Medicare going in ‘right direction’ on opioid epidemic

Reviewed by Alina Shrourou, B.Sc. (Editor)Jul 10 2019

Prescriptions for two drugs used to treat opioid addiction increased significantly from 2016 to 2018 for people on Medicare, according to a federal report out Wednesday.

About 174,000 Medicare beneficiaries received such a medication — either buprenorphine or naltrexone — to help them with recovery in 2018, according to the Office of Inspector General in the Department of Health and Human Services.

In addition, prescriptions for naloxone, the drug that can reverse an opioid overdose, spiked since 2016, rising 501% - and that is likely an underestimate because it doesn't include doses of the nasal spray Medicare members might have received through local programs, the OIG said.

"For now, the numbers are going in the right direction," said Miriam Anderson, lead investigator on the report. "But this is a national crisis and we must remain vigilant and continue to fight this epidemic and ensure that opioids are prescribed and used appropriately."

During the two years studied, the threat of new addictions appeared to slow. Prescriptions for an opioid through Medicare Part D decreased by 11%. The numbers of the beneficiaries considered at serious risk for misuse or overdose - either because they received extreme amounts of opioids or appeared to be "doctor shopping" - dropped 46%. And there were 51% fewer doctors or other providers flagged for prescribing opioids to patients at serious risk from 2016 through 2018.

The report says the OIG and other law enforcement agencies will investigate the highest-level prescribers for possible fraud and signs that some providers operate pill mills. The report mentions a physician in Florida who provided 104 high-risk Medicare patients with 2,619 opioid prescriptions.

It will be up to Medicare to follow up with patients whose opioid use suggests addiction, recreational use or resale. In one case, a Pennsylvania woman received 10,728 oxycodone pills and 570 fentanyl patches from a single physician during 2018. A Medicare member in Alabama acquired 56 opioid prescriptions from 25 different prescribers within one year.

In a statement, the Centers for Medicare & Medicaid Services said: "Fighting the opioid epidemic has been a top priority for the Trump administration. We are encouraged by the OIG's conclusion which finds significant progress has been made in our efforts to decrease opioid misuse while simultaneously increasing medication assisted treatment in the Medicare Part D program."

The agency points to recent efforts to curb opioid misuse including a seven-day limit on first-time opioid prescriptions, pharmacy alerts about Medicare beneficiaries who receive high doses of pain meds and drug management programs that may restrict a patient's supply. CMS says it does not use a "one size fits all" approach. Medicare patients in long-term care facilities or hospice care and those in cancer treatment are exempt from the opioid-prescribing restrictions.

The opioid-prescribing limits are raising alarms among some Medicare recipients, especially those who qualify based on a long-term disability and deal with severe, chronic pain.

Jae Kennedy, a disability policy expert at Washington State University, said cutting back on opioid prescriptions is generally a good development.

"But we hear from people in the disability community who feel like they're being victimized by this new, very stringent set of dispensing limits," said Kennedy. "People have been managing their pain, in some cases for many years without a problem, and now they're being kind of criminalized by this new bureaucratic backlash."

Anderson said the OIG agrees that "some patients need opioids and they should receive those needed for their condition. This report raises concerns that some patients may be receiving opioids above and beyond those needs."

While most Medicare beneficiaries are 65 or older, the 15% who are under 65 and disabled may be the key piece of this report. Kennedy's research shows they are up to three times more likely to describe persistent pain than are other adults and 50% more likely to report opioid misuse. A 2017 OIG report found that 74% of Medicare beneficiaries at serious risk for addiction and overdose deaths were under age 65.

Kennedy said it's good to see Medicare expanding access to medication assisted treatment, known as MAT, for addiction, but the agency needs to make sure that more buprenorphine prescribers accept all patients, not just the ones who are easiest to manage. Patients with disabilities often need many different medications for multiple physical and mental health conditions.

"Saying, 'Well, because you've got schizophrenia or manic depressive disorder, we can't treat you,' I think is discriminatory," Kennedy said. "It's happening with private buprenorphine prescribers in this country because there are so few."

Americans 65 or older have the lowest rates of opioid overdose deaths. Even so, the CDC says the number of deaths among seniors increased by 279% from 1999 to 2017.