Deeper than the Headlines: Opioid Prescription Oversight, by State

By now, the stories of increased oversight and enforcement of opioids are no longer breaking news. Nor is it a surprise that various agencies in both State and Federal governments have stepped in and begun devoting significant time and resources to fight the opioid epidemic.

To shed light on some of the State efforts, the OIG recently performed and completed a review, and they just published their findings in July 2019, titled “Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic.”

According to the summary of the report, the OIG performed the review because opioid abuse and in particular, overdose deaths have reached crisis levels in the United States. Inside the report, OIG shared the following:

• More than 47,000 Americans died of drug overdoses involving opioids in 2017.
• Ensuring the appropriate use and prescribing of opioids is essential to protecting the health and safety of Medicaid beneficiaries and the integrity of the Medicaid program.
• OIG analyzed Centers for Disease Control and Prevention (CDC) data showing State trends in opioid overdose deaths and selected eight States for review. They’ve summarized the results of those reviews in factsheets issued to each State and made publicly available on the OIG website.

Their report summarizes and compares information across eight States: Nebraska, Nevada, New Hampshire, Tennessee, Texas, Utah, Washington State, and West Virginia. There are three additional, ongoing State reviews of Ohio, Kentucky, and Alabama that were not covered in this report. They plan to issue factsheets for those States later this year. OIG identified actions that the selected States took related to their review of opioid prescribing and monitoring of opioid use in the following categories:

1. Policies and Procedures: State laws, regulations, guidance, and policies related to oversight of opioid prescribing and monitoring of opioid use (e.g., policies for prescribing opioids).
2. Data Analytics: Data analysis that the States perform related to opioid prescribing and monitoring of opioid use (e.g., analyzing data to determine the number of opioid prescriptions written by providers to detect high prescribing providers).
3. Outreach: Outreach that the States provide related to preventing potential opioid abuse and misuse (e.g., opioid-related training for providers).
4. Programs: State programs related to opioids (e.g., opioid-use-disorder treatment programs).
5. Other Actions: Other State activities related to opioids that are not covered by the previous categories.

The report provides numerous examples of these five categories throughout their report, including:

Policies and Procedures:

West Virginia passed the Opioid Reduction Act in 2018, codifying several opioid-related efforts. Among other requirements, this act requires prescribers to discuss the risks of opioid use and alternatives to opioid therapy, such as physical therapy, acupuncture, and massage therapy.

Data Analytics:

In Texas, analysts developed an algorithm that looks at outpatient pharmacy claims for opioid prescriptions that are disproportionately prescribed by non-pain providers participating in Medicaid.

Outreach:

In Utah, the “Use Only as Directed” campaign is designed to prevent and reduce misuse and abuse of prescription pain medications by providing information and strategies regarding safe use, safe storage, and safe disposal. Efforts include a paid media campaign, online presence, local community outreach, and nontraditional public relations events.

Programs:

Medicaid Lock-In Programs. At-risk beneficiaries are “locked in” to a specific provider type (e.g., a pharmacy or physician). The criteria used to identify at-risk beneficiaries vary by State. For example: In Utah, one factor is four or more pharmacies accessed for controlled medications in a 12-month period. Meanwhile, in Texas, one factor is four or more emergency room visits resulting in an opioid prescription.

Other Actions:

Many of the selected States’ efforts to address the opioid epidemic involve collaboration among various entities. Examples include:

• Washington’s Governor’s Executive Order 16-09 brought together multiple agencies to address the opioid crisis.
• Tennessee implemented the “Public Private Partnership,” a group whose objective is to ensure there is “no wrong door” for a Tennessean seeking treatment.

The report is full of other examples and specifics that are worthy of your review. Anything that any of us in the healthcare field can do is worthy of our time, consideration, and outreach. Because, as they say, “the more you know…”

I’ll be sure to keep my eyes open for the remaining fact sheets on the other three States later in 2019, and share with you my take on those findings when they’re released.

PS - You can find a copy of the full report here.

PPS - And here are the individual State fact sheets: Texas, West Virginia, New Hampshire, Nevada, Utah, Tennessee, Nebraska, Washington