Ending the epidemic: Collective efforts underway to stop opioid and other substance use disorders

As more healthcare systems assume a greater role in providing solutions for patients with substance use disorders, the American Medical Association (AMA) Opioid Task Force is calling on policymakers to adopt the Task Force’s newly released recommendations to end the U.S. opioid epidemic. The roadmap points to treatment barriers for substance use disorder and pain and other policies that leave too many patients with no help for getting well, such as prior authorization, step therapy and other administrative burdens, says an AMA news release. The organization says inadequate enforcement of state and federal laws that require insurance parity for mental health and substance use disorders is another serious roadblock to treatment. 

Meanwhile, government agencies are working in other areas to fight addiction. The Food and Drug Administration (FDA) released its own statement the same day (May 30) announcing a request for information on requiring fixed-quantity blister packaging for certain opioid pain medicines, which the agency says would help decrease unnecessary exposure to opioids

Healthcare vendors are also joining the effort with increasing number of suppliers rolling out products and services designed to help caregivers manage the crisis, including medication management systems, rescue kits, diversion prevention, surveillance systems, and other tools. 

Last year, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT Act), which also allows the FDA to require special packaging for opioids and other drugs that pose a risk of abuse or overdose. FDA opened a public docket to solicit feedback on requiring that certain immediate-release opioid analgesics be made available in fixed-quantity, unit-of-use blister packaging.

FDA says data suggests that if 5-, 10-, or 15-count unit-of-use blister package configurations of certain commonly-prescribed immediate-release opioid pain medications were made available, one or more of these options could be expected to meet the needs of many patients experiencing acute pain following medical procedures and other conditions where opioid treatment is suitable. Further, the blister packs would help prescribers to be more considerate when writing opioid prescriptions and could become the default option in cases where shorter durations are clinically appropriate. FDA did note that fixed-quantity unit-of-use blister packages would not replace traditional prescribing but would serve as another option.

The AMA, however, wants new policies that would address treatment for all. “We need help from policymakers to ensure that more people have access to treatment. Physicians are responding to the epidemic and we are seeing results: a reduction in opioid prescribing of 33 percent since 2013, increased use of prescription drug monitoring programs, enhanced education, and greater co-prescribing of naloxone,” said AMA President-elect and Task Force Chair Patrice A. Harris in her statement. “But we cannot enforce parity laws or eliminate administrative barriers without the help of state and federal authorities, and that’s what is limiting treatment now.”

New recommendations from the AMA Opioid Task Force:

·   Remove prior authorization, step therapy and other inappropriate administrative burdens or barriers that delay or deny care for FDA-approved medications used as part of medication-assisted treatment for opioid use disorder.

·   Support assessment, referral and treatment for co-occurring mental health disorders as well as enforce state and federal laws that require insurance parity for mental health and substance use disorders.

·   Remove administrative and other barriers to comprehensive, multimodal, multidisciplinary pain care and rehabilitation programs.

·   Support maternal and child health by increasing access to evidence-based treatment, preserving families, and ensuring that policies are nonpunitive.

·   Support reforms in the civil and criminal justice system that help ensure access to high quality, evidence-based care for opioid use disorder, including medication-assisted treatment.

“The original task force recommendations called on physicians to accept the responsibility to take a leadership role in ending the epidemic,” Dr. Harris said. “Yet, more people are dying each year, emphasizing the need for policymakers to protect patients’ access to evidence-based care for pain and for opioid use disorder.”

The original task force recommendations, issued in 2015, focused on actions that physicians could take to help end the epidemic, including registering for and using state prescription drug monitoring programs, enhancing education and training on effective, evidence-based treatment, supporting comprehensive care for patients in pain and those with a substance use disorder, removing stigma by treating patients with pain and with a substance use disorder with comprehensive care and compassion, not judgment, expanding access to naloxone in the community and through co-prescribing, and encouraging safe storage and disposal of opioids and all medications.

As for products, ZeOmega, a provider of technology-enabled population health solutions, just announced the launch of Jiva Opioid AI, an advanced solution for improving how health plans and other risk-bearing organizations identify and manage opioid abuse populations.

Developed using an evidence-based, machine-learning algorithm, the company says that Jiva Opioid AI helps identify the full spectrum of opioid abuse cases and guides patients into the most appropriate care management workflows. Unlike traditional approaches that rely on retrospective pharmacy claims, ZeOmega says its solution integrates social determinants of health and other non-claims data, helping to find at-risk individuals who don’t have any opioid prescriptions. Jiva Opioid AI integrates SDoH with claims and other data and as a machine-learning system, will constantly retrain to identify new overdose patterns, said the company.

“During development, we tested the theory that many at-risk individuals haven’t been prescribed opioids, which – using traditional methods – would limit the ability to identify and manage the full population successfully,” said Pravin Pant, ZeOmega’s Senior Director for BI, Analytics, and Machine Learning. “In a study of nearly 400,000 individuals, we identified about 1,400 who had overdosed on opioids. Of those, we learned 55 percent had not been prescribed an opioid in the 12 months leading up to their overdoses. It’s a compelling data point. How can we be successful if we’re getting to less than half the population?”

Sam Rangaswamy, Founder and CEO for ZeOmega told Healthcare Purchasing News that the system currently integrates household income, education levels (high school and college), and poverty levels. “We are in the process of expanding that to include data on an individual’s living situation, employment details, environmental and domestic safety issues, transportation access, and more,” he added.

Rangaswamy explained how the process works: “Jiva Opioid AI identifies individuals at risk for opioid overdose based on its evidence-based algorithms and artificial intelligence. Once individuals are identified, they are assigned a High, Medium, or Low risk score (defined by the client). That information is fed into the core Jiva system where it triggers care management rules configured by the client (i.e. each risk level is associated to a specific set of interventions established by the client). Based on those rules, members are automatically moved into the appropriate care management workflows. All this takes place automatically, with no manual effort involved.”