New Reports Highlight Opioid Growth Trends and the Challenges Ahead
By Emily McCarthy and Trevor Freeman
The Centers for Disease Control and Prevention, or CDC, estimates that 91 Americans die each day from an opioid overdose. The opioid epidemic is one of the biggest public health challenges in the United States today, leading to higher drug abuse rates, increasing health care costs and imposing additional stress on state budgets. Three new reports released in June 2017 demonstrate the growing need for solutions.
Opioid-Related Hospital Stays and Emergency Visits Increasing Across All Demographics
The Agency for Healthcare Research and Quality, or AHRQ, within the federal Department for Health and Human Services, recently analyzed the growth of opioid-related hospital stays and emergency department visits between 2005 and 2014. The rate of opioid-related hospital stays increased 64 percent, while the rate of opioid-related emergency department visits nearly doubled.
By the end of 2014, the AHRQ data did not reveal any particular age group as the leader for opioid-related inpatient stays, but patients aged 25–44 years reported the highest number of opioid-related emergency department visits in all states. In most states, females tend to show higher rates of opioid-related hospital stays, but males had higher rates of emergency visits than females. But with overall increases in hospital stays and emergency visits across the sexes and all ages, it is clear that opioid abuse is not limited to any single demographic.
Number of Opioid Use Disorders Rising Among Commercially Insured
Blue Cross Blue Shield Association, or BCBSA, reported recently that an increasing number of Blue Cross Blue Shield (BCBS) commercially-insured members are being diagnosed with opioid use disorder, or OUD. The report found a 493 percent increase in the diagnosis of OUD on medical claims over a seven-year period. BCBSA also categorized all opioids prescribed to members by duration (number of days taking opioids) and dosage (strength of each opioid). The findings showed that prescriptions of longer durations and higher dosages are associated with members diagnosed with higher rates of opioid dependence.
The 50-state chart below provides information about BCBS members by state. In terms of the number of opioid use disorders, the states showing the most diagnoses were Alabama, Louisiana, Oklahoma, Tennessee and West Virginia. Surprisingly, the states most impacted by opioid use disorders were not necessarily highest in medication-assisted treatments. The states reporting the highest percent of members who received medication-assisted treatment for OUD were Massachusetts, Maine, New Hampshire, Vermont and Washington.
Source: BlueCross Blue Shield Association, The Health of America Report, America’s Opioid Epidemic and Its Effect on the Nation’s Commercially-Insured Population, available at https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS-HealthOfAmericaReport-Opioids.pdf. The five states with the highest numbers in each category are highlighted in orange, and those states with the lowest numbers are highlighted in green.
Medicaid Spending on Opioid Treatment Drugs Increased by $535 Million in Five Years
With Medicaid funding on the minds of legislators everywhere, it is important to examine how opioids play a role in Medicaid expenditures. According to a report from the Urban Institute, Medicaid spending on opioid treatment prescriptions increased from $394.2 million to $929.9 million between 2011 and 2016. This puts an obvious burden on state Medicaid programs, yet effective medication may decrease overdoses, decrease relapses and improve health for people struggling with OUD.
Access to effective treatment for OUD among low-income adults can be challenging. With the passage of the Affordable Care Act, or ACA, thousands of low-income adults with OUD in the 31 states and the District of Columbia that expanded Medicaid gained access to the treatment drug buprenorphine, which is covered by all state Medicaid programs. Addicted persons are less likely to have access to affordable treatment in the 19 states that did not expand Medicaid. States with high opioid use rates could be hit particularly hard by potential reductions in Medicaid funding being considered in Congress.
What Can States do to Curb Opioid Abuse?
A variety of strategies can be utilized by government agencies, health departments and health care providers to help control opioid abuse.
The CDC recommends the following solutions for more appropriately prescribing opioids, expanding access to substance abuse treatment, and monitoring illegal opioid use:
- Improve opioid prescribing to reduce exposure to opioids, prevent abuse, and stop addiction
- Expand access to evidence-based substance abuse treatment, such as Medication-Assisted Treatment, for people already struggling with opioid addiction
- Expand access and use of naloxone—a safe antidote to reverse opioid overdose
- Promote the use of state prescription drug monitoring programs, which give health care providers information to improve patient safety and prevent abuse
- Implement and strengthen state strategies that help prevent high-risk prescribing and prevent opioid overdose
- Improve detection of the trends of illegal opioid use by working with state and local public health agencies, medical examiners and coroners, and law enforcement
In addition, Governing magazine and Blue Cross Blue Shield published a toolkit called “Confronting a Crisis: A Practical Guide for Policymakers to Mitigate the Opioid Epidemic” that includes some additional state solutions:
- Setting limits on opioid prescriptions and implementing medication safety programs that offer non-opioid solutions
- Expanding fraud monitoring systems to identify prescribers with a high fraud risk and any signs of waste or abuse
- Implementing Medicaid lock-in programs to identify high-risk patients and require them to use a single doctor or pharmacy for their opioid prescriptions
- Participating in drug take-back days to gather unused opioid drugs, supported by the Drug Enforcement Agency, or DEA, on National Prescription Drug Take Back Day
- Provide consumer and provider education to prevent opioid abuse
- Using drug treatment courts to stop the cycle of opioid use disorder
- Promoting medication-assisted treatment programs that provide a combination of counseling and medication
- Lisa Clemans-Cope, Marni Epstein and Genevieve M. Kenney, The Urban Institute, “Rapid Growth in Medicaid Spending on Medications to Treat Opioid Use Disorder and Overdose,” June 28, 2017.
- Audrey J. Weiss, Molly K. Bailey, Lauren O’Malley, Marguerite L. Barrett, Anne Elixhauser, and Claudia A. Steiner, Agency for Healthcare Research and Quality, “Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014,” June 2017.
- Blue Cross Blue Shield Association, “America’s Opioid Epidemic and Its Effect on the Nation’s Commercially Insured Population,” June 29, 2017.