Prior Authorization for Opioid Use Disorder Versus Pain Medications: Lessons Learned for Parity Enforcement

2021 ◽  
Vol 82 (2) ◽  
pp. 214-218
Author(s):  
Tami L. Mark ◽  
William J. Parish ◽  
Ellen M. Weber ◽  
Gary A. Zarkin
Keyword(s):  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Prior Authorization ◽  
Opioid Use ◽  
Pain Medications

An Emergency Preparedness Response to Opioid-Prescribing Enforcement Actions in Maryland, 2018-2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 9S-17S
Author(s):  
Jessica C. Acharya ◽  
B. Casey Lyons ◽  
Vijay Murthy ◽  
Jennifer Stanley ◽  
Carly Babcock ◽  
...  
Keyword(s):  
Emergency Preparedness ◽  
Data Access ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Mitigation Strategies ◽  
Federal State ◽  
Opioid Use ◽  
Time Data ◽  
Enforcement Action ◽  
State And Local

Federal and state enforcement authorities have increasingly intervened on the criminal overprescribing of opioids. However, little is known about the health effects these enforcement actions have on patients experiencing disrupted access to prescription opioids or medication-assisted treatment/medication for opioid use disorder. Simultaneously, opioid death rates have increased. In response, the Maryland Department of Health (MDH) has worked to coordinate mitigation strategies with enforcement partners (defined as any federal, state, or local enforcement authority or other governmental investigative authority). One strategy is a standardized protocol to implement emergency response functions, including rapidly identifying health hazards with real-time data access, deploying resources locally, and providing credible messages to partners and the public. From January 2018 through October 2019, MDH used the protocol in response to 12 enforcement actions targeting 34 medical professionals. A total of 9624 patients received Schedule II-V controlled substance prescriptions from affected prescribers under investigation in the 6 months before the respective enforcement action; 9270 (96%) patients were residents of Maryland. Preliminary data indicate fatal overdose events and potential loss of follow-up care among the patient population experiencing disrupted health care as a result of an enforcement action. The success of the strategy hinged on endorsement by leadership; the establishment of federal, state, and local roles and responsibilities; and data sharing. MDH’s approach, data sources, and lessons learned may support health departments across the country that are interested in conducting similar activities on the front lines of the opioid crisis.

scholarly journals Partnering with State Health Departments to Address Injection-Related Infections during the Opioid Epidemic: Experience at a Safety Net Hospital

2021 ◽  
Author(s):  
Rebecca H Burns ◽  
Cassandra M Pierre ◽  
Jai G Marathe ◽  
Glorimar Ruiz-Mercado ◽  
Jessica L Taylor ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Medical Center ◽  
Safety Net ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Curative Therapy ◽  
Safety Net Hospital

Abstract Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health (MDPH) and Boston Medical Center (BMC), the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus (HCV) in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for opioid use disorder (MOUD), harm reduction services including overdose education and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.

scholarly journals A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder 

2020 ◽  
Author(s):  
Rebecca L. Haffajee ◽  
Barbara Andraka-Christou ◽  
Jeremy Attermann ◽  
Anna Cupito ◽  
Jessica Buche ◽  
...  
Keyword(s):  
Focus Group ◽  
Addiction Treatment ◽  
Online Survey ◽  
Extended Release ◽  
Insurance Coverage ◽  
Method Comparison ◽  
Opioid Use Disorder ◽  
Prior Authorization ◽  
Opioid Use ◽  
Random Group

Abstract Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD. Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

scholarly journals Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado

2020 ◽  
Vol 17 (9) ◽  
pp. 3251 ◽  
Author(s):  
Amalie K. Kropp Lopez ◽  
Stephanie D. Nichols ◽  
Daniel Y. Chung ◽  
Daniel E. Kaufman ◽  
Kenneth L. McCall ◽  
...  
Keyword(s):  
State Level ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Data ◽  
Opioid Use ◽  
Drug Enforcement Administration ◽  
Pain Medications ◽  
Recreational Marijuana ◽  
Cannabis Policy ◽  
Prescription Opioid Use

There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007–2012) versus post (2013–2017) marijuana legalization revealed statistically significant decreases for Colorado (P < 0.05) and Maryland (P < 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (–31.5%) than the other states (–14.2% to –23.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.

scholarly journals iOAT in the ED – Lessons Learned

2020 ◽  
Vol 43 (2) ◽  
pp. 22
Author(s):  
Stacey Whitman ◽  
Cristina Zaganelli ◽  
Sharleen Luzny
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Administrative Support ◽  
Treatment Plan ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Medical Team ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Optimal Care

Emergency Strategic Clinical NetworkTM Quality and Innovation Forum Presentation Proposal Name: xx Position (e.g. patient care manager, professor): Manager Primary Affiliation: (AHS) Other: AHS Project Title: iOAT in the ED – Lessons Learned Hospital: All adult sites in Calgary Location: Calgary Team Members: xx & xx Background Deaths related to opioid poisoning have continued to climb over the last few years. The Injectable Opioid Agonist Treatment program (iOAT) provides injectable hydromorphone to those individuals with moderate to severe opioid use disorder and a history of injection drug use who have been unsuccessful with oral OAT and continue to be at high risk for opioid poisoning. Working with the emergency departments (ED) was identified as a critical step in the initial roll out of iOAT. Implementation  The iOAT program began operating in October 2018. The clinic provides prescribed hydromorphone to clients within the program. Additionally, the team is comprised of physicians, nurse practitioners, nurses, social worker, peer support workers and administrative support to provide comprehensive wrap around care to every client that is registered to the program. It was recognized early on that the clients that were being served by iOAT were also high users of the ED and UCCs. Being part of iOAT became a factor that needed to be considered when these clients presented to the ED due to their prescription of hydromorphone. Working with management, medical leadership, and nurse educators, support and education were provided to ensure that iOAT clients were provided with optimal care when in the ED. Ongoing communication has been the primary strategy that has been used. Evaluation Methods  The evaluation for this project has been informal and ongoing. The medical team at iOAT has worked with the medical team for the Calgary EDs to develop a detailed treatment plan that is visible on SCM. Telephone and emails have been the primary mode of feedback for both parties, and the plan is adjusted as necessary along the way. Results Improving the knowledge and understanding for all staff involved to understand iOAT and the role of the ED has been demonstrated to be effective when clients stay in the ED and don’t leave against medical advice, which likely occurred before. Additionally, the trust that is built within the iOAT clinic is maintained when the ED is a partner in care and as appropriate, provides them with the dosing that they would normally receive at iOAT. Advice and Lessons Learned 1)      Involve the emergency department management in planning or initial implementation 2)      Communicate, Communicate, Communicate 3)      Use continuous feedback to adjust to find the best strategies to provide patient care

scholarly journals A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder

2020 ◽  
Author(s):  
Rebecca Haffajee ◽  
Barbara Andraka-Christou ◽  
Jeremy Attermann ◽  
Anna Cupito ◽  
Jessica Buche ◽  
...  
Keyword(s):  
Focus Group ◽  
Addiction Treatment ◽  
Online Survey ◽  
Extended Release ◽  
Insurance Coverage ◽  
Method Comparison ◽  
Opioid Use Disorder ◽  
Prior Authorization ◽  
Opioid Use ◽  
Random Group

Abstract Background Evidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods.Results Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing either buprenorphine or extended-release naltrexone. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD.Conclusions Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

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