Study Shows Longer Duration Predicts Higher Risk of Opioid Misuse and Abuse

Aetna’s continuing work on helping combat the opioid epidemic includes a study suggesting the strength of the drug might not be the best predictor of misuse.

In a study coauthored with Harvard Bioinformatics, findings show that among surgery patients with no history of recent or chronic opioid use, there was a higher risk of misuse and abuse if they were taking the opioids for a longer duration. The study appeared in the January 2018 edition of BMJ and the research relied on insights derived from Aetna’s pharmacy and medical claims data.

“We hope this paper facilitates a change in culture among surgeons in how they manage post-operative pain,” said Dan Knecht, M.D., M.B.A, vice president and head of Clinical Strategy and Policy at Aetna.

The study is part of Aetna’s commitment to battling opioid misuse, which includes initiatives targeting super-prescribing clinicians and changing its policies to limit overprescribing and increase access to addiction treatment.

Hal L. Paz, M.D., M.S., executive vice president and chief medical officer at Aetna, recently discussed Aetna’s efforts in a PBS documentary called, “Understanding the Opioid Epidemic.” The documentary looks at the factors that led to the epidemic, its impact on the country and how it can be addressed.

Inappropriate prescribing and misuse and abuse of prescription drugs is a contributing factor to the epidemic. In a well-intentioned effort to more aggressively treat their patients’ pain, some physicians may have underestimated the dangers of dependence and abuse.

“Because of the addictive properties of these drugs and the fact that they are very effective in eliminating pain, the pendulum swung way out, but at a tremendous cost and in tragic ways,” Paz said. “We have to bring it back to the middle.”

Paz appears in Chapter 4 of the documentary, which you can watch below:

Empowering physicians to prescribe more responsibly

Paz emphasized Aetna’s role is not to “second-guess” physicians when they write a prescription for a narcotic. Instead, the health company analyzed data to identify prescribing patterns and shared this information to better inform physicians about their outlier status and empower them to prescribe more responsibly.

This led to an initiative in 2016, where Paz sent signed letters to nearly 1,000 doctors, who were identified as super-prescribers and were in the top 1 percent when it comes to refilling opioid prescriptions. The letters included guidelines and additional resources on appropriate prescribing.

“We expect that our physicians are going to be well-trained and they’re going to practice appropriately, professionally and ethically,” Paz said.

Aetna continued the super-prescriber initiative in 2017 by identifying 480 super-prescribing dentists and 249 super-prescribing oral surgeons in the U.S.

And the company also made changes to increase access to treatment. Aetna was the first national payer to waive copays for Narcan for its fully-insured commercial members after their deductible is met. The health company also limited the quantity of opioids prescribed for acute pain and post-surgery to a seven-day supply for its commercial pharmacy members, which aligns with the CDC guidelines as well as the above study.

Aetna also eliminated the pre-authorization requirements on all buprenorphine products, which are used to treat opioid addiction, in March.

Read more about Aetna’s five-year goals and its commitment to fighting the opioid epidemic.