An effective opioid management program requires a delicate balance between prevention of abuse while also ensuring that patients who legitimately need pain medication have access, says Tyson Thompson, PharmD, of UMass Medical School’s Clinical Pharmacy Services.
On one hand, it is critical for state Medicaid programs, health plans and hospitals to ensure there is not an “abundance of misuse and abuse” when it comes to the prescription of powerful, opioid-based pain killers, Thompson notes. But they must be flexible enough to ensure that patients with legitimate needs can have access to powerful, but addictive opioid medications.
Drug overdose deaths across the country “likely exceeded” 59,000 in 2016, a 19 percent increase over the year before, The New York Times recently reported.
“We have an escalating issue,” says Thompson, a clinical consultant pharmacist who works with state agencies and Medicaid plans to develop best practices in opioid management. “We have had escalating prescriptions and an escalating issue with opioid overdoses over the last two decades.”
An effective opioid management program must not just cut down on abuse, but also still “allow for appropriate access for individuals who have medical necessity,” Thompson says.
Striking this balance can be both time consuming and difficult for state Medicaid plans and others, some of which have turned to UMass Medical School for help.
Thompson points to one of opioid management programs developed for Medicaid program, patients prescribed high doses of opioid-based pain medication are first required to consult with a pain management specialist and have a patient prescriber agreement in place with their physician.
“It is a big challenge trying to keep an eye on things like that while trying to make sure you are not having any of your members go with pain that is not managed, which is a big problem in and of itself,” Thompson said.
Thompson is a member of the Opioid Therapeutic Class Management Workgroup for MassHealth, an opioid management program developed by UMass Medical School for the Massachusetts Medicaid program. The initiative has led to a drop in the overall use of opioid-based medications, including a reduction in average daily doses and a decline in total drug costs.