The national opioid epidemic has been a public health issue overshadowed amid the current COVID-19 global pandemic – even in an election year. From 1998 to 2018, almost 450,000 people died from overdoses involving opioids, including both prescription and illicit opioids. See the CDC's Understanding the Epidemic. Things have improved, and overall utilization has declined as opioid prescriptions have dropped by 91 million from 2013 to 2019, which represents a 37.1% decrease. See AMA Opioid Task Force 2020 Progress Report.
However, a recent report issued by Mitchell, which examined clinical trends in 2020, warned the workers' compensation and auto claims industries that “two major issues have signaled that the opioid crisis is far from over, despite the progress made.” See Mitchell's 2020 in Hindsight: Clinical Trends and Predictions.
First, the report points to the fact that an increase in synthetic opioids, like fentanyl, are leading to an escalation in overdose fatalities. This is based upon Centers for Disease Control and Prevention (CDC) data indicating that between 2015 and 2019, deaths from synthetic opioids surpassed those from other categories. See CDC's Provisional Drug Overdose Death Counts. Second, the report indicates the COVID-19 pandemic has contributed to an increase in drug abuse. The report cites to a University of Baltimore paper detailing suspected overdose increases by 18% since the start of the pandemic lockdown. The Mitchell report also cautioned on monitoring the fact that this past April, “the DEA allowed for prescribing opioids via telehealth without an in-person visit.”
Mitchell's report acknowledged that overdoses are not directly connected to opioids a claimant may be prescribed during the course of treatment in a workers' compensation or auto claim. However, the report continued, “there is still cause for concern.” This is due to the fact “an estimated 4 to 6 percent who misuse prescription opioids switch to heroin and about 80 percent of people who used heroin first misused prescription opioids.” See National Institute on Drug Abuse Study.
Lastly, the Mitchell report cautioned the industry to be cognizant of providers who might prescribe opioids with greater frequency and cited to various studies showing orthopedists and surgeons prescribed opioids at higher rates.
Effects of the COVID-19 pandemic on opioid abuse and overdoses are not fully known. Moreover, as the Michell report and sources cited suggest, we're not out of the woods yet regarding the crisis. The workers' compensation industry, states and federal government have taken great strides to curb abuse and overdoses, change prescribing patterns, flag potential instances of misuse and promote additional safeguards. In the intersection of workers' compensation and Medicare compliance, the Centers' for Medicare & Medicaid Services (CMS) has even provided guidance around opioids and professional administrators of Medicare Set Asides (MSAs). We're still in the throes of an opioid crisis and dealing with the fallout. Perdue Pharma recently pleaded guilty and agreed to pay $8 Billion in fines relating to its role in the opioid epidemic.
It will be critical for the industry and stakeholders involved in prescribing, managing and monitoring opioids to remain vigilant to ensure the safety and well-being of individuals taking opioids.
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