Opioid Abuse Treatment: Navigating Trends to Deliver Optimal Outcomes with Cost-Effective Care
by Micah Hoffman, MD, DABPN, FAPA
AllMed Behavioral Health Medical Director
While much of the focus of the past two years has been on the Covid-19 pandemic, another health crisis has been growing in the United States. More than 100,000 people died of drug overdoses during the 12-month period ended April 2021, a record high fueled primarily by opioids.1 Skyrocketing demand for treatment of opioid use disorder is exacerbating the ongoing strain on limited behavioral and mental health resources.
Meanwhile, the exodus of mental and behavioral health practitioners across the country continues, leaving fewer resources available for those in need. Healthcare organizations are looking urgently for ways to extend those resources to deliver effective member care that aligns with plan policy. Collaborating with the board-certified psychiatrists and psychologists on the AllMed reviewer panel can provide your team with the specialized expertise needed to bridge the gap.
Meeting Universal Challenges with Limited Geographic and Plan Resources
Two key factors are driving the unprecedented rise in opioid addiction and death. First, the increased availability of more potent and less expensive synthetic opioids has made taking the drugs deadlier and resisting them more difficult for those in recovery. Then, pandemic-related stresses and disruptions—such as social isolation and decreased access to substance use treatment, harm reduction services, and emergency services—likely have magnified the problem.2
Nationwide limited and uneven access to resources presents a significant challenge for members, providers, and healthcare organizations. A shortage of residential treatment, medical detox, and inpatient beds as well as of practitioners was a serious problem even before the pandemic. Now, it affects everyone at every step in the treatment process.
As an example of the severity of the issue, according to SAMHSA, in the entire state of Wyoming, there is no opioid treatment program. South Dakota has just one.3 While these states don’t have large populations, they represent a very large geographic area, and the scarcity of treatment options makes providing and receiving appropriate care extremely challenging. Situations like this exist in communities across the country, leaving those who are impacted frustrated and often desperate.
Preventing Misuse Before It Starts
Many members who end up abusing or misusing prescription opiates or opioids started using them to manage chronic pain. Studies show that approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and between eight and 12 percent of people using an opioid for chronic pain develop an opioid use disorder.4
The likelihood of developing an opioid use disorder depends on many factors, including the length of time a person is prescribed to take opioids for acute pain, and length of time that people continue taking opioids (whether as prescribed or misused).5 With this awareness, providers must constantly balance the need to control pain with the possibility of abuse or misuse when prescribing opiates for pain control.
In terms of prevention, long-time providers note that there has been a significant change in the way they approach pain management, based on knowledge gained in recent years. Whereas previously there was a broader acceptance of prescribing, more recent regulations—instituted and reinforced by payers, medical boards, and health systems—call for prescription limitations to the lowest effective dosage. These limitations may take the form of dose calculations to equate milligrams of opiate to morphine or strictly limiting the number of pills that are prescribed.
The Centers for Disease Control (CDC) provides guidelines for calculating the total daily dose of opioids in MMEs (morphine milligram equivalents) to help providers identify members who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, or other measures to reduce risk of overdose.6 While this approach may create frustration for both members and providers, evidence has shown it to be effective at curbing non-medical use of prescription medications. CDC research comparing dosages of 1 to <20 MME/day to dosages of 50 to <100 MME/day indicates that the risks for opioid overdose at least double at the higher dosages.7
Expert Help When You Need It
Partnering with specialized, board-certified physicians from AllMed can help your team successfully navigate the challenging realities of treating members with opioid use disorder. Our on-demand services are designed to support optimal member outcomes and control costs, with a focus on appropriate medications and care settings.
In the coming weeks, we’ll explore the factors that influence identifying appropriate treatment options for opioid use disorders—in crisis situations, in rural communities where resources are scarce, and among members dealing with housing instability. We’ll also look at the challenges that health plans and payers face in retaining qualified psychiatrists to manage complex member claims. Please check back in this space.