“To manage and (eventually) reverse the opioid epidemic, state Medicaid programs should now take a deeper look at the role prescribing plays…”,

“The drug industry was more than willing to meet the need of increased opioid administration and more than willing to advance its usage…..
Adding to this pressure to overprescribe powerful analgesics was the decision by Medicare to adjust payments to hospitals according to their Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. This naïve thought put medical treatment on par with any other commodity. But, medicine is different—often patients have an erroneous view of what is in their best interest. Thus, they may be dissatisfied with appropriate medical decisions. In response, many hospitals have fostered a hotel-like approach to please patients.
This practice has led to patients being discharged with a plethora of powerful analgesics to assure hospitals receive excellent scores.
These series of missteps by the medical establishment, the government and public desire has led, in our nation, to drug overdoses (primarily opioids) as the leading cause of accidental deaths.” (A)

“In a recent letter to the Health and Human Services inspector general, Johnson noted that opioid problems appeared much worse from 2013 to 2015 in states that expanded Medicaid under the Affordable Care Act than those that didn’t, based on Census data and statistics from the Centers for Disease Control and Prevention…
Overall, overdose deaths per million residents increased twice as fast in Medicaid expansion states than in non-expansion states.
Correlation doesn’t automatically equal causation, but Johnson provides reason to think it exists in this case. Based on police comments, he reports someone with a Medicaid card can obtain up to 240 oxycodone pills for as little as a $1 co-pay. Those pills can then be resold for $4,000 on the black market.
It’s not unreasonable to think some people will exploit the system for fast cash, especially since others (taxpayers) foot almost all up-front costs.” (B)

“We need a plan. Now that the President has labeled this as a national health emergency, we need to act on this momentum to effectively combat this crisis….
Addiction is an illness, and we must start treating those struggling with substance abuse like patients.
Part of this approach must include improving access and use of treatment and recovery services, offering support to people who have become addicted, and using research data to prevent high-risk populations from ever encountering opioids. And we need more post-treatment rehabilitation programming that reintegrates recovering patients into society.
And importantly, we need to focus on prevention and improve education and training for the physicians and healthcare professionals who are on the front lines of this crisis. Similarly, we all need to understand the dangers of opioid abuse and the risk of addiction and overdose.
Federal money should go towards funding innovative solutions– (C)

STRATEGIES
“Following on the heels of last week, advocates, social service providers and people with a history of drug use staged a protest on Thursday at the office of Governor Andrew Cuomo to raise the visibility of the epidemic of overdose raging across the state and demand bolder political action.
Protestors called on the Governor to: 1) guarantee universal access to sterile syringes, naloxone, buprenorphine and methadone to every New York State resident struggling with a heroin or opioid addiction; 2) mandate that every Office of Alcohol and Substance Abuse Services (OASAS) funded program at least offer buprenorphine and/or methadone to people using opioids; 3) support the creation of safer consumption spaces, also known as supervised injection facilities.
…
New York State does need to ensure immediate access to drug treatment on demand for all its residents, but to tackle the overdose crisis it must also ensure that the treatment offered adopts evidenced-based approaches that work. Additionally, many New Yorkers, especially those in rural counties, have limited or no access to proven public health interventions like sterile syringe access, naloxone, buprenorphine or methadone, leading them to continued heroin and opioid use.” (D)

“Physicians are increasingly being asked for pain medication and some struggle to determine how to prescribe appropriately. It may be obvious that a patient needs some pain management after a procedure or while managing a painful condition. And it might be clear that an endless supply of opioids puts a person at high risk for addiction. But how much is enough? How much is too much? Three tablets? Six? 12?…
Practicing Wisely™, a new initiative aimed at developing measures of clinical appropriateness, does just this. States can use the program’s opioid measures to track variation in physician prescribing behavior for specific cases of opioid use, such as prescription rates following a C-Section. Comparing physicians’ prescribing patterns to the prescribing patterns of like-specialty physicians, performing the same procedure on a similar patient population can help to identify physician outliers. That is, physicians whose prescription rate deviates constantly from the rates of their peers for a given type of opioid use. Importantly, physicians can gain insight into how their peers are responding to demand for opioids and can consider any adjustments to their own behavior that might be more in line with what is typical among a similar population.
To manage and (eventually) reverse the opioid epidemic, state Medicaid programs should now take a deeper look at the role prescribing plays, and they can tackle the “gray” area of appropriate prescribing through the deployment of appropriateness measures.”(E)

“In the wake of President Trump declaring the opioid epidemic “a national emergency,” Express Scripts, the nation’s largest pharmacy benefit manager (PBM), has rolled out a new opioid management program that will limit the number and strength of opioid drugs to first-time patients…
Express Scripts’ Advanced Opioid Management solution is expected minimize early exposure to opioids while helping prevent progression to overuse and abuse, while ensuring access to medication patients need.
In a pilot study, the PBM observed a 38% reduction in hospitalizations and a 40% reduction in emergency room visits after educating patients about the risk of opioid use. An educational letter was also sent out to providers who showed high prescribing patterns and held counseling calls. Among this subset, a 19% decrease in the day’s supply of opioid dispensing during six-months of follow up, was observed.
Meanwhile, the American Medical Association (AMA) has found fault with the program, saying that treatment decisions should be left to physicians and their patients.
Here are 7 things to know about Express Scripts’ program to limit opioids:..” (F)

“Three local library systems are training staff in the use of the opioid overdose antidote naloxone and others are considering the move as more government agencies are joining the fight against Maryland’s opioid epidemic.
Library staff in Harford, Carroll and Anne Arundel counties have begun to offer training in administering naloxone, also known by its brand name, Narcan.
Meanwhile, library systems across the region are giving patrons access to a database of ebooks, audiobooks and other resources on addiction, recovery and the opioid epidemic, part of an effort to make libraries a greater resource for people confronting drug abuse.” (G)

“Mr. President, if you are serious about stopping America’s opioid crisis, instruct Attorney General Jeff Sessions to have the Department of Justice join in these legal actions, bringing the investigatory and legal weight of the FBI to battle the multibillion-dollar pharmaceutical opioid industry and the largest distributors and retailers of the drugs. Don’t waste federal resources on isolated overprescribing doctors and puny drugstores — the states can handle those cases. Tell Sessions to nip this tsunami in the bud by going after entities that garner more than a billion dollars a year off opioids. Tell Sessions to nip this tsunami in the bud by going after entities that garner more than a billion dollars a year off opioids.
Stop the export of America’s opioid crisis.
Stop the import of fake and copycat foreign-made opioids. “ (H)

“Dr. Leslie Blackhall handled that case and two others at the University of Virginia’s palliative care clinic, and uncovered a wider problem: As more people die at home on hospice, some of the powerful, addictive drugs they are prescribed are ending up in the wrong hands.
Hospices have largely been exempt from the national crackdown on opioid prescriptions because dying people may need high doses of opioids. But as the nation’s opioid epidemic continues, some experts say hospices aren’t doing enough to identify families and staff who might be stealing pills. And now, amid urgent cries for action over rising overdose deaths, several states have passed laws giving hospice staff the power to destroy leftover pills after patients die.” (I)

(A) America’s self-inflicted opioid crisis, by Ken Fisher, http://medicaleconomics.modernmedicine.com/medical-economics/news/america-s-self-inflicted-opioid-crisis?page=0%2C1
(B) Government’s role in opioid crisis deserves review, http://newsok.com/article/5560720
(C) Abuse Deterrent Formulations are a Critical Step in Solving the Opioid Crisis, by Doug Schoen , https://www.forbes.com/sites/dougschoen/2017/08/18/abuse-deterrent-formulations-are-a-critical-step-in-solving-the-opioid-crisis/#708e9a174b87
(D) CityViews: Calling Out Cuomo for the Opioid Crisis, By Jeremy Saunders, http://citylimits.org/2017/08/18/cityviews-calling-out-cuomo-for-the-opioid-crisis/
(E) How Medicaid Programs Are Managing the Opioid Crisis, by Parie Garg, http://health.oliverwyman.com/transform-care/2017/08/how_medicaid_program.html
(F) Seven things to know about Express Scripts’ plan to limit opioids, by Tracey Walker, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/seven-things-know-about-express-scripts-plan-limit-opioids
(G) Libraries join opioid addiction fight through Narcan training, by Mina Haq and Jon Kelvey, http://www.baltimoresun.com/health/bs-md-library-opioid-resources-0809-story.html
(H) How Not to Handle the Opioid Crisis, by LAURIE GARRETT, http://foreignpolicy.com/2017/08/22/how-not-to-handle-the-opioid-crisis/
(I) Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, by Melissa Bailey, http://khn.org/news/dying-at-home-in-an-opioid-crisis-hospices-grapple-with-stolen-meds/