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Medicare goes in the right direction against opioid epidemic

The prescriptions of two drugs used to treat opioid addiction have increased significantly from 2016 to 2018 for people receiving Medicare, according to a federal report report outside Wednesday.

According to the Office of the Inspector General of the Department of Health and Social Services, approximately 174,000 Medicare recipients have received such a drug, either buprenorphine or naltrexone, to help them recover.

In addition, prescriptions for naloxone, the drug that can cure an opioid overdose, have increased by 501% since 2016, which is probably an underestimate because it does not include doses of Nasal spray that Medicare members were able to receive through local programs, the OIG said.

"For now, the numbers are going in the right direction," said Miriam Anderson, chief investigator of the report. "But this is a national crisis and we must remain vigilant and continue to fight this epidemic and ensure that opioids are properly prescribed and used."

During the two years studied, the threat of new addictions seemed to slow down. Prescriptions for an opioid through Medicare Part D decreased by 11%. The number of beneficiaries considered to be at serious risk of misuse or overdose – either because they received an extreme amount of opioids, or that they appeared to be a "doctor" – dropped by 46%. And there were 51% fewer physicians or other providers reported to prescribe opioids to patients at serious risk from 2016 to 2018.

The report states that OIG and other law enforcement agencies will investigate potential high-level prescribers for fraud and that some claimants operate manufacture of pills. The report mentions a Florida doctor who administered 2,619 opioid prescriptions to 104 high-risk Medicare patients.

Medicare will monitor patients whose opioid use suggests addiction, recreational use, or resale. In one case, a Pennsylvania woman received 10,728 oxycodone tablets and 570 fentanyl patches from a single doctor in 2018. A Medicare member in Alabama acquired 56 opioid prescriptions of 25 different prescribers in the space of one year.

In a statement, the Centers for Medicare & Medicaid Services said:The fight against the opioid epidemic has been a top priority for the Trump administration. We are encouraged by the conclusion of the OIG, which notes that significant progress has been made in our efforts to reduce opioid abuse while simultaneously increasing drug-assisted treatment in the Medicare Part D. "

The agency points to recent efforts to limit opioid abuse, including a seven-day limit on opioid prescriptions for the first time, pharmaceutical alerts regarding Medicare recipients receiving high doses of pain medications and drug management programs. medicines that may limit the patient's supply. CMS says that it does not use a "one size fits all" approach. Medicare patients in long-term care facilities or in hospices and those on cancer treatment are exempt from opioid prescribing restrictions.

The limits prescribed for opioids are causing concern for some Medicare beneficiaries, especially those who qualify due to a long-term disability and who face severe and chronic pain.

Jae Kennedy, an expert in disability policy at Washington State University, said reducing opioid prescriptions is usually a good development.

"But we're hearing from members of the disability community who feel they're victims of this new, very strict set of prescribing limits," said Kennedy. "People are managing their pain, sometimes for many years without a problem, and now they are somehow criminalized by this new bureaucratic reaction."

Anderson said the BIG was in agreement that "some patients need opioids and that they should receive the ones they need. This report raises concerns that some patients may be receiving opioids beyond these needs. "

Although most Medicare beneficiaries are at least 65 years old, 15% under 65 and the disabled can be the focus of this report. Kennedy research shows that they are up to three times more likely to describe persistent pain than other adults and 50% more likely to report misuse of opioids. A 2017 IGO report found that 74% of Medicare beneficiaries with a serious risk of addiction and overdose deaths were under 65 years of age.

Kennedy said it was good to see Medicare expand access to medication-assisted treatment, known as MAT, for addiction, but the agency needs to ensure that more buprenorphine prescribers accept all patients not just the ones that are the easiest to manage. Patients with disabilities often require many different medications for multiple physical and mental health problems.

"Say," Well, because you have schizophrenia or a manic-depressive disorder, we can not cure you, "I think it's discriminatory," Kennedy said. "That's what happens with private buprenorphine prescribers in this country because there are very few."

Americans aged 65 and over have the lowest rates of overdose deaths from opioids. Nevertheless, the CDC reports that the number of deaths among seniors increased by 279% between 1999 and 2017.

Related Topics

Medicare Public Health

Abuse of opioid substances CMS

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