Tighter Controls on Opioid Prescriptions Driving Some Patients to the Streets

| | Evidence Based Medicine, Utilization Review

Lisa Robinson Opioid Crisis Graphic 2015

Opioid users are almost 40 times more likely to use heroin than people who use alcohol or marijuana. This growing trend may hold answers to the escalation of heroin use and overdose deaths.

We know we’re in the midst of an opioid crisis. Efforts to combat it include drug formularies, prescription monitoring databases, tighter prescribing controls, abuse deterrent drugs, and other strategies. While these efforts may be helping to slow prescription opioid abuse, what happens to patients who are addicted to opioids and can no longer get them?

If doctors stop prescribing opioids, will patients stop taking them? Unfortunately, addiction doesn’t work that way. Many patients who can’t get opioids from their physicians are hitting the streets to get heroin. In fact, over the last decade, heroin use has increased by 63 percent,which amounts to about 300,000 new users.

Opioid Abuse Linked to Heroin Use

According a recent CDC report individuals who abuse opiate painkillers are 40 times more likely to abuse heroin. Research suggests that one of the reasons is that the drugs act similarly in the brain; however, another reason is that heroin is cheap, about one-fifth the cost of prescription opioids. More alarming, according to the CDC annual survey results, is that almost half of young people surveyed who have injected heroin said they had used prescription painkillers before using heroin.

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Fentanyl and Heroin – A Deadly Combination

Not only are patients who can no longer get opioids through their physicians turning to the streets for heroin, but Fentanyl is now a factor. Fentanyl acts fast, is 80 to 100 times more potent than morphine and is being used as a heroin substitute because it creates an intense high. The Drug Enforcement Administration (DEA) noted that seizures of drugs containing the painkiller Fentanyl increased over 28 percent in a single year, resulting in the need for the DEA to issue a warning on Fentanyl as a threat to public health and safety in March of this year.

Naloxone is Helping but is it Enough?

Naloxone, an antidote for opioid overdose and at one time only available via prescription, is increasingly available to the general public. Over 10,000 deaths are estimated to have been avoided due to Naloxone, and while it can’t save every life, Texas Congressman Michael Burgess suggested if it were available over the counter at 24-hour pharmacies, it could save more lives.

Opioid-related deaths are still high but leveling off, while heroin-related deaths are turning sharply upward. Deaths related to cocaine have remained relatively low, and marijuana-related deaths are non-existent.

Critical Questions Remain Unanswered

We have learned that with tighter controls around prescription opioids, users are hitting the streets in large numbers to get heroin.

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With heroin use and overdose deaths on a steep upward climb, a critical question needs to be answered: Is the rise in heroin- related deaths a coincidence, or is it related to the leveling off of prescription opioid- related deaths?

Answering these important questions will require a commitment from participants in all areas of the healthcare ecosystem: doctors, insurance companies, employers, pharmacy benefit managers and regulators. In the case of workers’ compensation, utilization review companies like UniMed Direct keep a watchful eye on opioid usage and can alert system participants about potential problems.

Technology can also play a role. Good utilization review software and savvy data usage, for example, can help system participants manage and forecast health care population needs in order to develop strategies that mitigate problems. To learn more about utilization review services from UniMed Direct and ReviewStat® software, visit www.unimeddirect.com.