At the 2018 Insurance Rehab Synergy Group Annual Conference Robert Hall, MD and Tron Emptage both from Optium Workers’ Compensation, discussed opioid intervention strategies.
One of the problems is that opioid medications are too easy to obtain:
- 60% of US citizens have leftover narcotics in their home.
- 70% of opioid prescriptions abused come from a friend or relative.
- 91% of patients who overdose receive another opioid prescription within 10 months.
Education of all stakeholders is needed to stop the opioid crisis. This includes patients, medical providers, policy makers, payers, and employers. Some great tools for education include letters to the prescriber and the patient, medication reviews, and communication with the pharmacist.
Tools that can help:
- Work with pharmacy benefit manager to identify high risk claims.
- Evaluate patients with opioid doses that exceed guidelines or have repeated requests for dose escalation.
- Know signs of abuse.
- Promote medication agreements with one prescriber of opioid medications.
- Initiate clinical interventions as appropriate including prescriber outreach, medication reviews, and urine drug monitoring.
Part of the strategy includes managing the expectations for pain:
- Patient – Duration of pain, functional restoration, treatment plans.
- Provider – Workers’ comp guidelines, patient satisfaction, co-morbid conditions, increasing regulations.
- Employer – Modified duty, employee concerns.
- Payer – Return to work, length of therapy, claim closure, non-medication therapies.
Opioids should not be the only part of the treatment plan for pain. Providers need to be considering non-opioid medications and non-pharmacologic treatments.
Abuse-deterrent formulation of opioids were designed to stop people from crushing, snorting or injecting the opioids. But most people abuse opioids by taking the pill orally and these ADF do nothing to change that. They do not solve the problem of opioid abuse.
Something being developed by drug companies is monoclonal antibodies to treat chronic pain. These antibodies will attack the pain pathways in the nerves to block them. When these hit the marketplace, they will be very expensive.
A multi-disciplinary pain management is a great way to teach patients to cope with their pain with less medications. Those programs utilize psychological counseling, physical therapy, occupational therapy, and other modalities to help patients learn pain management skills.