The Opioid Epidemic A Generation in Crisis
Presented to AASCIF Las Vegas, Nevada December 5, 2017
Topics to cover 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.
SCOPE OF THE EPIDEMIC?
National Overdose Deaths Number of Deaths from All Drugs 60,000 52,404 Total Female Male 50,000 40,000 32,957 30,000 20,000 19,447 10,000 0 Source: CDC Wonder Includes intentional, unintentional and undetermined deaths
National Overdose Deaths Number of Deaths from Opioid Drugs 35,000 Total Female Male 30,000 25,000 20,000 15,000 10,000 5,000 0 Source: CDC Wonder
National Overdose Deaths Number of Deaths from Prescrip8on Opioid Pain Relievers (excluding non-methadone synthe8cs) 20,000 Total Female Male 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Source: CDC Wonder
National Overdose Deaths Number of Deaths from Benzodiazepines 10,000 9,000 Total Female Male 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Source: CDC Wonder
National Overdose Deaths Opioid Involvement in Benzodiazepine Overdose 10,000 Total Benzodiazepines and Opioids 9,000 Benzodiazepines without Opioids 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0
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.
Rapid Rise of Pain Medication Rxs A Bottle for Every American Adult 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. 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 opioids.
Scope of the Epidemic? SOURCE: IMS, National Prescription Audit (NPA™), 2012.
Scope of the Epidemic The Deadliest Crisis in American History It is estimated In 2015 In 2016 that over 97.5 overdoses 2 MILLION killed roughly MILLION 64,000 people have people used an opioid use prescription people disorder opioids 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 overdose 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?
Increase in Heroin use. Heroine is an Each day 580 Heroine usage has extremely potent people initiate risen 58% over the and illegal opioid. heroine use. last 10 years in adults of 26+ years of age.
Increase in Heroin use.
National Overdose Deaths Number of Deaths from Heroin 14,000 12,989 Total Female Male 12,000 10,000 9,881 8,000 6,000 4,000 3,108 2,000 0 Source: CDC Wonder
National Overdose Deaths Number of Deaths from Heroin and Non-Methadone Synthe8cs ( captures illicit opioids) 25,000 Total Female Male 20,000 15,000 10,000 5,000 0 Source: CDC Wonder
National Overdose Deaths Number of Deaths from Cocaine 8,000 7,000 Total Female Male 6,000 5,000 4,000 3,000 2,000 1,000 0 Source: CDC Wonder
Opioid Involvement in Cocaine Overdose 8,000 Total Cocaine and opioids 7,000 Cocaine without Opioids 6,000 5,000 4,000 3,000 2,000 1,000 0
East Baton Rouge Parish Heroin Deaths Baton Rouge, Louisiana Deaths It forms the parish seat of East Baton Rouge Parish and is 50 located on the eastern bank 41 of the Mississippi River. As the 40 35 capital city, Baton Rouge is the 28 political hub for Louisiana, and 30 is the second-largest city in the 20 state after New Orleans, with an estimated population of 5 10 228,590 in 2015. 0 2012 2013 2014 2015
What Changed? Ø Why is Heroin use increasing? Perfect Storm. Adoption of Decriminalization of Depletion of legal Prescription Heroin – non violent supply = Price Monitoring criminals. increase. Programs (PDMP) to help curtail Heroin is cheap and “doctor unregulated. shopping”.
What Changed? Heroin surge tied to Rx opioids. People who are addicted to… Rx OPIOID ALCOHOL MARIJUANA COCAINE PAINKILLERS are are are are 2x 3x 15x 40x … more likely to be addicted to heroin.
IMPACT ON STATE WORKERS’ COMPENSATION SYSTEMS.
Impact on State Workers’ Compensation Systems WCRI – most recent multi-state review. 26 states share data with WCRI.
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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
Solutions. 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.
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