By Kate
Morgan, for Blue Cross Blue Shield Association Published
6:38 a.m. ET March 22, 2019 | Updated 5:36 p.m. ET March 26, 2019
The data shows that
substance use disorder is still widespread, but innovations in treatment,
prescribing and awareness are helping.
Blue Cross Blue Shield plans team up with community partners to
address the crisis.
Between 1999 and 2016, more than 350,000
people died from an overdose involving an opioid – a class of medications
derived from compounds in the opium poppy plant (or synthetic versions of those
compounds) – used to treat pain.1 Substance use disorder has
become a huge problem in communities across America.
In the 1990s, the number of prescription
opioids – medications like morphine, codeine, hydrocodone and oxycodone – began
to rise. The pharmaceuticals bind to pain receptors in the brain and throughout
the body, making them very effective at treating the moderate-to-severe pain
that might be experienced after surgery or an injury, or as a result of a
condition like cancer. Unfortunately, the medications are also highly
addictive, especially with long-term use, and abuse of these drugs can lead to
overdose and death.
As the opioid crisis continues to dominate
national conversation, there is reason to be optimistic about the progress
being made in the medical and health care communities. A recent Blue Cross Blue
Shield Association (BCBSA) report published in July of 2018
found that the total number of opioid prescriptions filled by members has
declined 29% since 2013. Of the opioid prescriptions that were filled in 2017,
45% were within the CDC’s recommended guidelines for the dose and duration least
likely to contribute to misuse, up from 39% in 2013.
Confronting stigmas is critical to address the
crisis properly
An ongoing roadblock to stemming the opioid
epidemic is the stigma too often attached to those suffering from substance use
disorder. “Unlike other chronic diseases, such as diabetes or heart disease,
substance abuse is often considered a personal weakness,” says Lorina
Marshall-Blake, president of the Independence Blue Cross Foundation. “We hear
again and again how drug abuse is a self-inflicted problem, and that people who
use drugs are flawed.”
In the southeast Pennsylvania region, the
Independence Blue Cross Foundation ran a campaign called “Someone You Know.”
Through billboards, videos and print stories, the campaign worked to raise
awareness that addiction is a disease and needs to be treated like one.
“We want to let those who are struggling know
that recovery is possible; there are others fighting the same battle and you
can too,” Marshall-Blake says. “They are parents and grandparents, artists,
veterans, community leaders and advocates for recovery. In short, they are
someone you know.”
New methods are needed for effective addiction
recovery
In addition to shifting public perception,
medical experts are making critical changes to treat abuse. Anthem Blue Cross
Blue Shield (BCBS) of Connecticut, New Hampshire and Maine is tackling
addiction recovery through a groundbreaking partnership with Aware Recovery
Care. Aware offers an alternative to traditional residential treatment options,
reaching more BCBS members and their families through in-home programs.
“The partnership with Aware maximizes our
opportunities for innovation,” says Stephen Friedhoff, MD, chief clinical
officer and senior vice president at Anthem. “There are circumstances where a
multiple week residential or inpatient intervention is necessary, but studies
show only about 10-30% of people show sustained recovery after leaving
inpatient and residential treatment.”
Throughout the year-long Aware Recovery Care
program, a multidisciplinary medical team works with a member in their home,
often using a combination of drug therapy and counseling to develop an
individualized treatment program. The model, Friedhoff says, makes treatment
for substance use disorder more accessible.
“It’s not always realistic that someone can
leave their job or their family for weeks,” he says. “This is a wonderful opportunity
not only for people in that position, but also for people who may have tried an
inpatient program in the past.”
Since Anthem first partnered with Aware in
October of 2015, there have been 728 members admitted to the program, and about
60% have gone on to complete it. Anthem was the first health insurance plan to
cover the in-home treatment program, but based on its success, Friedhoff
expects the industry will begin to move toward the approach as a standard of
care.
Balancing pain management and addiction is key
in opioid prescribing
Before abuse ever occurs, a major step toward
bringing the crisis under control involves educating the medical community
about at-risk populations and the long-term risks of opioid prescribing.
Another successful alliance between Blue Cross Blue Shield (BCBS) of Michigan, the University of Michigan, and Michigan Department of Health and Human Services, works directly with physicians to reduce the number of opioids in our medicine cabinets.
Another successful alliance between Blue Cross Blue Shield (BCBS) of Michigan, the University of Michigan, and Michigan Department of Health and Human Services, works directly with physicians to reduce the number of opioids in our medicine cabinets.
The partnership, known as the Michigan Opioid
Prescribing Engagement Network, or Michigan OPEN, aims to address opioid
dependence by focusing on preventing it from developing.
“Our challenge is to successfully manage
patients’ pain while minimizing the risk of chronic opioid use or eventual
overdose,” explains Tom Simmer, MD, chief medical officer of BCBS Michigan.
Initial research into 12 procedures for which opioids were virtually always
used for post-surgical pain found that patients were prescribed, on average,
four times more pills than they actually needed to treat their pain. Having
more pills on hand, though, dramatically increased the number patients took.
For every 10 additional pills prescribed, patients took five.
Taking care to prescribe only the number of
pills a patient actually needs, Simmer explains, also reduces the number of
opioids available for non-medical use.
“People have children, they have parties, and
next thing you know there’s someone rummaging through the medicine cabinet.
We’ve seen anecdotal evidence to suggest that’s another way people get started
misusing opioids.”
To treat the issue of opioid dependence at its
source, Michigan OPEN has used data from both patients and practitioners to
establish prescribing recommendations for 25 common surgical procedures. Recommendations
range from 30 5mg oxycodone or hydrocodone tablets for radical mastectomy or
lymph node dissection, to no opioids at all for wisdom teeth extraction, which
was once been accompanied by a prescription for as many as 40 pills.
BCBS of Michigan has incentivized the
network’s physicians to adopt the new prescription guidelines by offering
enhanced payment on six common procedures, including bariatric surgery and
gallbladder removal.
“A lot of surgeons are quickly moving over to
the best practices,” Simmer says. “We’ve been able to make substantial
reductions in prescribing while not reducing success in pain management or
patients’ satisfaction with their procedure.”
As the approach continues to make an impact in
Michigan, Simmer says the number of procedures with the enhanced payment
incentive will increase. Michigan OPEN will also continue to hold medication
take-back and disposal events to stem the flow of opioids into communities.
When it comes to solving the country’s opioid
epidemic, Simmer says, reducing prescriptions is just one piece of the puzzle.
“It’s not the complete answer, and we still need to work on providing treatment
and assistance for people on the other end, who have already developed a
dependency,” he says.
From important awareness campaigns to
innovative partnerships and programs, Blue Cross Blue Shield companies are
changing the way we approach the opioid crisis for the health of
America.
All trademarks and brands identified above are
the property of their respective owners, which are in no way associated or
affiliated with the Blue Cross and Blue Shield Association. Use of these
trademarks and brands does not imply endorsement.
The Blue Cross Blue Shield Association is an
association of independent, locally operated Blue Cross and Blue Shield
companies.
Members of the editorial and news staff of the
USA Today Network were not involved in the creation of this content.
No comments:
Post a Comment