By the latest CDC tally, the year 2015 saw more than 33,000 opioid overdose deaths, two-thirds of which were attributed to prescription opioids.1
More than ever these statistics crystalize the need to explore and develop alternative chronic pain therapies. However pharmaceutical companies continue to invest in the development of new opioid products, and the Food and Drug Administration (FDA) continues to approve them. Thus far in 2017, we have already seen approvals for several new opioid products. Long-acting Arymo® ER (morphine sulfate) and Vantrela® ER (hydrocodone bitartrate) were approved early in the year – and more recently, RoxyBond™ (oxycodone HCl), which is being marketed as the first and only immediate-release opioid analgesic with abuse-deterrent label claims.
These ongoing approvals, combined with a robust pipeline of upcoming opioid products, underscore the unfortunate fact that opioids will continue to be a complex challenge. More than ever, opioid management remains a critical component of managing medical and cost outcomes in the injured worker population, and it will continue to remain so for the foreseeable future.
Cost Without Benefit
It is true that an effort is underway to make future opioid products safer, although motivations for these improvements may vary among different stakeholders. Many products either recently approved or undergoing clinical trials have been developed with a greater emphasis on reducing patient risk, through measures that include abuse-deterrent formulations, improved side-effect profiles, and diminished addictive properties.
But “safer” is a term relative to the population to which it’s being applied. And in workers’ compensation we are left shaking our heads. With all of the damage inflicted by opioids on our patient populations and their resultant clinical outcomes, it feels unlikely that the most effective solution is more opioids. Yet these new opioid formulations are being positioned as at least a part of the solution.
To date, efforts to bring safer opioids to market have largely centered on abuse-deterrent formulations, despite insufficient evidence that these products have a direct impact on rates of abuse and overdose. A number of states currently have bills proposed that, if passed, will require insurance coverage for abuse-deterrent formulations of opioids, which has the potential to create a significant cost burden.2 From a national perspective, abuse-deterrent opioids represented less than 5% of opioids prescribed in the U.S. in 2016, yet they accounted for a significant $2.4 billion in sales.3
And some workers’ comp insurers are feeling the costly sting of these products without seeing a resultant benefit for their injured worker patients. The FDA defines abuse-deterrent opioids as having properties shown to meaningfully deter, though not fully prevent, abuse. By this definition, the clinical misuse that occurs more commonly in the workers’ comp population becomes an under-addressed issue, because abuse-deterrent opioids are typically developed with the recreational abuser in mind. Ultimately, these formulations may add increased costs to the pharmacy bill without providing a safety benefit for the injured worker. Costs that could instead be allocated to other treatment modalities that go beyond pain management and more effectively treat the patient’s condition or injury.
A Better Solution
The workers’ compensation industry has put forth enormous efforts to tackle the opioid problem, and finally with some measurable success, as opioid prescribing rates have begun to decline in recent years.4 So it is not surprising that our industry views the continued development and approval of new opioid products with caution and trepidation. For those of us dedicated to the safe and effective care of injured workers, opioids will largely remain the enemy of patient outcomes, rather than the answer. And we will continue to look for new opportunities and strategies to mitigate this long-standing and evolving challenge.
For a look at what we can expect from the opioid pipeline in 2017 and beyond, read “Future Opioids and The Injured Worker: Why ‘Safer’ Is a Relative Term,” featured online in Healthesystems’ RxInformer clinical journal.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, physical medicine, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
This is a sponsored post from WorkCompWire marketing partner Healthesystems.
1Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released December 2016.
2State Pain Policy Advocacy Network. Abuse Deterrent Formulations. American Academy of Pain Management. http://sppan.aapainmanage.org/abusedeterrent Accessed February 16, 2017.
4Thumula V, Wang D, Liu T-C. Workers Compensation Research Institute. Interstate Variations in Use of Opioids, 3rd Edition. June 2016. WC-16-22.