Careful Management Key to Fighting Opioid Epidemic

Millions of individuals in the United States are misusing opioids or have developed substance use disorder in recent years. The huge financial and human costs make the opioid epidemic a timely and significant topic of discussion among pharmacists—and for a presentation at Asembia’s Specialty Pharmacy Summit 2018.

Opioid use disorder costs a collective $78.5 billion each year, according to Dick Creager, MD, MPA, medical director for CVS Health, who discussed effective strategies to fight widespread opioid abuse.

“A person who has opioid use disorder has medical costs that are about $15,500 year greater than a person who does not have opioid use disorder,” he said. Beyond the financial costs, Creager said, is the “incredible human cost” of opioid use disorder, such as incarceration, broken dreams, and death. The misuse and abuse of prescription opioids is outpacing all other illegal drug use, including cocaine, heroin, and methamphetamines combined. According to the US Department of Health and Human Services, 11.8 million people reported misusing opioids in 2016, and 36.8% obtained them through a prescription. “The vast majority of recreational users get them for free from family and friends,” Creager said.

Better management of opioid distribution and decreasing prescriptions can help curb the epidemic, according to Creager.

One example: the size of a patient’s first prescription. Research findings reveal that an individual’s likelihood of developing opioid use disorder significantly rises along with the size of the first supply. Investigators have found that a patient given a 5-day supply has about a 10% risk of becoming a chronic opioid user, whereas patients with a first prescription for 30-day supply have a 45% chance of developing an opioid substance use disorder within 1 year. The most recent CDC guidelines advise prescribers to assess whether the benefits of prescribing opioids outweigh the risks of abuse, addiction, and dependence, Creager said. Prescribers should first consider nonopioid alternatives and prescribe opioids just when necessary and then “start low, go slow,” using the lowest possible dose for the shortest period of time.

After a prescription is filled, prescribers should continue to monitor the patient and help reduce risks, according to Creager. “Once [a patient is] on opioids, a doctor should stay on top of it,” he said. “Is the patient getting opioids from another MD?”

For its part, CVS Health has aligned its standards to complement the CDC guidelines, Creager said. The company’s pharmacy benefit manager, CVS Caremark, and its retail business, CVS Pharmacy, are also making efforts to fight the opioid epidemic.

CVS Health initiatives include prevention education, proper medication disposal, increased access to opioid overdose reversal medication, and ongoing advocacy efforts. One program sends pharmacists into schools to talk with students and show a video that addresses the destructive impact of bad decisions.

Collection units placed at CVS pharmacy locations give consumers a way to safely dispose of unneeded medications, Creager said. In addition, pharmacists are being trained to spot warning signs of opioid use disorder and provide clinical counseling. “Pharmacists should be looking for patients with continued use of opioids,” he said.

In October 2017, the company launched programs designed to decrease inappropriate opioid use while allowing access to patients with genuine chronic pain needs.

"We're already seeing very significant impact," Creager said. "We saw a 70% decrease in the number of patients new to opioid therapy with an acute condition who receive more than a 7-day supply."

CVS Health also attemps to assist patients with opioid use disorder, according to Creager. The company offers the opioid reversal drug naloxone to patients in 46 states without requiring prior authorization and with no limit on duration. Signs posted in stores aim to reduce the stigma associated with opioid use disorder and encourage patients to speak with a pharmacist about naloxone.