Wouldn’t you know? No sooner do I come out questioning the effects of the recent commitment by policymakers and the medical establishment to upping the ante in addressing the nation’s opioid epidemic than a new report appears pointing toward signs of success. This report, authored by IQVIA Institute for Human Data Science, suggests the various measures undertaken to fight the opioid epidemic appear to be having an impact. The report says that in 2017, retail opioid prescriptions declined by 10.2 percent. In addition, the number of patients who received opioid prescriptions for the first time fell by 8.7 percent last year. On average, prescription opioid volume has decreased every year over the last five years in all 50 states.
Before we get too carried away with the news, it should be noted that at the same time, the number of new monthly prescriptions for medications that treat opioid addiction nearly doubled over the past two years. While these medications may help temper cravings, they do not necessarily lead to kicking the habit. As pointed out in a recent New York Times report, “Although the number of people taking medications to combat addiction is rising, it remains a small fraction of the roughly 2.6 million people believed to suffer from ‘opioid use disorder,’ or addiction.” There is also no way of knowing from the data whether the prescriptions came with behavioral therapy and other support.
“Unfortunately, we’re … still … massively overprescribing,” Dr. Andrew Kolodny, head of the Opioid Policy Research Collaborative at Brandeis University and executive director of the advocacy group Physicians for Responsible Opioid Prescribing, told STAT News. While Dr. Kolodny is pleased with the news that we are “moving in the right direction,” he believes many Americans are still going to become addicted until prescribing doctors become much more cautious.
As noted by the Times: “The declines come amid a flurry of new insurance company policies and state laws setting limits on opioid prescribing. States have also been tracking opioid prescriptions more closely through electronic databases and requiring more doctors to check the databases for signs of ‘doctor shopping’ or misuse before giving a patient opioids.”
The IQVIA Institute report also underscores questions as to whether some pain patients are now being undertreated, as well as whether tightened prescribing over the last few years has contributed to the surge in overdose deaths from heroin, especially fentanyl. The nation’s opioid epidemic continues to be responsible for the death of more than 115 people every day in this country.
It is hoped that pressure being applied by policymakers is also starting to persuade the medical establishment to begin taking alternative treatment approaches more seriously.
“The issue here is there are startling gaps in quality of care for people receiving medication-assisted treatment,” Dr. G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, explains to the New York Times. “So it’s really important that we do a better job of improving it and building out systems of care that can deliver it en masse.”
Meanwhile, in scattered places such as Lafayette, Colorado, the practice of incorporating alternative medicine into mainstream medical care is paying dividends. In an eight-week course available to Colorado Kaiser Permanente members for a fee of $100, high-risk opioid patients are being educated on an integrated program on pain management.
The key element of Kaiser Permanente’s Integrated Pain Service program is just that: truly integrated. For patient care, a doctor, two mental health therapists, a clinical pharmacist, a physical therapist and a nurse are available, all on one floor. Patients have the option to meet with this support team all at once or in groups. There is no need for referrals or making doctor appointments at different facilities. This approach appears to be working.
Kaiser researchers tracked more than 80 patients over the course of a year and found the group’s emergency room visits decreased 25 percent. Inpatient admissions dropped 40 percent, and patients’ opioid use was dramatically down.
While some patients need to go to the chemical dependency unit for medication-assisted treatment, they also have access to drug alternatives such as exercise, acupuncture, meditation and mindfulness. Similar projects to Kaiser Permanente’s Integrated Pain Service program in states like California have been equally successful.
“The future of health care is integrated and unfortunately, our history is very fragmented and we’re just now catching up to developing a system of care that meets the needs of people,” Benjamin Miller, an expert on integrated care with the national foundation Well Being Trust, reminds NPR.
But programs such as this have proved to be difficult to implement universally. According to NPR, one challenge is scale. Big systems like Kaiser have resources to afford to run programs like this. Another challenge is payment. Some insurers will not pay for alternative treatments, while others have separate payment streams for different kinds of care. Often medical health and behavioral health are paid for by entirely different systems.
Even in Colorado, there remains a severe shortage of treatment options. In December of last year, the state’s largest substance abuse treatment provider, Arapahoe House, announced it was closing its doors.
Clearly, there remains lots of work to be done to stem the tide of the opioid epidemic in this country.
Write to Chuck Norris with your questions about health and fitness. Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook’s “Official Chuck Norris Page.” He blogs at ChuckNorrisNews.blogspot.com.