By Dr. Mitch Freeman, Pharm.D., Chief Clinical Officer
The ripple effects of 2020 will be felt for years to come. COVID-19 was the stone thrown in the water and every other aspect of public health is now feeling its effect.
Recent research from Virginia Commonwealth University found that “for every two deaths attributed to COVID-19 in the U.S., a third American dies as a result of the pandemic.” These excess deaths are inclusive of anything from dementia to heart disease to overdoses.
An especially important area caught in the ripples of the pandemic is the opioid epidemic. The pandemic has only amplified a crisis that has troubled the United States for decades. As we continue to battle both the pandemic and epidemic, what should the workers’ compensation industry know and consider? Let’s look at the recent numbers and ways for the industry to continue to mitigate the opioid crisis.
The Pandemic is Fueling the Opioid Epidemic
In the U.S., the C.D.C. estimates that nearly 450,000 people have died from opioid overdoses, including prescription and illicit opioids. The first decline in drug overdose deaths occurred in 2018, with a 4.6% age-adjusted drop from the year prior. However, preliminary data from the CDC suggests that the twelve months ending in February 2020 saw an increase of 7.6% of reported drug overdose deaths.
This unfortunate trend has continued in 2020. Amidst the pandemic, we are still battling the opioid epidemic, and recent data suggests that the first is exacerbating the latter. A brief released by the American Medical Association in October highlights the gravity of the situation, with more than 40 states reporting increasing opioid-related mortality in their jurisdictions. The ODMap from the University of Maryland reported that suspected drug overdoses increased 18% in the three months after stay-at-home orders compared to the three months prior.
It’s not hard to see why overdoses are increasing this year. With heightened stress, uncertainty, isolation and trauma, every American is struggling in one way or another. For many, that means turning to substance use. The CDC reported in August that “40% of U.S. adults reported struggling with mental health or substance use”, with 13% of those people having started or increased substance use to “cope with stress or emotions related to COVID-19.” Additionally, for those already struggling with opioid use disorder or addiction, care has been harder to come by as states limit in-person interactions.
Note that these increases are driven mainly by synthetic opioids such as fentanyl. The CDC reported in March 2020 that “prescription opioid-involved overdose death rates decreased by 13.5%” from 2017 to 2018. However, the impact of prescription opioids on the overall opioid epidemic stretches further than just overdoses from those prescriptions.
According to the National Institute on Drug Abuse, in 2017, “an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.” Beyond that, the Institute reports that around 21-29% of people who receive prescription opioids for chronic pain misuse them, and that 4-6% of those who misuse prescription opioids then turn to heroin.
An October 2020 study released by WCRI also found that “the strongest predictors of longer-term opioid prescribing are related to opioid prescribing early in a claim.” The study states, “Workers with a higher number of days’ supply of opioids early after an injury had a higher predicted likelihood of longer-term opioid dispensing.”
With this in mind, we should be heartened by the work the industry has done to help reduce prescription opioid overdoses by more than 13%, but we must stay vigilant in our work to address new opioid prescriptions, chronic opioid users, and potential abuse in claims. Many workers’ compensation patients may be suffering from opioid use disorder, which could be exacerbated by the pandemic. Careful monitoring of your claims is key to ensuring your patients stay on track to recovery.
Numbers Can be Overwhelming, But They Can Drive Action
Numbers and statistics have become a blur in today’s world. We all see COVID-19 related cases and deaths rise day after day; eventually, it becomes easier to ignore the constant uptick. But it’s important to pay attention to numbers, especially those related to the ripple effects of COVID-19. Data helps us determine where to place our focus and how to solve the issues at hand. Here are some insights and tips as you continue to navigate your pharmacy program through the pandemic.
- Monitor Risk: Work closely with your PBM to monitor claims that are at high risk of opioid abuse or addiction
- Monitor Mental Health: Monitor claimants that may be at risk of mental health struggles, such as those who are isolated or are facing extreme stress
- Monitor Changing Guidelines: Follow state guidelines on care, including any emergency protocols
- For instance, in April, the DEA made it easier to access buprenorphine and methadone to treat those with opioid use disorder by providing physicians and other health professionals with a waiver to prescribe the drugs via telephone to new and existing patients.
- DEA guidance for prescribing controlled substances during the pandemic.
About Dr. Mitch Freeman
Dr. Mitch Freeman is the Chief Clinical Officer for Mitchell International, Pharmacy Solutions. Prior to joining Mitchell, Freeman was the CEO of First Coast Health. He has a wealth of industry expertise and leadership in the workers’ compensation industry including the chief sales and marketing officer of PMSI, vice president of sales at Ameritox, vice president and general manager for ExpressScripts, and president of pharmacy services for MSC.
Freeman is a frequent guest speaker and author. Freeman is a graduate of Florida A&M University where he received his doctorate of pharmacy.
Headquartered in San Diego, California, Mitchell International, Inc. delivers smart technology solutions that simplify and accelerate claims handling, repair processes and pharmacy transactions, driving more accurate, consistent and cost-effective resolutions. Mitchell integrates deep industry expertise into its workflow solutions, providing unparalleled access to data, advanced analytics and decision support tools. Mitchell’s comprehensive solution portfolio and robust SaaS infrastructure connect its customers in ways that enable tens of millions of electronic transactions to be processed each month for more than 300 insurance providers, over 70,000 pharmacies and 30,000 collision repair facilities, as well as countless other Property & Casualty industry supply partners across the Americas and Europe.
Mitchell, Genex, and Coventry have recently combined their joint industry expertise and advanced technology solutions into one organization to simplify and optimize property, casualty and disability claims processes and services. For more information, please visit Mitchell.com.
Mitchell is a WorkCompWire ad partner.
This is not a paid placement.