Blue Promise: Combating the Opioid Epidemic (Part 1)

December 18, 2019

[Music] DAN:
More than 2 million Americans are addicted to opioids. That isn’t surprising when you
consider that enough opioid prescriptions are written each year for every adult American
to have their own bottle. New prescribing rules were put in place to
try to stem the tide of the misuse of these drugs, but how well are they working we have
the authors of a new study about the regulations here to tell us about it thanks for joining
us for this episode of Blue Promise I’m Dr. Dan McCoy and I’m here with Ross Blackstone ROSS:
Thanks Dr. McCoy we have Dr. Leanne Metcalf here with us she is our executive director
of planning and research at Blue Cross and Blue Shield of Texas and we also have Phiyen
Tra she’s a pharmacist who’s the director of clinical programs at Blue Cross Blue Shield
so ladies thanks for being here. Phiyen I’ll start with you give us an idea about why you all did this study. What’s the background? Why’d you look into it? PHIYEN:
Well opioids killed more than 33,000 Americans in 2015 and half of those deaths were related
so prescription opioids so we definitely decided that that was a topic that would be of interest
to not only our members but also it was within the national headlines and as part of the
opioid epidemic was growing it seem natural that you know regulations and legislation
would follow and with this particular legislation that was released October 6th of 2014 it basically
involves the reclassification of hydrocodone containing products from a schedule 3 to schedule
2 and with this classification it basically puts more stringent parameters around how
these medications can be prescribed and as part of the three classification we expected
to see a decrease in the number of prescriptions that were being written for these product
and that we also expected to see some type of shift from the schedule 2 products over
to drugs such as Tramadol for instance. DAN:
So let me kinda retalk that for just a minute because you said something interesting these
were reclassified to make them harder to prescribe. PHIYEN:
Right DAN:
Is that what that means when you change the schedule of a drug? PHIYEN:
Yes, there definitely stringent restrictions on schedule 2 drugs such as limiting refill
on these prescriptions and also the ability to transfer the prescription from one pharmacy
to another DAN:
So when you mean more restrictions you mean it makes it harder for a doctor to write the
prescription for the medicine? PHIYEN:
Right and in additionally states have regulations around these two classifications. DAN:
So it’s hard to know exactly what was going on but you can imagine by making it harder
the thought process would be that they would be more appropriately prescribed. PHIYEN:
Right I think that was the intention of the regulation. ROSS:
13 percent of people use opioids use them inappropriately so that was the idea of what was behind
all these deaths. DAN:
So Leanne so here’s the deal we have a lot of data so this policy happened, what did we
see? LEANNE:
Yeah, so just like Phiyen said we went into this looking to confirm that this was an effective
strategy instead what we saw, or at least what we saw for the same as what the CDC saw
scripts went down and so that was great… DAN:
Wait, wait a minute, so that’s a success story right? LEANNE:
Yes that is a success story the number of scripts went down I think that was part of
the intention but however what we saw was an increase in the number of hydrocodone pills
that were given so the days supplies increased and then we also saw the strength of the medication
increased not just for hydrocodone but other substitutions. So in general the overall strength
and dosage of number of pills increased for the population that was being scripted. DAN:
So it sounds like that the policy worked in one respect in that it lowered the number
of actual scripts that were written and a lot of medical associations have claimed victory
right in that this actually worked and that I know there’s been some recent press where
people have touted that this is a success story, but the story is bigger and deeper because
the stronger the prescriptions and the more pills you have I would think that’s a bad thing. LEANNE:
Right because other researchers have shown the stronger the dosage that you get especially
initially the higher the likely hood it is that you become addicted and also if you have
extra pills it’s highly likely that either you or someone in your household someone who
has access to your household or your medicine cabinet could do something
else with those pills. DAN:
So is it fair to say that policy of making it harder to write a prescription may have
actually encouraged providers to write the higher dosage and longer treatment cycles
so they didn’t have to do it again? LEANNE:
Yes we do think so. ROSS:
So maybe instead of getting two bottles of an opioids for a month I would get one bottle
but instead of 60 pills I would get 90 pills. LEANNE: Yeah, right. ROSS: It’s interesting Dr. McCoy that brings up
this idea that doctors trying to make it easier for their patients to get the medication that
they need. I had read one study that was done by a media
organization who found that doctors who write the most opioids prescriptions get paid the
most by pharmaceutical companies that make the opioids so is there a little something
fishy going on here. Why did this happen? LEANNE:
Phiyen I think you had some other comments on that PHIYEN:
Right it is interesting though there was a correlation between drug manufacturers essentially
giving these doctors who wrote for these opioid medications additional perks not so much in
terms of paying them to prescribe opiates that rather than taking their highest prescribers
and giving them opportunities to speak at conferences and just kind of bonus type of
acknowledgments on the side of course this is just related to the few bad apple prescribers
that are out there, I think the majority of prescribers do genuinely want to help their
patients with appropriate prescribing and safe practices. DAN:
So I think the issue there is that there may be some bad apples but really what the issue
is that this public health intervention of changing the policy didn’t work. PHIYEN/LEANNE:
Right DAN:
It lead to an overall increased amount of opioids medication if you think about it by higher
dosage and number of pills put in the mouths of patients. LEANNE:
Right and we went back in history after we finish this particular research just to see
how policies in general have affected opioid utilization and you find that when policies
are made in a vacuum so one governing board without the voices of lets just stop in one
case and another case you still had relative increases and opioid utilization so this is
definitely one of those case studies where we really need to come together with the data
the providers that have that experience a legislative bodies so that we can come up
with the best solution collaboratively rather than doing something and then kinda pushing
burdens on different groups that may have unintended consequences. DAN:
Now I think it may be also fair to say to that, the problems gonna be tougher to fix
now. You alluded to it that the stronger the dosage
and I assume the longer the treatment the higher the risk of addiction or dependence
and abuse of these medications which means people actually want more of them. LEANNE:
Yes. DAN:
So it’s going to be a tougher problem to fix. LEANNE:
Definitely, yes. ROSS:
It’s interesting because 80 percent of people who are addicted to heroin actually got their
start with prescription opioids so it is a public health concern Dr. McCoy and I think
Leanne your point about trying to find the right solution is important we’re making
steps we’re getting there we’re making some progress but we certainly have not solved
it yet so coming up in our next segment Dr. McCoy we’re going to talk about the background.
How we got, how we actually got to where we are so to get us a better understanding of
how we should be moving forward. DAN:
Well thanks for being here and thanks for sharing this information and thanks for joining
us with this episode of Blue Promise.

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