The Centers for Disease Control’s (CDC) release of new opioid prescribing guidelines in March 2016 broadened the spotlight on the already robust national conversation about prescription drug abuse. The guidelines, while voluntary, are aimed at helping primary care providers make important decisions about initiating and discontinuing opioid therapy in chronic pain patients, choosing the right medication for each patient’s unique circumstances, and assessing the risk of abuse and addiction.
Soon after the release of the CDC’s recommendations, CVS Health sponsored a forum where health care leaders, including U.S. Surgeon General Dr. Vivek Murthy, could discuss the new guidelines, share their own experiences and explore what it will take to change the “culture of prescribing” among health care providers. The event, convened by POLITICO in Washington, D.C., fostered frank and open discussions among payers, prescribers, pharmacists and government entities who proposed solutions to the opioid abuse epidemic in several areas:
Education – Participants agreed that continuing education about prescription opioid use and abuse is critical throughout a prescriber’s career, and should focus on evidence-based recommendations for acute pain management and chronic pain treatment. For patients, a campaign similar to efforts to reduce unnecessary antibiotic use could help lower demand for prescription opioids and promote less-dangerous options and non-pharmacological interventions.
Technology – Prescription drug monitoring programs (PDMPs) provide prescribers the information they need to determine whether a patient is at risk for abuse and to prevent unnecessary prescriptions from being written, but the technology is limited in scope. For example, providers can only see information for the state in which they practice, not for all states where a patient may have been prescribed medication. While participants disagreed about whether government-mandated use of PDMPs would help or hurt, they recognized that improving and enhancing the technology could make a big difference in its effectiveness.
Provider incentives and reimbursement – Participants who prescribe medication expressed concerns about the link between patient satisfaction scores, prescribing practices and insurance reimbursement. In addition, they noted that longstanding reimbursement practices could actually encourage prescribers to order more pills than necessary. Payers and prescribers alike acknowledged that a review of provider incentives and reimbursement policies could yield effective changes, and asked that government entities keep these issues in mind as they develop new delivery system and payment models.
Stigma reduction and treatment for addiction – Participants noted the importance of talking about and treating substance abuse disorder as a disease rather than a criminal activity, to reduce stigma and make it easier for patients to seek treatment.
As the nation’s largest pharmacy provider, representatives from CVS Health shared our unique perspective on this complex issue and reiterated our commitment to being a part of the solution by advancing legislation, promoting technology and creating safer communities. Policy solutions we support include PDMP interoperability across state lines; e-prescribing for controlled substances; and daily PDMP data submissions from pharmacies to state databases.
Read more about the working group’s prescription opioid discussion and recommendations.