Health Insurers Could Be Driving Opioid Problem

(CN) – Health care insurers may have helped fuel the country’s growing opioid epidemic that claimed the lives of 42,000 Americans in 2016, a new study shows.

(AP Photo/Patrick Sison)

In their study, researchers at Johns Hopkins Bloomberg School of Public Health examined major insurers’ policies for what types of drugs were used to treat chronic back pain.

The researchers found that the insurance policies they looked at pushed people toward opioid use and insurers missed chances to point patients in the direction of safer and more effective pain treatments.

“Our findings suggest that public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said senior study author Dr. G. Caleb Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology.

The study was published online on Friday in the Journal of the American Medical Association. The study provides a comprehensive look at insurers’ pain coverage policies as opioid addiction continues to affect millions of Americans.

“While every health plan we examined was actively trying to combat the epidemic, their focus was generally on … identifying high-volume prescribers and patients, rather than on comprehensive strategies to improve the treatment of chronic pain,” Alexander said.

These coverage policies help explain why the opioid epidemic has taken root in America, Alexander said.

The U.S. Department of Health and Human Services has estimated that 42,249 Americans died in 2016 from opioid overdoses, the most of any year on record. More than 2.1 million Americans had an opioid addiction that year, according to the JAMA study.

Economic costs of the opiod epidemic are estimated to be as high as $504 billion, the study said.

Friday’s opioid study analyzed the health insurance policies of 15 Medicaid plans, 15 Medicare Advantage plans and 20 commercial insurers in 2017. The team focused on insurance plans in 16 states that represent about a half of the U.S. population.

The researchers also conducted interviews with 43 senior health care executives that oversaw insurance plans. They focused on 62 prescription drugs used to treat chronic lower back pain, one of the most common types of chronic, non-cancer pain that prescription opioids are used for.

The analysis found that many insurers did not use evidence-based rules to discourage opioid overuse and did not encourage health care providers to prescribe safer and more effective alternatives to opioids.

“Opioids are just one tool in the pain-management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander said.

The researchers said public and commercial plans tend to make opioids relatively cheap for patients. The median commercial plan in the study placed 74 percent of opioid painkillers in the lowest cost category, and the median commercial co-pay for Tier 1 opioids was $10 for a month’s supply.

“Insurers can either be part of the problem, or part of the solution,” Alexander said. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go.”

Post-operative pain from surgery is one of the main sources of chronic pain. Dr. Timothy Brennan, an anesthesiologist and professor at University of Iowa Medical Center, said opioids remain the primary strategy for treatment of acute post-operative pain, but opioid requirements and pain can vary greatly among patients – even for the same surgery.

Minimally invasive procedures typically cause less pain than open surgeries, and a variety of other strategies can be employed rather than opioids, such as peripheral nerve blocks, ketamine administration, neuraxial infusion of local anesthetics and oral or intravenous anti-inflammatories and acetaminophen, according to Brennan.

While there are alternatives to opioid in pain management, those who abuse opioids and suffer overdoses are more likely to die within a year from suicide or a range of other diseases, according to Stephen Crystal, a Rutgers University professor who has studied the opioid epidemic.

The opioid epidemic has gained momentum in the last 10 years. According to the JAMA study, between 2005 and 2014 opioid-related emergency department visits in the United States roughly doubled, while opioid-related hospital inpatient stays increased by nearly two-thirds.

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