National: President’s War on Opioids Includes Prescription Limits

Liz Carey

Washington, DC (WorkersCompensation.com) – Among President Donald Trump’s initiatives on curbing the opioid epidemic are plans to reduce the over-prescription of opioids, and the development of a vaccine to prevent opioid addiction.

Announced in March, the President’s “Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand” includes tougher punishments for illicit drug dealers, as well as cracking down on the supply of opioids and illicit drugs getting into the country. But also among his initiatives were plans to “reduce demand and over-prescription.”

Part of that plank of the initiative would be to launch a nationwide public education campaign to teach Americans about the dangers of prescription and illicit opioid use. The other parts of that initiative are to:

  • “Support research and development efforts for innovative technologies and additional therapies designed to prevent addiction and decrease the use of opioids in pain management, including “supporting research and development for a vaccine to prevent opioid addiction and non-addictive pain management options.”
  • Reduce the over-prescription of opioids which has the potential to lead Americans down a path to addiction or facilitate diversion to illicit use.
  • Implement a Safer Prescribing Plan to achieve the following objections:
    • Cut nationwide opioid prescription fills by one-third within three years
    • Ensure that 75 percent of opioid prescriptions reimbursed by Federal healthcare programs are issued using best practices within three years, and 95 percent within five years.
    • Ensure that at least half of all federally-employed healthcare providers adopt best practices for opioid prescribing within two years, with all of them doing so within five years.
    • Leverage Federal funding opportunities related to opioids to ensure that states transition to a nationally interoperable Prescription Drug Monitoring Program network.”

It was not immediately clear how the White House intended to achieve those goals. Calls to the White House Communications Office for comment were directed to an email address, emails to which were not responded to by press time.

“We’re taking action to prevent addiction by addressing the problem of overprescribing,” he said during his speech. “And our Department of Justice is looking very seriously into bringing major litigation against some of these drug companies. We’ll bring it at a federal level. Some states are already bringing it, but we’re thinking about bringing it at a very high federal level. And we’ll do a (good) job.”

What was unclear in the President’s initiative was what punishments, if any, would be leveraged against physicians over-prescribe opioids.

“We’re going to cut nationwide opioid prescriptions by one-third over the next three years,” he said. “We’re also going to make sure all prescriptions reimbursed by the federal government follow best practices for prescribing. We’ll ensure that opioid addiction is not subsidized by the American taxpayer.”

In his remarks in New Hampshire during the release of the Initiative, Trump noted physicians and pharmacists as part of those arrested by the Department of Justice in 2017.

“Last year, the Department of Justice prosecuted more than 3,000 defendants in cases involving opioids, all of the trafficking and the related crimes — 3,000 cases — including a pharmacist, a physician’s assistant and an opioid trafficker, each charged with committing serious drug crimes in New Hampshire,” he said during his speech. “Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”

Prior to the President’s announcement, however, the American Medical Association (AMA) sent Congressional leaders a letter outlining what its members had done to decrease opioid prescriptions. In 2016, the organization said, opioid prescriptions were already declining.

“From 2013 to 2016, opioid prescriptions in the United States decreased by 43 million — a nearly 15 percent decrease nationally,” Dr. James L. Madara, president of the AMA wrote. “There has also been a significant increase — of 121 percent — in the number of queries by health professionals to state Prescription Drug Monitoring Programs (PDMP), from roughly 60 million queries in 2014 to more than 136 million in 2016.”

The AMA pointed to a plan in Colorado that reduced opioid prescribing by more than one-third over a 6-month period.

“One program that might be of interest to the Committee is a 10-hospital pilot led by Colorado’s emergency medicine community to improve pain care and reduce the state’s opioid supply available for diversion, which recently reported a 36 percent decrease in opioid prescribing during the 6-month pilot,” Dr. Madara wrote. “While the Colorado pilot study may not be replicable in all states, it is the type of tangible, physician-led, team-based effort to improve pain care that the AMA recommends be at the heart of all efforts to reduce opioid-related harms.”

While there is no real estimate of how many workers’ compensation claims result in opioid addiction, there are indications that prescriptions to opioids have a high likelihood of becoming addictions.

“With 5,000 people a week being injured and disabled for at least 1 week, chronic pain becomes a reality for many,” according a blog post by Christopher Mandell with the International Risk Management Institute. “While reliable data showing the proportion of injured workers that may be addicted to opioids is hard to find, it is estimated around 60 percent of all those prescribed. Regardless, we do know that 1.75 deaths per 1,000 patients occur among those taking a medium to high dose of opioids.”

Still, adherence to strict protocols, like those the President’s initiative recommends, does help reduce opioid dependency.

In Ohio, adherence to strict protocols for workers’ compensation claims in regards to physician prescribing and patient monitoring has led to decreases in the number of workers addicted to opioids. The Ohio Bureau of Workers’ Compensation (BWC) reported that 3,315 injured workers were clinically dependent on opioids in 2017, a nearly 60% decrease since 2011.

“That means we have 4,714 fewer injured workers at risk for opioid addiction, overdose and death than we had in 2011,” BWC’s pharmacy director, Nick Trego, said in an interview with WorkersCompensation.com. “These falling numbers are the direct result of our efforts to improve our protocols, more closely monitor our opioid population and encourage best practices from our prescribers.”