How Utilization Review Can Help Prevent Opioid Addiction

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opioid abuse

Prescription narcotics (also called opioid pain relievers), were intended to treat severe pain, such as cancer pain and short-term acute pain, when other drugs were ineffective. Opioids were never intended to be a long-term solution for chronic pain, nor to typically be used for more than three months at most. The effects of using opioid pain relievers long term are far-reaching and can often lead to drug dependence. The utilization review (UR) process can support medical professionals in preventing or reversing opioid dependence in a number of ways, and in the process, empower patients to take an active role in their healthcare choices.

UR Knowledge of Opioids

As opioid-related deaths and drug dependence continue to rise across the healthcare spectrum, stronger safety measures are being implemented. Drug monitoring programs, tamper-proof pills, microchips, random drug testing, physician-patient pain contracts and tighter prescribing restrictions on schedule II drugs are just a few of the measures being taken to help prevent opioid dependence. UR and drug formularies are additional measures that can help opioid-related problems and spiraling medication costs.

In order to effectively review requests for opioid treatment, UR professionals must stay up-to-date and well informed about the 100,000+ drug options available to patients. In order to do this, information is pulled from a variety of resources.

UR professionals access a growing body of evidence-based literature regarding the appropriateness and effectiveness of opioid treatments. In addition, they perform in-depth medical history reviews on individual patients, which include current and past medications, and they participate in peer discussions with treating physicians. With all the pieces of the puzzle in place, UR professionals can apply their knowledge and clinical expertise to assess the risk vs benefit and determine whether particular patients would benefit from prescribed opioids short term or if safer alternatives may be available. Keeping clinical knowledge up-to-date with the most current medical practices, breakthrough research and evidence-based guidelines, reviewers can more accurately assess whether or not a patient is at risk for opioid dependence and work in tandem with other members of the healthcare team to ensure the patient’s safety and well-being.

The Educating Providers

Prescription drug advertising is a multi-billion dollar industry, which includes around $3 billion per year directly targeting consumers. A study published in Sept 2013 concluded that around 60% of drug ads exaggerated drug benefits, left out important information, and provided opinions and/or made meaningless associations to make the drug more attractive. Positive opioid advertising entices patients to desire opioids for treatment, and this message to patients should be avoided.

In workers’ compensation alone, $1.4 billion goes to pay for narcotics that provide minimal benefits for patients and for which very little evidence-based research exists to support their use. UR professionals have an opportunity to educate the healthcare provider community and patients about the dangers of prescribing opioids, the addiction associated with their use, and escalating death rates. Providers, in turn, must grow comfortable with frankly discussing treatment options with patients. As patients, we need to ask the hard questions of our doctors; after all, everyone can make mistakes.

Patients need to be aware of the risks associated with opioid treatment and the resources available to them to seek help if needed. Education is critical to reversing the opioid dependence crisis in our nation. Giving patients the knowledge to make informed health care decisions will give them the opportunity for the best quality of life possible.

UR professionals can outline the lack of supporting evidence related to prescribing opioids and discuss with the treating physician safer and better alternatives based on the patient’s unique healthcare needs. Providers can share this information with their patients and create an environment that empowers them to take control and accountability for their healthcare choices. When this knowledge is harnessed to prevent unnecessary opioid treatment, the UR process is doing its job: ensuring that patients receive the best care.

Lisa Robinson

Director of Quality and Medical Technology for UniMed Direct, Lisa works hand-in-hand with the technology department to design and build advanced clinical decision support within the ReviewStat system. Her intent is to help clients, physicians and all other related healthcare professionals better manage the utilization review process.

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