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Prescription Opioid Abuse: Fighting Back on Many Fronts

Monday, September 29, 2014


According to the Centers for Disease Control and Prevention (CDC), drug overdose is the leading cause of injury death in the United States. In 2010, opioid pain relievers accounted for approximately 17,000 of overdose deaths— more than twice the number of deaths from cocaine and heroin combined. Despite the tremendous importance of prescription drugs in treating pain, some medications have a high risk of being misused or abused. Some researchers have voiced concerns that prescription painkillers could even be a gateway drug for heroin users. With the steady rise in prescription rates and drug overdose deaths, policymakers are coming to a consensus that this national problem must be addressed.

What prescription drugs are being abused and who is abusing them? What drives the economics of the problem? What are prescription drug monitoring programs (PDMPs) and how can these programs effectively share data across states? What role do Patient Review and Restriction programs (PRRs) or “lock-ins” play in curbing abuse? Why are payers concerned about this issue, and what innovations are they using to tackle it?

Grant Baldwin, CDC, spoke about prescription drug abuse epidemic levels and how the abuse of these drugs has emerged into a serious public health and cost issue.

Allan Coukell, Pew Charitable Trusts, described prescription drug monitoring programs and best practices across states.

Jo-Ellen Abou Nader, Express Scripts, discussed what different payers are doing to address opioid abuse.

Sarah Chouinard, a physician at a community health center in West Virginia, highlighted the issue of balancing access to medication and some of the anti-abuse measures.

Ed Howard of the Alliance and Mark Merritt of PCMA co-moderated.

Follow the briefing on Twitter: #OpioidAbuse

Contact: Beeta Rasouli (202)789-2300

The event was sponsored by the nonpartisan Alliance for Health Reform and the Pharmaceutical Care Management Association (PCMA).

If you were unable to attend the briefing, here are some key takeaways:

**Deaths related to opioid pain relievers have increased fourfold in the past decade and opioid overdose costs have reached $20 billion annually, said Grant Baldwin.

**While 49 states and DC have legislation authorizing Prescription Drug Monitoring Programs (PDMPs), their scope and impact varies greatly between states, stated Allan Coukell. Patient Review and Restriction Programs (PRRs) also exist in Medicaid and private plans, but legislation would be required for PRR inclusion in Medicare Part D.

**For every dollar of abused drugs obtained through "doctor shopping," an additional $41 are wasted on related medical claims, such as emergency room costs, unnecessary x-rays, and CAT scans, according to Jo-Ellen Abou Nader.

**Primary care physicians are not trained to handle chronic pain, stated Dr. Sarah Chouinard. Following implementation of Community Care of West Virginia's program, which requires patients to meet with an anesthetist to assess pain care needs and maintain a "pain contract," 30% of patients remained on pain medication, 30% were sent to rehab, 20% received alternative treatment, and 20% failed to maintain their contract.

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Adobe Acrobat PDF), 9/29/2014
Full Webcast/Podcast: Video

Speaker Presentations

Grant Baldwin Presentation (Adobe Acrobat PDF), 9/29/2014
Jo-Ellen Abou Nader Presentation (Adobe Acrobat PDF), 9/29/2014
Allan Coukell Presentation (Adobe Acrobat PDF), 9/29/2014

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 9/29/2014
Materials List (Adobe Acrobat PDF), , 9/29/2014
Source List (Adobe Acrobat PDF), , 9/29/2014
Speaker Biographies (Adobe Acrobat PDF), , 9/29/2014

Offsite Materials (briefing documents saved on other websites)

Controlling Opioid Drug Excess: Health Plan Interventions, National Health Policy Forum, 6/20/2014
The Double-Faced Pain Problem: Reflections on July's Narrative Matters Essay, Health Affairs Blog, 7/28/2014
Fact Sheet: Opioid Abuse in the United States, Office of National Drug Control Policy, 1/1/2014
In Move to Curb Drug Abuse, DEA Tightens Rule on Widely Prescribed Painkiller, The New York Times, 8/21/2014
Opioid Painkiller Prescribing, Where you Live Makes a Difference, National Center for Injury Prevention & Control, CDC, 1/1/2014
Policy Impact: Prescription Painkiller Overdoses, National Center for Injury Prevention & Control, CDC, 1/1/2011
Prescription Drug Abuse Epidemic: Spotlight on Methadone, The Pew Charitable Trusts, 8/20/2014
Prescription Drug Abuse Project, The Pew Charitable Trusts, 1/1/2014
Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy, National Governors Association , 1/1/2014
Rx Abuse and Pharmacy Fraud: Deadlier than Cocaine and Heroin Combined, Express Scripts, 1/1/2014
Assessing the Present State and Potential of Medicaid Controlled Substance Lock-In Programs, Journal of Managed Care Pharmacy, 5/1/2014
Chicago and 2 California Counties Sue Over Marketing of Painkillers, The New York Times, 8/24/2014
Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications, Journal of Urban Health: Bulletin of the New York Academy of Medicine, 8/1/2013
Combating Misuse and Abuse of Prescription Drugs: Q&A with Michael Klein, PhD, U.S. Food & Drug Administration , 7/1/2014
Ensuring Safe and Appropriate Prescription Painkiller Use: The Important Role of Community Health Plans, Alliance of Community Health Plans, 11/27/2012
FDA Approves New Extended Release Oxycodone with Abuse-Deterrent Properties, U.S. Food & Drug Administration, 7/23/2014
Group Health’s Initiative to Avert Opioid Misuse and Overdose Among Patients with Chronic Noncancer Pain, Health Affairs , 8/1/2011
Measures Such As Interstate Cooperation Would Improve The Efficacy of Programs To Track Controlled Drug Prescriptions, Health Affairs , 2/1/2013
Pain Management and Opioid Abuse: A Public Health Concern, American Academy of Family Physicians , 1/1/2011
Patient Review & Restriction Programs: Lessons Learned from State Medicaid Programs, National Center for Injury Prevention & Control, CDC, 8/1/2012
Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose-Naloxone-Good Samaritan Law, The New York Academy of Science , 12/1/2013
Prescription Drug Abuse: Strategies to Stop the Epidemic, Trust for America's Health, 10/1/2013
Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse, Vital Signs: Centers for Disease Control & Prevention's MMWR, 11/1/2012
SAMHSA Opioid Overdose Prevention Toolkit” Substance Abuse and Mental Health Services Administration, , 8/1/2014
State Substance Abuse Agencies, Prescription Drugs, and Heroin Abuse: Results from a NASADAD Membership Inquiry, National Association of State Alcohol and Drug Abuse Directors, 5/1/2014
Understanding the Etiology of Prescription Opioid Abuse: Implications for Prevention and Treatment, Qualitative Health Research , 5/1/2013


Deaths related to opioid pain relievers have increased fourfold in the past decade and opioid overdose costs have reached $20 billion annually, Grant Baldwin, director, Division of Unintentional Injury Prevention, CDC, stated at a September 29 Alliance briefing, Prescription Opioid Abuse: Fighting Back on Many Fronts.


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