Extreme risk of opioid addiction, OIG finds

Extreme risk of opioid addiction, OIG finds

With 80% of the Medicare Part D beneficiaries who are at-risk of misusing or overdosing on opioids receiving extreme amounts of the type of drug, HHS’ Office of the Inspector General recommends that CMS do more.

A new federal report recommends CMS take a more active role in ensuring Medicare beneficiaries get access to treatment for opioid use disorder after finding less than a tenth of at-risk patients received medication-assisted treatment in 2017.

The analysis, released Thursday by the HHS Office of the Inspector General, identified more than 71,000 Medicare Part D beneficiaries of being at serious risk for misusing or overdosing from opioids in 2017.
Approximately 80% of those beneficiaries received “extreme amounts” of opioids that year, defined as taking an average daily morphine equivalent dose of 240 mg for 12 months. The report found more than 14,000 in 2017 showed signs of engaging in ‘doctor shopping’, which was defined as taking an average daily morphine equivalent dose of more than 120 mg for at least three months during the year plus getting medications from four or more opioid prescribers and four or more pharmacies.

The report did show progress had been made in decreasing opioid use among at-risk beneficiaries. The number of those who received extreme amounts of opioids fell from 57,611 in 2017 to 27,137 in 2018. The biggest decline was among those who engaged in doctor shopping, the number of which decreased from 14,814 beneficiaries in 2017 to 2,452 in 2018.

But four out of five beneficiaries at serious risk of opioid misuse or overdose in 2017 still received high amounts of opioids in 2018.

Study co-author Miriam Anderson, a team leader in HHS OIG’s Office of Evaluation and Inspections, said the findings indicate efforts to reduce or stop the use of opioids among high-risk beneficiaries need to be improved.

“We were particularly concerned about this group because receiving these extremely high amounts or having behaviors that appear to be doctor shopping can signal that their care is not being monitored or coordinated properly, or that the beneficiary’s care needs to be reassessed,” Anderson said.

The need to monitor and track opioid use among at-risk beneficiaries is especially important now when many addiction treatment centers have been forced to scale down their services due to shelter in place orders as a result of the COVID-19 pandemic. Experts have said the temporary loss of in-person counseling services has increased anxieties among those with substance use disorder, which raises the risk of them relapsing.

HHS OIG on Thursday also released a toolkit to instruct stakeholders how to use prescription drug claims data to analyze patients’ opioid levels and identify certain patients who are at risk of opioid misuse or overdose.

Despite the progress in monitoring, the report found more needed to be done to expand treatment. Roughly half of the at-risk beneficiaries were diagnosed with opioid use disorder in 2017 or 2018, with just 7% receiving medication-assisted treatment through Part D.

Anderson said the fact that only a small share of beneficiaries received MAT highlights the challenges they face in accessing treatments from prescribers.

Medication-assisted therapies like buprenorphine and methadone are considered part of the gold standard for treating opioid use disorder. A study published in JAMA Network Open in February found buprenorphine and methadone was associated with a 58% decrease in drug overdoses over a 12-month span.
The report recommended CMS develop strategies to raise awareness among providers and Part D beneficiaries about how to get access to MAT drugs.

But tight regulations around prescribing both medications have limited their access. Methadone can only be dispensed at one of nearly 1,500 federally approved opioid treatment programs, while healthcare providers must complete eight hours of training to get a waiver to be allowed to prescribe buprenorphine.

“There’s concern that they may have not had access to, or known how to access, a prescriber with one of these special waivers,” Anderson said.

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