“At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence…..”

“The president promised two months ago that his administration would “spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”
Sens. Elizabeth Warren (D-Mass.) and Lisa Murkowski (R-Alaska) are pushing President Donald Trump to formally declare the opioid epidemic a national emergency, something he promised in August but has yet to do.
It’s been 63 days since Trump verbally referred to the opioid crisis as a “national emergency,” the senators noted in a letter they sent to the president Thursday.
“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency. It’s a national emergency,” Trump told reporters while at his golf club in Bedminster, New Jersey. He said his administration was “drawing documents now” and planned “to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”
Declaring the national emergency would allocate more federal funding to state and local officials dealing with the crisis, as well as pressure lawmakers to take more long-term steps. But no documents have been filed, and the administration hasn’t said when Trump will make an official declaration.
White House press secretary Sarah Huckabee Sanders said in September that the delay was due to “a much more involved process,” and cited legal and administrative issues.” (A)

“New Jersey Gov. Chris Christie said Tuesday President Trump’s failure to officially declare the opioid crisis a national emergency was “not good,” according to a report.
“I think the problem is too big to say that if he had declared an emergency two months ago that it would make a significant difference in two months,” Christie said, per the Associated Press. “But I would also say you can’t get those two months back. And so it’s not good that it hasn’t been done yet.”
The two-term Republican governor chairs Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, which was established in March via an executive order to specifically tackling the opioid epidemic that the body estimates claims about 142 Americans every day.
When asked about the delay, Christie said he had been told by the White House that there were “legal” issues involved with making such a declaration since it was not a natural disaster and had no firm end date.
Christie, however, added that the inaction had “lessened” the commission’s work as one of the key recommendations it made in a July draft report was to name the problem a national emergency.” (B)

“At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.
The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.
Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis.
ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them.
In contrast, almost every plan covered common opioids and very few required any prior approval.
The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found.” (C)

“Nationally, according to the Centers for Disease Control and Prevention (CDC), a baby is born suffering from opioid withdrawal every 25 minutes.
Dayton Children’s Hospital has a program for such babies — a result of the mother using drugs like heroin or other opioids, like painkillers or fentanyl, while pregnant. The hospital’s neonatal intensive care unit treats 20 to 30 babies a year with an average stay of 17 days, down from 58 in 2012. In a hospital where the norm was once broken bones and the flu, the impact of the opioid epidemic is felt in every corner.
Ashley Hudson’s 12-day-old daughter A’Layjah was undergoing treatment at Dayton’s neonatal ICU in September. Her newborn son passed away last year, and she blames her drug use. “I can’t live through that again,” Hudson said.
Hudson said she stopped using heroin during this pregnancy but was treated with a maintenance drug that left A’Layjah born dependent. The unit was helping to treat the baby girl with both medicine and nonpharmacological measures — including low lighting and skin-to-skin bonding — and doctors said her prognosis was good.
For those infants born dependent on opioids, there’s a follow-up clinic, or developmental pediatrics program, where Jude Seidler, a precocious 2-year-old, was making his presence known one day last month.
Jude’s mother had used heroin every day of her pregnancy, and at nine days old, he went home with adoptive parents, Jay and Ashley Seidler. Dayton Children’s Hospital, they say, has been their lifeline.
“We’ve been able to chart his progress,” Jay Seidler said.” (D)

The data show that the situation is dire and getting worse. Until opioids are prescribed more cautiously and until effective opioid addiction treatment becomes easier to access, overdose deaths will likely remain at record high levels.
The opioid epidemic in 6 charts, by ANDREW KOLODNY, https://www.cbsnews.com/news/opioid-epidemic-in-6-charts/

“The national opioid crisis is a dilemma of dichotomies. There are challenges with both prescription and illicit drugs. The solutions must consist of efforts that realistically can reduce the number of people who become addicts in the first place, as well as cure those who do. The underlying issue of pain management can, in many cases, be addressed without drugs or certainly with less addictive formulations. There are public health challenges of both improving the treatment of pain and at the same time reducing the potential for addiction. Clearly, there are choices that can be made for suffering patients that are proven to be effective without the high risks associated with the powerful prescription opioids available today.
For all these issues, data specialists in the medical field can and must become key participants in our solutions effort. These data intelligence engineers can lead the development of fact-based plans of action that are capable of producing real change — change that results from the development of sophisticated data mining and pattern-matching algorithms that target factors associated with addiction. These algorithms can speed up the evaluation and viability of strategies that focus on reducing the death rate immediately and lowering the number of potential addicts in the future. It’s a huge task, but one that a new generation of data analytics tools can handle.” (E)

“The University of Pittsburgh’s Program Evaluation and Research Unit (PERU) is working with Pennsylvania officials to standardize death data from overdose victims.
“It’s represented by age, by gender, by ethnicity, by location,” Dr. Janice Pringle, PERU director, told Fox News.
The purpose of the project, Overdose Free PA, is to provide more detailed reporting in real-time that could help show where the problem areas are, Pringle said. Previously, each coroner’s office had a unique way of recording data on overdose victims, but the project provides them with a template for a standardized option of data reporting.
“That helps you understand that in certain parts of the state there may be patterns,” she told Fox News.
The data is also divided by the type of overdose death, including drugs that are not opioids, like cocaine and LSD, according to the website.
In 2016, there were 4,652 drug overdose deaths in the state, according to a Drug Enforcement Administration report. That equates to roughly 13 drug-related deaths per day.
Specifically, the study found the presence of an opioid, either illicit or prescribed by a doctor, in 85 percent of drug-related overdose deaths in the Keystone State.
Pringle said they’ve already seen the program’s impact in some areas.
“We do have a couple of counties in Pennsylvania that are stabilizing with their overdose rates,” she said.” “(F)

“The headlines from the opioid epidemic seem to be all about overdoses in public parks, homes, and elsewhere in the community. But the drugs can cause problems even in a setting where patients are under the direct care of doctors and nurses: the hospital.
Among the most common trouble spots:
Administration. These events included cases in which patients were given the wrong type of medication, such as a fast-release drug when the slow-release version was indicated. They also included events with the wrong frequency or dose of a drug, incorrect or omitted documentation, administration of opioids without an order, or inadequate patient assessment at administration.
Diversion. These cases include those in which opioids were “unsecured” or where the amount on the shelf did not match records. They also included removal of opioids without documentation that were given to a patient and the failure to account for disposal of leftover drugs.
Prescribing. Problems included prescribing more than one drug at a time or the wrong dose of a drug, and filling duplicate orders of drugs.” (G)

“Families across the United States are demanding that more be done to end the despair and devastation of addiction. Here are eight steps to take — now. They include some of the recommendations of the president’s commission….
SAVE LIVES Active users need to be kept alive long enough to seek treatment…
TREAT, DON’T ARREST Nearly 300 law enforcement agencies..participate in the Police Assisted Addiction and Recovery Initiative, which offers treatment for drug users who ask the authorities for help…
FUND TREATMENT Repealing Obamacare would eliminate Medicaid-funded treatment for thousands of addicts…
COMBAT STIGMA Misunderstanding of opioid addiction shrouds nearly every effort to reduce its toll…
SUPPORT MEDICATION-ASSISTED TREATMENT One of the most effective methods of treating drug addiction is through continuing medication therapies like methadone, naltrexone and buprenorphine…
ENFORCE MENTAL HEALTH PARITY Half to 70 percent of people with substance abuse problems also suffer from depression, post-traumatic stress or other mental health disorders…
TEACH PAIN MANAGEMENT The opioid crisis is rooted in our health care system: American physicians prescribe opioids for pain management at far higher rates than physicians prescribe them in any other nation.
START YOUNG WITH PREVENTION A 2015 study by the National Institute on Drug Abuse found that “Life Skills Training” for seventh graders helped them avoid misusing prescription opioids throughout their teenage years…. “(H)

“CVS is rolling out a series of changes aimed at addressing the nation’s opioid crisis.
The retailer announced that it will impose a seven-day limit on the supply of opioids dispensed for certain prescriptions and will also limit the daily dosage of certain opioids.
When a patient receives an opioid prescription, pharmacists will first discuss the risks of dependence and answer any questions the patient may have.” (I)

“Google implemented new restrictions on advertising related to searches for addiction treatment after “misleading experiences” involving treatment centers, a company spokeswoman said. Credit Dominick
As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.
But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.
This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.” (J)

“State attorneys general battling the opioid crisis have turned their attention to health insurance companies and “unnecessary overprescription” of the class of painkillers. The letter urged payers to take action, though it didn’t acknowledge the many steps insurers have already taken.
The National Association of Attorneys General (NAAG) sent a letter America’s Health Insurance Plans, asking its members to “review payment and coverage policies and revise them, as needed, to encourage healthcare providers to choose alternatives to prescribing” opioids.
“When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective nonopioid alternatives, ranging from nonopioid medications such as nonsteroidal anti-inflammatory drugs to physical therapy, acupuncture, massage and chiropractic care,” the NAAG letter (PDF), signed by 37 state and territorial attorneys general, argued.” (K)

“A local hospital group has developed a program that helps patients get alternative treatments for chronic pain besides prescription opioids, helping the network decrease its opiate use by 20 percent since it started implementing the steps in 2013.
The opioid overdose crisis has been in part connected to over-prescription of high power painkillers, and the KetteringHealth Network said at a Monday press conference that its goal with its new program, called “Pause,” is to get providers and patients to pause and consider alternatives to prescriptions that patients may become addicted to.
As the region’s opioid crisis intensified through the first half of this year, Montgomery County hospital emergency departments received 2,565 overdose patients — more than any other Ohio county. In all, Ohio emergency departments treated 19,128 overdoses during the period, including 2,204 in Cuyahoga County, the state’s most populous.
The state also has guidelines for treatment of chronic pain. Ohio Mental Health & Addiction Services’ guidelines encourage providers to assess whether they are in compliance with prevailing standards of care. The guidelines also ask providers to look into non-opioid therapy options and avoid long term prescribing opioids.” (L)

“A new University of Michigan initiative aiming to address societal health problems will begin with the opioid crisis, President Mark Schlissel announced Tuesday, Oct. 3…..
Michigan health-care providers wrote 11 million prescriptions for opioid drugs in 2015 and another 11 million in 2016, compared to roughly 8 million prescriptions in 2009. That equates to about 1.1 prescriptions for every Michigan residents, according to the state’s drug monitoring system.
“When patients undergo surgery and get an opioid prescription, some achieve good pain control using the prescribed dose, but many others don’t. And some become addicted,” Schlissel said. “Most new chronic users receive their first opioid prescription for post-surgical care, and 6 percent of patients who have never had an opioid before will become dependent long after surgery. Some patients don’t take their full dose, meaning unused pills can end up in the wrong hands.”
Schlissel said the project will examine ways health professionals can predict how much pain medication someone will need, based on their individual genetic profile, physiological condition and social, environmental and lifestyle factors, tailoring how they help individual patients manage pain.” (M)

“Cigna says it won’t cover prescriptions for the brand OxyContin for most customers starting next year — it’ll be taken off group preferred commercial drug lists.
In 2016, Cigna laid out a three-year plan to cut down on opioid use among its customers by a quarter. It seems this move is an effort to help meet that goal.
There are a few caveats to this announcement: Cigna will still cover at least one oxycodone alternative, and people who use OxyContin for hospice or cancer care will have their prescriptions covered. The company also says it’ll consider approving OxyContin if a customer’s doctor deems it medically necessary.
Cigna is notifying patients with current OxyContin prescriptions and their doctors about the future change.
“While drug companies don’t control prescriptions, they can help influence patient and doctor conversations by educating people about their medications. The insights we obtain from the metrics in the new value-based contract will help us continue to evolve our opioid management strategies to assist our customers and their doctors,” Jon Maesner, Cigna’s chief pharmacy officer, said.” (N)

“Wisdom teeth surgery involves pliers, so there’s often some post-operative pain. For years, dentists have prescribed painkilling opioids, like percocet or vicodin for patients.
But with opioid abuse claiming lives in Colorado and across the country, oral surgeons and other health care providers are looking to alternatives. Lafayette oral surgeon Curt Hayes recently switched to FDA-approved local anesthetic Exparel, a non-opioid. When he injects it into his patient’s’ gums the area will stay numb and pain free for two to three days.
He can now generally remove wisdom teeth without using any narcotics for pain — so there’s no need to prescribe his patient a dozen or more pills.
“I’ve backed off to where I don’t give any narcotics whatsoever,” said Hayes. “I have people just using ibuprofen and then over-the-counter Tylenol, and that’s acceptable. And it takes care of the pain.”
Hayes followed the development of Exparel, also known by its generic name bupivacaine, in journals. Other doctors started using it for C-Sections. He started using it mainly for patients who had abused narcotics in the past, to avoid relapses. After seeing positive results, Hayes started making it an option for all his patients….
Colorado’s dental board is developing new best practices and the Colorado Dental Association is holding educational seminars. Dr. Brett Kessler, a dentist in Denver and past president of the state association, said across the board, medical providers are re-examining their role in the opioid crisis.
“It’s on every health care practitioner’s mind,” Kessler said. “Looking for alternatives to manage the pain is huge, and it’s a growing trend nationally.” “(O)

“How to help someone with an opioid problem
The state’s Next Level Recovery website suggests watching for these seven signs that you or someone you care about might have an opioid-use disorder:
• Needing higher doses of the opioid to get the same effect that a lower dose used to provide.
• Trying to quit more than once without having success.
• Thinking about getting high as soon as you wake up in the morning.
• Getting anxious or agitated within several hours of your last dose.
• Experiencing vomiting, diarrhea or nausea after quitting for a short period of time.
• Having less interest in activities you used to enjoy.
• Using opioids when driving or caring for children.” (P)

“In the state morgue here, in the industrial maze of a hospital basement, Dr. Thomas A. Andrew was slicing through the lung of a 36-year-old woman when white foam seeped out onto the autopsy table.
Foam in the lungs is a sign of acute intoxication caused by an opioid. So is a swollen brain, which she also had. But Dr. Andrew, the chief medical examiner of New Hampshire, would not be certain of the cause of death until he could rule out other causes, like a brain aneurysm or foul play, and until after the woman’s blood tests had come back….
After laboring here as the chief forensic pathologist for two decades, exploring the mysteries of the dead, he retired last month to explore the mysteries of the soul. In a sharp career turn, he is entering a seminary program to pursue a divinity degree, and ultimately plans to minister to young people to stay away from drugs.” (Q)

(A) Elizabeth Warren, Lisa Murkowski Push Trump To Declare Opioid Crisis A National Emergency, by By Paige Lavender, https://www.huffingtonpost.com/entry/warren-murkowski-opioids_us_59df88b9e4b00abf3646f4dc
(B) Chris Christie: Trump’s delay in declaring the opioid crisis a national emergency is ‘not good’, by Naomi Lim, http://www.washingtonexaminer.com/chris-christie-trumps-delay-in-declaring-the-opioid-crisis-a-national-emergency-is-not-good/article/2637108
(C) Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers, by KATIE THOMAS and CHARLES ORNSTEIN, https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html
(D) A Generation at Risk: Children at Center of America’s Opioid Crisis,by DANIEL A. MEDINA, KATE SNOW, ML FLYNN and ERIC SALZMAN, https://www.nbcnews.com/storyline/americas-heroin-epidemic/generation-risk-children-center-america-s-opioid-crisis-n806456
(E) Using Big Data Medical Analytics To Address The Opioid Crisis, John Kelley, https://www.forbes.com/sites/forbestechcouncil/2017/10/02/using-big-data-medical-analytics-to-address-the-opioid-crisis/#18c0e84c142c
(F) Opioid crisis: Researchers employ new method to track overdose victims, by Michelle Chavez, http://www.foxnews.com/health/2017/10/10/opioid-crisis-researchers-employ-new-method-to-track-overdose-victims.html
(G) Even in hospitals, opioids can cause harm, by Tom Avril, http://www.philly.com/philly/health/addiction/opioid-overdose-in-hospital-medication-error-narcan-20171016.html
(H) America’s 8-Step Program for Opioid Addiction, https://www.nytimes.com/2017/09/30/opinion/opioid-addiction-treatment-program.html?mcubz=0
(I) CVS is taking steps to address the nation’s opioid crisis, http://abc13.com/health/cvs-imposes-opioid-limits-to-address-nations-crisis/2441143/
(J) Google Sets Limits on Addiction Treatment Ads, Citing Safety, by By MICHAEL CORKERY, https://www.nytimes.com/2017/09/14/business/google-addiction-treatment-ads.html?_r=0
(K) State AGs push health insurers to rein in opioid prescriptions, fail to acknowledge they’re already doing so, by Gienna Shaw, http://www.fiercehealthcare.com/payer/how-do-health-insurance-companies-control-opioid-abuse
(L) Hospital program attempts to reduce opioid use in patients, Kaitlin Schroeder, http://www.daytondailynews.com/news/local/hospital-program-attempts-reduce-opioid-use-patients/m61zU9FMvhQL1mWzEZ1NxI/
(M) University of Michigan tackling opioid crisis in new health initiative, by Martin Slagter , http://www.mlive.com/news/ann-arbor/index.ssf/2017/10/university_of_michigan_tacklin.html
(N) A top health insurance company is joining the fight against the opioid epidemic., by Cristina Mutchler, http://www.wtmj.com/newsy/health-insurer-drops-oxycontin-coverage-to-fight-opioid-crisis
(O) Colorado Dentists And Other Docs Seek Opioid Alternatives As Crisis Worsens, by John Daley, http://www.cpr.org/news/story/colorado-dentists-and-other-docs-seek-opioid-alternatives-as-crisis-worsens
(P) How to help someone with an opioid problem, by Jenny Ung and Jennifer Morlan, https://www.usatoday.com/story/news/nation-now/2017/10/08/how-help-someone-opioid-problem/745046001/
(Q) As Overdose Deaths Pile Up, a Medical Examiner Quits the Morgue, by KATHARINE Q. SEELYE, https://www.nytimes.com/2017/10/07/us/drug-overdose-medical-examiner.html?_r=0

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