Are Primary Care Physicians Leaving Opioid Deaths to Chance?

A recently released study from the Journal of Addiction Medicine has uncovered an alarming trend. Patients with opioid addiction, also referred to as opioid use disorder (OUD), experience an alarmingly high death rate – one 10 times higher than those not suffering opioid addiction. Not surprisingly, the study has raised some tough questions about the existing treatment infrastructure, and the system’s failure to identify and aid such at-risk individuals.

The Sobering Stats

Using electronic health records from a major university healthcare system from more than 2,500 patients ranging in age from 18 to 64, all identified as having an OUD, 465 deaths were observed during the eight-year period studied, 2006-2014. Drug overdose and disorder was the leading cause of death (19.8%), with deceased patients commonly experiencing other substance abuse disorders (tobacco, alcohol, cannabis, cocaine). Other causes included cardiovascular disease (17.4%), cancer (16.8%) and infectious disease (13.5%, of which 12% had hepatitis C). Alcohol abuse and hepatitis C were identified as primary markers. Compared to the general population, the deceased were more likely to be male (41.7% vs 31.6%), uninsured (87.1% vs 51.3%), and older at the time of initial OUD diagnosis (48.4 vs 39.8 years).

Unintended Effects

Though health care reforms (Federal Mental Health Parity, Addiction Equity Act, and the Affordable Care Act) were intended to lead to an expansion of services for substance abuse disorders in primary care, shifting them from previously isolated treatment centers, there appears to be a significant portion of the population slipping through the cracks. This suggests multiple issues within the current healthcare delivery system in identifying and addressing patients battling addiction:

  • Ignorance of the true risks of opioid abuse and corresponding treatments.
  • A lack of timely and sufficient screening for identifying patients with addiction.
  • Identification of addiction issues too late to provide appropriate/effective interventions.
  • A lack of addiction specialists on-site, as well a as a lack of outside resources for treatment.

The healthcare industry must find a better way to identify and treat patients suffering substance abuse disorders – before they pay the ultimate price. Clinicians in the primary healthcare setting could be a driving force – provided they receive proper training and assistance. For the worker, an effective pharmacotherapy review program ensures that recommended prescription treatment plans are necessary and appropriate and can help eliminate the potential for addiction.

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Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

  • Evzio (2014)
    The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
  • Narcan (2016)
    A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at today.


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Landmark Reforms Hoped to Aid New York in the Fight against Opioid Addiction

It is hoped to be a happier new year for Empire State residents suffering from opioid abuse. In a landmark legislative package that took effect January 1st of this year, health insurance plans will now be required to cover treatment services to New Yorkers suffering opioid addiction. In a state plagued by the effects of opioids and heroin, whose overdose death rates are far outpacing nearly every state in the union, legislators are hopeful those grappling with the effects of these drugs can finally gain access to the help they need in overcoming addiction.

The Plan to Expand Access to Opioid Addiction Care

Signed into law by Governor Andrew M. Cuomo, the reforms are expected to remove burdensome treatment access barriers, help expand prevention strategies from within communities, and limit opioid over-prescriptions statewide. What is the governor’s Heroin and Opioid Task Force plan to stamp out abuse?

  • Insurance-Related Protections
    • Insurance pre-authorization no longer required for immediate access to inpatient care and (emergency) drug treatment medications when needed.
    • Utilization review (insurance) cannot become involved until after 14 days of uninterrupted treatment.
    • Insurers must use objective, state-approved criteria when making coverage determinations.
    • Opioid-reversal medication coverage is mandated.
    • Requirements apply to small, large group, and individual plans regulated by the DFS.
  • Addiction Treatment Services Enhancements
    • Individuals incapacitated by drugs can now receive 72, not 48 hours of emergency treatment and evaluation.
    • Hospitals are now required to provide follow-up service at discharge, connecting at-risk patients with nearby treatment options for continuous care.
    • Trained professionals no longer risk licensure when administering naloxone in emergencies.
    • Wraparound services (legal, support, transportation, childcare) have been expanded to support long-term recovery.
  • Community Prevention Strategies
    • Prescription limits reduced from 30 to 7 day supply maximum (with exceptions).
    • Required continuing education for all physicians/prescribers on addiction/pain management.
    • Pharmacists must provide materials on addiction risks and nearby treatment services.
    • Opioid overdoses and overdose medication use must be reported quarterly.

Ensuring Appropriate Treatment Options For Opioid Addiction 

Much like the measures put forth by the state of New York, ANS Solutions’ Pharmacotherapy Review Program strives to uphold appropriate treatment options for patients, offering protection against opioid dangers with a three-stage approach to injury recovery that far-surpasses drug utilization review. Comprehensive and effective, it both protects against unnecessary expenses and safeguards patient treatment outcomes. Utilizing personal, face-to-face communication and integrative case-management methods, over-prescription of dangerous narcotics and potentially deadly drug-to-drug interactions commonly experienced with multiple prescribers can be prevented, success achieved with evidence-based treatment protocols and cemented by written proposal to achieve maximum results.

Don’t stand on the sidelines of the epidemic. Take part in the solution. Reinvent the way you handle claims with the help of ANS Solutions today.

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Comorbidities Compound Workers Comp Costs & Recovery

Underlying Conditions Complicate Workers’ Comp Injury Rehabilitation

New research from a Harbor Health Systems study demonstrates the significant impact of underlying conditions on workers’ comp claims. Commonly associated with higher costs and increased duration, this latest research illustrates an undeniable link between patients with comorbidities and undesirable claims outcomes.

A Problematic Pile-Up

Analyzing data from more than 7,000 workers’ comp claims, encompassing seven common comorbidities: Obesity, hypertension, diabetes, mental health, addiction, tobacco use, and combination comorbidities, claims associated with comorbid conditions were found to have incurred an array of undesirable side effects…

  • Higher medical costs
    • Multiple comorbidities increased total costs a whopping 341%
  • Longer claims duration
    • 76% increase with multiple comorbidities
    • 67% increase with addiction
    • 55% increase with obesity
  • More temporary total disability days (TTD)
    • Significantly higher overall in all groups
    • 285% higher with multiple comorbidities
    • 274% higher with addiction
  • Increased surgery rates
    • Up 123% with multiple comorbidities
    • Up 140% with obesity
  • Increased litigation
    • 147% higher with multiple comorbidities
    • 224% higher with addiction
    • 248% with mental health-related claims

Overall Outlook

While tobacco use had little effect on claims, multiple comorbidities and obesity had the greatest impact on overall, followed by addiction, mental health, and hypertension. Relationships between comorbidities were also found further complicate health and financial risks, with worker age throwing yet another wrench in the works.

Changing Direction

Given these research findings, it is obvious a more comprehensive, systemic approach to workers’ comp claim management is essential to improving treatment results, from a more thorough intake data analysis and the management of multiple health issues addressed by numerous providers and prescriptions, to identifying and finding alternative treatments to those that could result in narcotics abuse.

Quality Matters

Minimizing these risks and providing optimal outcomes for injured workers while controlling workers’ comp costs is no easy feat, and requires a tried and true strategy. ANS Cost Containment Programs work uniquely to address these issues with the only true face-to-face, end-to-end pharmaceutical cost containment program in the industry that genuinely puts patients first while minimizing claims costs through personalized relationships and in-depth case knowledge and review.

Rapid treatment progress and reduced claims costs are possible. Achieve maximum all-around results. Discover how with today.

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New Opioids Reduce Pain – and Addiction Risk

A new generation of opioid drugs are on the horizon, possibly offering the much maligned class of drugs a second chance to make a good impression. After years of opioids like oxycodone and fentanyl driving up drug addiction rates nationwide, a second subset of once odious opioids is being introduced, touting all the painkilling power of its conventional counterpart – less the dangerous and deadly side effects.

A Different Approach

While pharmaceutical companies continue to crank out new prescription formulations geared toward treating the side effects of opioid drug use and addiction rather than eliminating the painkillers, researchers are seeking a new path to both help patients – and repair the reputation of opioids. To combat ever-rising opioid addiction rates and overdose deaths, researchers are working with three (new) compounds:

  • Oliceridine
    Created by Trevena, this drug has been given preferential regulatory treatment by the FDA.
  • Mitragynine Pseudoindoxyl
    Derived from leaves of the Southeast Asian kratom plant, this compound has demonstrated a decreased addiction risk in mice.
  • Compound PZM21
    Early testing has produced results that, according to researchers, are unlike those seen from other potential painkiller compounds.

Mitigating Risks

Working like morphine to bind to proteins in the brain, spinal cord, and other organs, this new family of opioid drugs activates a different signaling pathway than their predecessors, using a route through which information flows from one molecule to another. These essential differences are hoped to decrease the risk of addiction, as well as the leading cause of overdose death – respiratory depression – the elimination of which has been deemed an essential goal.

Ensuring Optimal Outcomes

To combat the high economic and human/personal costs of opioid abuse, dependence, and overdose, as well as to ensure a post-injury recovery process that yields maximum results and quality of life, ANS Solutions has developed Pharmacotherapy Review. This unique and industry-leading approach far surpasses run-of-the-mill drug utilization programs, providing comprehensive care and an attention to detail that protects injured workers and workers’ compensation payers alike against the concurrent risks and costs of unnecessary treatment regimens, including the over-prescription of opioids, through…

  • Exceptionally credentialed Legal Nurse experts, Doctors of Pharmacy, and staff.
  • Face-to-face collaboration.
  • Consolidation/coordination of drug therapies between all prescribers.
  • Identification of excessive dosages.
  • Weaning programs for over-prescribed narcotics.
  • Consideration of evidence-backed treatment alternatives.

Set off on a new path to injury and disability treatment. Uncover the benefits of Pharmacotherapy Review from today.

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Alabama Doctor Arrested In Connection with Matt Roberts of 3 Doors Down Overdose Death

In mid-August of this year, fans were stunned by the death of 38-year-old Matt Roberts, former guitarist of 3 Doors Down. Alabama physician Dr. Richard Snellgrove was arrested November 16th for allegedly providing the rocker with drugs outside the course of his professional practice. Snellgrove prescribed some five different medications, including methadone, hydrocodone, lorazepam and fentanyl — all prescribed in the names of different individuals, but intended for Roberts.

Slated to perform at a charity event for veterans, the rocker’s father, Darrell Roberts, who often traveled alongside the star, learned of his son’s death the morning following rehearsals. The elder Roberts was informed his son was “either asleep or passed out in the hallway of his hotel” by authorities. Roberts’ father indicated that his son had been fighting a prescription medication addiction to combat his anxiety since joining the band.

A Serious Issue Beyond Over-Prescription
While Roberts’ father noted that he didn’t have any bitterness or anger toward the doctor, he drew attention to the seriousness of the issue in the medical community across the U.S. Prescription drug abuse causes the largest percentage of deaths from drug overdosing, with opioid painkillers the most common culprit. Roberts is among a string of stars over the past decade, including Prince, Whitney Houston, Michael Jackson, Brittany Murphy, Heath Ledger, and Anna Nicole Smith – alongside thousands of other unnamed “average” Americans – sons, fathers, mothers, daughters, brothers, sisters, and friends – all lost to the prescription drug abuse epidemic sweeping the nation, unheeded by age, race, gender, or income level.

Re-Thinking “the Norm”
In chronic pain treatment, particularly where opioids are concerned, there seems to be a disconnect between a drug’s approval for use and its potential for harm, leading to over-prescription and deadly drug interactions. This is why ANS developed its unique pharmacotherapy review program, the only drug utilization review system in the industry with a hands-on, state by state jurisdictional approach. Sometimes to help an injured worker, “it takes a village”, and the ANS face-to-face collaborative process uses locally based legal nurse experts to bring doctors, patients, insurers, and legal representatives all onto the same page. Other drug utilization processes act superficially and fail to follow up, but the ANS process consistently achieves the most impactful patient outcomes while producing the lowest MSA’s and most improved loss ratio’s in the industry. All this while offering a risk free “No Fee Assurance” guarantee for WC payers who wish to try the program.

To truly improve patient treatment outcomes and stop the opioid epidemic try scientifically-based, cost-effective pharmacotherapy review programs. Contact us today.

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The Impact of Workers Compensation Compounding

As custom-made compound prescriptions concoctions continue to rack-up higher workers’ compensation costs, insurers are scrambling to find alternatives and employers are looking for relief from equally inflated premiums. With little to no evidence as to the efficacy of such creations, many states have implemented treatment guidelines directing doctors to more evidentiary-based, easily reimbursable options. Despite guidelines and formularies however, loopholes in coverage continue to allow providers to sell millions of dollars of compounds, with many companies submitting inflated reimbursement bills in their attempts to get paid.

A Growing Issue in Workers Compensation

This June, the U.S. Attorney’s Office brought criminal charges against such providers across the country, accusing them of defrauding the Medicare, Medicaid, and Tricare health insurance programs that serve the military and their families. Additionally, the Inspector General of the U.S. Postal Service identified compound drugs as attributable for 34% of the postal service’s prescriptions, and 53% of prescription drug costs in 2015, a rise from 22% and 27% in 2014, respectively. State and federal prosecutors also continue to finger some pharmacies for offering doctor kickbacks in exchange for prescriptions.

Money or medicine?

Industry guidelines point to the use of such compounds as a last resort, accepted in instances where a person is allergic to an ingredient in a drug, or when a liquid version of a commercially available drug is necessary for one who cannot swallow capsules. Some doctors prescribe initially despite these guidelines. The unnecessary prescription of compounds is costing the workers’ comp industry billions annually.

Deep impact

2015 calculations indicate…

  • Re-packaged drugs dispensed by physicians cost employers 60% to 300% more than those dispensed at retail pharmacies.
  • The average paid per compound drug increased by more than two-thirds from $460.00 to $774.00, though non-compound drugs fell slightly from $113.00 to $108.00.
  • The U.S. Postal Service alone spent a whopping $390,000.00 a day for compound drugs in 2015.

Tired of paying more for ineffective treatments?
Proven, more affordable, clinically tested and approved options to compounds do exist. It’s time to find a better way. Discover how to achieve better claims outcomes with ANS Solutions Pharmacotherapy Review. Contact today.

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