BCBS members diagnosed with opioid use disorder declined in 2017 for the first time in five years. The figure fell to 5.9 out of every 1,000 members from 6.2 in 1,000 in 2016, the BCBSA report found.

[Related: Tackling Prescribing Patterns to Combat the Opioid Crisis]

However, that means a substantial number of BCBS members and other Americans were still misusing opioids. This ongoing crisis, the report concludes, calls for continued efforts to curb inappropriate prescribing and increase access to effective treatment.

That’s why BCBSA is creating the Blue Distinction® Centers for Substance Use Treatment and Recovery program. These centers will use evidence-based treatment and focus on long-term success of their patients.

BCBSA will also launch a national hotline to help connect people to quality treatment centers. Both the hotline and the Blue Distinction Centers will be operational by January 2020.

“BCBS companies are deeply committed to improving how we care for those currently suffering from opioid use disorder,” said Scott Serota, president and CEO of BCBSA. “Our goal is to assess the effectiveness of treatment options and close the gap in care to make a difference in not just our members’ lives, but the lives of all Americans.”


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