REDUCING THE IMPACT OF PRESCRIPTION DRUG ABUSE IN THE WORKFORCE

Transcription

1 Tuesday, November 7 8:30 9:30 a.m. REDUCING THE IMPACT OF PRESCRIPTION DRUG ABUSE IN THE WORKFORCE Presented by Teresa Bartlett Senior Vice President and Medical Director Sedgwick CMS A combination of rising drug costs and overprescribing has put a target on prescription costs as a fast-growing component of total workers compensation costs. Further, and more importantly, overprescribing narcotics has created an epidemic of abuse and addiction that destroys lives. By pairing traditional techniques with some more progressive and recently developed tools, some employers are seeing a noticeable impact in cost savings and more responsible use of prescription narcotics. Learn how modern tools such as patient contracts when narcotics are prescribed, risk assessments that provide early indicators of potential addiction, drug screenings, and morphine calculators to avoid overprescribing can help contractors and their employees feel better and return to leading productive lives following an injury. To print on both sides of the page, set your printer for duplex printing. Copyright 2017 International Risk Management Institute, Inc. 1

2 Teresa Bartlett, M.D. Senior Vice President and Medical Director Sedgwick CMS Dr. Bartlett has been a senior vice president and medical director at Sedgwick CMS since January of Her background in family medicine led to a 20-year business career with a large automotive manufacturer. She spent 20 years managing large, self-insured, multistate workers compensation programs and the Canadian workers compensation program. The short-term disability (STD) program that Dr. Bartlett managed was union negotiated. She developed an evidence-based medical substantiation process, which saved millions of dollars and reversed the escalating STD trend. She led the team that won the Corporate Health Achievement Award from American College of Occupational and Environmental Medicine in 2005 for the Development and Implementation of a Best Practice Clinical Model. During her career, Dr. Bartlett has had the opportunity to manage and mold wellness and fitness programs that evolved into award-winning programs that were integrated into the benefit and claim structure. She was the recipient of the Crain s Detroit Business 2008 Health Care Hero Award for bringing a new and innovative program to address back pain into the workplace. In 2012, she was a Business Insurance recipient of Women to Watch. In 2015, Dr. Bartlett was the recipient of the President s Honor Roll of the Comp Laude award for Work Comp Central for her work with physicians who had aberrant prescribing patterns in California. Dr. Bartlett volunteers each week for Crisis Text Line, providing help for those in the moments they most need it. She is a frequently requested national speaker on various health topics in the industry. As medical director for Sedgwick CMS, Dr. Bartlett is the senior adviser in matters affecting the design and delivery of medical management services for the company s claims clients. She provides strategic counsel and operational support in all areas of medical management, including managed care, return-to-work, medical outcomes protocols, and health and safety matters. She also advises on best practices to integrate the delivery of occupational and nonoccupational medical services and the matters affecting health care as part of the claims services process. 2

3 Speaker SVP, Medical Quality Sedgwick 2 3

4 Agenda The effect of opioids on the brain Best practice prescribing Potential causes Impact on aging population Trends and statistics Strategies for preventing and controlling abuse Side effects and consequences Dangerous combinations New CDC guidelines Recent headlines 3 How opioids impact the brain Opioids attach to the Mu receptors in the brain The Mu receptors release endorphins Opioids stimulate these receptors and initially increase pleasure and relieve pain Repeated stimulation of these receptors creates a tolerance which requires more drug for the same effect Over a relatively short period of time the receptors become blocked/desensitized to the opioids This impacts mood, behavior, breathing, gastro-intestinal motion and perception of pain 4 4

5 Possible explanations 1 out of every 3 Americans has chronic pain Congress passed a law in late 2000 declaring a Decade of Pain Control and Research, which was signed by the president Manufacturers misled physicians about indications and implications Addictive properties not well understood or communicated Doctors allow dosages to escalate in response to complaints of pain No objective measure for pain 5 Opioid use in workers compensation of group health drug spend is on prescription opioids of drug spend for workers compensation is on opioids Studies show that overall the effectiveness of chronic opioid therapy on addressing pain is modest and effect on function is minimal. 1,2 1.Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med 2012;2012: Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. The Cochrane database of systematic reviews 2010:Cd

6 The medical perspective Pain relief Drowsiness Mental confusion Nausea Constipation Respiratory depression Hyperalgesia Addiction Dependence and tolerance 7 Opioid-induced constipation (OIC) Common phrase Large football game advertising for Movantic $5 million for 30 second commercial Asked to instead spend some of that money on prevention of opioid addiction and refused OPIOIDS CAUSE THE WORST CONSTIPATION OF YOUR LIFE 8 6

7 Opioid contract/informed consent 10 7

8 Urine drug screen Identify aberrant behavior Undisclosed drug use and/or abuse Verify compliance with treatment Based on risk assessment overdose or abuse Low risk once/year Moderate risk twice/year High risk three to four times/year Unusual or suspicious behavior any time Losing prescription Requesting early refills Multiple prescribers Demonstrating intoxication Slurred, slow speech 12 8

9 BEERS criteria MEDICATIONS TO BE AVOIDED WITH OLDER ADULTS Drug to drug interactions Drugs that impact kidney function Medications can cause dementia and memory loss High likelihood of falls and dizziness 13 Dangerous combinations HOLY TRINITY Methadone and medication used for cardiovascular/respiratory health Tramadol and SSRI medications such as Lexapro, Zoloft, Paxil or Celexa can cause serotonin syndrome (sweating, high body temperature, muscle rigidity and high blood pressure) 14 9

10 Public service announcement Lock up ALL medications Pill parties Safe disposal of medications 15 DEA activity The Drug Enforcement Administration announced a reduction by 25% of the amount of opioid medications that can be manufactured for sale and research in the US in 2017/2018 Medication involved oxycodone, hydrocodone, fentanyl, hydromorphone and morphine This is the second year of a 25% decrease in manufacturing National Survey on Drug Use in 2015 released mid 2016 found that 6.5 million Americans over the age of 12 used opioids for nonmedical reasons Doctors requesting a pre-approve fee in case one of their patients cannot obtain the original Rx 16 10

11 New CDC guidelines Provide clear guidance and warnings for opioid prescribing Morphine Equivalent Dose ceiling threshold moved from 120 to 80 with caution even at 20 or 30 Try everything else first Launched an smart phone app for doctors Surgeon General letter to all physicians Vivek H. Murthy, MD,MBA August 2016 Asks three things Take a pledge at Treat pain safely and effectively use CDC guidelines Screen patients for opioid use disorder and use evidence-based medicine Treat addiction as a chronic illness, not a moral failing 18 11

12 New CDC guidelines The rate of long-term use 1 Day = 6.0% on opioids 1 year >8 Days = 13.5% on opioids 1 year >31 Days = 29.9% on opioids 1 year (Authorization of a second opioid prescription doubles the risk for opioid use 1 year later) 50% of those taking an opioid for 30 days will be on it 3 years later 60% of patients taking an opioid at 90 days are still taking an opioid 5 years later (the 90 day cliff ) 20 12

13 New CDC data 1.9 million people/year abuse or become dependent on opioids $20.4 billion is the yearly cost for opioid-related overdoses $53.4 billion for nonmedical use of prescription opioids One out of every 32 patients will die from opioids if on doses greater than 200 MED Methadone represents <2% of opioid prescriptions yet has been found to account for 30% of opioid-related deaths 21 Turning to Heroin (CDC statistics) 22 13

14 More data from the CDC 70% of abused prescriptions are provided by or stolen from friends and family 22% of opioid deaths involve alcohol More overdoes are caused by prescription drugs than illegal drugs Women are 30% are more likely to use opioids than men 23 Fentanyl is the new complication for heroin users 75% of heroin on the street is now laced with fentanyl Taste is a tell tale factor (heroin is bitter/fentanyl is sweet) Causes Wooden Chest Chest wall rigidity Causes Lock Jaw Cannot do CPR Cannot perform rescue breathing Turn Blue within seconds Only hope for reversal is Narcan Many using buddy system or shooting up in pharmacy parking lots 24 14

15 In the headlines 25 In the news Washington Post, in a June 24, 2017, report by Cleve R. Wootson Jr., stated in a headline, A doctor prescribed so many painkillers, she s been charged with murdering her patients, authorities say. NBC News, in a Storyline America s Heroin Epidemic report on August 7, 2017, by Corky Siemaszko, stated in a headline, Opioid Crisis: The Awful Arithmetic of America s Overdoses May Have Gotten Worse

16 Top 10 state ranking fatal deaths due to drug overdoses West Virginia New Hampshire Kentucky Ohio Rhode Island Pennsylvania Massachusetts New Mexico Utah Tennessee Source: Centers for Disease Control and Prevention 27 Meet the new drug Carfentanil (Wildnil) Has recently been found on the streets of small town America Fentanyl is 50 times stronger than morphine Carfentanil is used to sedate elephants It is 100 times stronger than fentanyl and 10,000 times stronger than morphine 28 16

17 We know of no other medication routinely used for a non-fatal condition that KILLS patients so frequently. Dr. Tom Frieden, Prior Director of the CDC

18 Contact information Teresa Bartlett, M.D. SVP, Medical Quality Sedgwick 31 18