An overwhelming majority of practice leaders polled in a Nov. 30 MGMA Stat poll said their organizations have tightened opioid prescription protocols amid the public health emergency.
The 83% of respondents said regulatory changes, increases in patient opioid abuse and implementation of new guidelines were primary reasons for the tightening of prescribing protocols. Only 14% of those polled indicated they have not tightened protocols, though some noted their organization already has a tight protocol in place. The remaining 3% reported they are unsure.
The Nov. 30 poll had 409 applicable responses from practice leaders who previously responded to a Nov. 14 MGMA Stat poll that asked if they educate patients on the misuse of opioids. Of 1,029 applicable responses, 61% said they offer patient education on opioid misuse while only 12% of respondents said they do not. Another 27% said their organization does not prescribe narcotics.
Opioid prescribing remains a key component of the current crisis, as suggested by a new study published in the medical journal Addiction last week. Researchers with the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore concluded that “high-risk patients obtain a substantial proportion of prescription opioids from low-volume prescribers,” and that risky prescribing practices significantly contribute to the number of opioid-related deaths. About one in 10 opioid prescriptions, the study notes, were concurrent with a benzodiazepine prescription; combinations of those medications are known to increase overdose risks.
Research presented in the Journal of the American College of Surgeons earlier this year noted that “vigilant prescribing guidelines” for post-discharge based on surgical inpatients’ opioid painkiller use on their final day pre-discharge could reduce opioid use by up to 40%.
Another major study – published last month in the American Journal of Psychiatry – showed that most opioid-related deaths from 2001 to 2007 among adults in the Medicaid program across 45 states were from chronic pain patients with an opioid prescription. The rate at which opioid painkillers have been prescribed has declined each year since it peaked in 2010, according to the Centers for Disease Control and Prevention (CDC), though that same report notes prescribing levels in 2015 were still about three times as high relative to 1999, when the current spate of opioid-related deaths first began to increase.
The White House’s Council of Economic Advisers (CEA) released a report last month estimating a drastic increase in the cost of the opioid crisis to the nation, putting the total at $504 billion. The estimate is more than six times the most-recent previous estimate, as the CEA included consequences related to opioid-related deaths in addition to nonfatal consequences, such as spending in healthcare and the criminal justice system.
Last week, two members of Congress introduced a bill to limit an initial prescription of opioids for acute pain treatment to seven days, in line with published recommendations from the Centers for Disease Control (CDC) after research showed that addiction risk rises after that seven-day period of use.
The bill does exempt cases involving end-of-life and palliative care, cancer care, traumatic injury or chronic conditions.
Another proposal offered last week by New Jersey Gov. Chris Christie – in his capacity as leader of the Trump administration’s commission on the opioid crisis – involved mandating continuing medical education (CME) on opioid prescribing as a condition of Drug Enforcement Administration (DEA) licensure.
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