In the Texas Community
Policymakers attempted to combat the opioid epidemic by placing regulations on the prescribing and dispensing of opioids. How well did those rules work? We discuss in this Blue Promise.
Policymakers attempted to combat the opioid epidemic by placing stringent regulations on prescribing and dispensing of opioids. How well did those rules work? A new study using BCBSTX data examined the regulations, and we have the authors here to discuss the results. Leanne Metcalfe, PhD, Executive Director of Planning and Research, Phiyen Tra, PharmD, Director of Clinical Programs, and co-host Ross Blackstone, Director of Strategic Influence, join Dr. McCoy for this edition. You can listen to the complete discussion in podcast form on Apple Podcasts and SoundCloud.
Additional links in the Combating the Opioid Epidemic series:
Blue Promise is an online video blog and podcast that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.
More than 2 million Americans are addicted to opioids that isn’t surprising when you consider that enough opioid prescriptions are written each year for every adult American to have their own bottle. New prescribing rules were put in place to try to stem the tide of the misuse of these drugs but how well are they working we have the authors of a new study about the regulations here to tell us about it thanks for joining us for this episode of Blue Promise I’m Dr. Dan McCoy and I'm here with Ross Blackstone
Thanks dr. McCoy we have Dr. Leanne Metcalf here with us she is our executive director of planning and research at Blue Cross and Blue Shield of Texas and we also have Phiyen Tra she’s a pharmacist who’s the director of clinical programs at Blue Cross Blue Shield so ladies thanks for being here. Phiyen I’ll start with you why you why you all did this study look into it
Well opioids killed more than 33,000 Americans in 2015 and half of those deaths were related so prescription opioids so we definitely decided that that was a topic that would be of interest to not only our members but also it was within the national headlines and as part of the opioid epidemic was growing it seem natural that you know regulations and legislation would follow and with this particular legislation that was released October 6th of 2014 it basically involves the reclassification of hydrocodone containing products from a schedule 3 to schedule 2 and with this classification it basically puts more stringent parameters around how these medications can be prescribed and as part of the three classification we expected to see a decrease in the number of prescriptions that were being written for these product and that we also expected to see some type of shift from the schedule 2 products over to drugs such as Tramadol for instance
So let me kinda retalk that for just a minute because you said something interesting these were reclassified to make them harder to prescribe
is that what that means when you change the schedule of a drug
Yes there definitely stringent restrictions on schedule 2 drugs such as limiting refill on these prescriptions and also the ability to transfer the prescription from one Pharmacy to another
So when you mean more restrictions you mean it makes it harder for a doctor to write the prescription for the medicine
Right and in additionally States have regulations around these two classifications
So it’s hard to know exactly what was going on but you can imagine by making it harder the thought process would be that they would be more appropriately prescribed
Right I think that was the intention of the regulation
12 percent of people use opioids use them inappropriately so that was the idea behind all these deaths
So Leanne so here’s the deal we have a lot of data so this policy happened what did we see
yep so just like Phiyen said we went into this looking to confirm that this was an effective strategy instead what we saw, or at least what we saw for the same as what the CDC saw Scripts went down and so that was great…
wait wait a minute, so that’s a success story right
Yes that is a success story the number of scripts went down I think that was part of the intention but however what we saw was an increase in the number of hydrocodone pills that were given so the days supplies increased and then we also saw the strength of the medication increased not just for hydrocodone but other substitutions as well so the overall strength and dosage of number of pills increased for the population that was being scripted
So it sounds like that the policy worked in one respect in that it lowered the number of actual scripts that were written and a lot of medical associations have claimed victory right in that this actually worked and that I know there’s been some recent press where people have touted that this is a success story but the story is bigger and deeper because the stronger the prescriptions and the more pills I would think that’s a bad thing
Right because other researchers have shown the stronger the dosage that you get especially initially the higher the likely hood it is that you become addicted and also if you have extra pills it’s highly likely that either you or someone in your household someone who has access to your household
Or your medicine cabinet could do something else with those pills
So is it fair to say that policy of making it harder to write a prescription may have actually encouraged Providers to write the higher dosage and longer treatment cycles so they didn’t have to do it again
Yep we do think so
So maybe instead of getting two bottles of an opioids for a month I would get one bottle but instead of 60 pills I would get 90. It’s interesting Dr. McCoy that brings up this idea that Dr’s trying to make it easier for their patients to get the medication that they need. I had read one study that was done by a media organization who found that Dr’s who write the most opioids prescriptions get paid the most by pharmaceutical companies that make the opioids so is there a little something fishy going on here.
Phiyen I think you had some other comments on that
Right it is interesting though there was a correlation between drug manufacturers essentially giving these doctors who wrote for these opioid medications additional perts not so much in terms of paying them to prescribe opiates that rather than taking their highest prescribers and giving them opportunities to speak at conferences and just kind of bonus type of acknowledgments on the side of course this is just related to the few bad apple prescribers that are out there, I think the majority of prescribers do genuinely want to help their patients with appropriate prescribing and safe practicing
So I think the issue there is that there may be some bad apples but really what the issue is that this public health intervention of changing the policy didn’t work
it lead to an overall increase amount of opioids medication if you think about it by higher number of dosage and number of pills put in the mouths of patients
Right and we went back in history after we finish this particular research just to see how policies in general have affected opioid utilization and you find that when policies are made in a vacuum so 1 governing board without the voices of lets just stop in one case and another case you still had relative increases and Opioid utilization so this is definitely one of those case studies where we really need to come together with the data the providers that have that experience a legislative bodies so that we can come up with the best solution collaboratively rather than doing something and then kinda pushing burdens on different groups that may have unintended consequences
Now I think it may be also fair to say to that, the problems gonna be tougher to fix now Right now
You alluded to it that the stronger the dosage and I assume the longer the treatment the higher the risk of addiction or dependence and abuse of these medications which means people actually want more of them
So it’s going to be a tougher problem to fix
It’s interesting because 80 percent of people who are addicted to heroin actually got their start with prescription opioids so it is a public health concern Dr. McCoy and I think Leanne your point about trying to find the right solution is important we’re making steps we’re getting there we’re making some progress but we certainly have not solved it yet so coming up in our next segment Dr McCoy we’re going to talk about the background how we got how we actually got to where we are so to get us a better understanding of how we should be moving forward
Well thanks for being here and thanks for sharing this information and thanks for joining us with this episode of Blue Promise
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