Opioid Abuse Prevention: How Grand Rounds is Fighting the Deadliest Epidemic in a Generation

By Gus Crothers
December 17, 2017

Since the federal government recently made its long-overdue announcement that the opioid crisis has reached the level of a national public health emergency, there’s been no shortage of alarming statistics about opioids in the news. For example, more than 90 Americans die every day from opioid overdose; more than 1,000 are treated in the emergency room daily for misusing prescription opioids; and as many as one in four people who receive long-term prescription opioids struggles with addiction.1

It’s widely accepted that this epidemic began with the prescribing patterns of U.S. physicians over the last 20 years, and, unfortunately, this revelation has shaken the public’s trust in the medical community. Even more frustrating is the fact that state, federal, and numerous specialty-society pain management guidelines have cautioned against the liberal use of prescription opioids for years, yet physicians have continued to escalate their prescriptions, ignoring the mounting evidence and consensus guidelines. One especially startling study from 2017 found that 39.7% of patients in Pennsylvania continued to receive prescriptions opioids from their doctors even after suffering a near-fatal opioid overdose.2 How can such reckless prescribing persist in the face of a national emergency? The most recent public health data shows that U.S. physicians are finally starting to curb their opioid prescribing. However, when you consider that U.S. physicians still prescribe three times more opioids per person than physicians in European countries3 and four times more opioids than they did in 19994 (with no improvement in pain control), you begin to realize how far we still have to go.

While the physician workforce slowly changes its practices (studies suggest it takes up to 17 years for emerging research to reach bedside practice) what can large employers and other purchasers of health care do to keep patients safe and help fight this epidemic?

We invite you to talk to us. At Grand Rounds, we’re all too familiar with widespread variability in physician practice patterns and the impact that can have on outcomes, cost, and quality. Our core thesis is that higher quality health care ultimately drives better outcomes, less spending, and happier, healthier patients. We build tools and technologies to enable large employers to match each of their employees and their dependents with the highest quality and most appropriate care available, no matter who they are or where they live.

Prescription opioids are a potent example of why quality matters in health care, and we believe this issue represents an opportunity for employers to make a dramatic impact on their populations.

As an example, one large employer customer of ours recently asked us to investigate problematic opioid prescribing within its member population. Our analysis found that, collectively, this customer’s members had made 10,000 visits in 12 months to PCPs with track records of irresponsible opioid prescribing—this represented 6% of all PCP visits that year. Additionally, almost 20% of that employer’s members who had received a prescription that year had been prescribed an opioid.

What is the significance of this finding? Research shows that as many as one in four patients who are prescribed long-term opioids in primary care will struggle with Opioid Use Disorder,5 a disease with a 2% annual mortality (15 times higher than the general population),6 and a direct cost of $10,600 annually.7 Additionally, epidemiologic studies show that, even after controlling for disease and pain severity, prescription opioid usage is significantly associated with worse pain, worse self-reported health, lower levels of activity and employment, higher health care utilization, and poorer quality of life.8 Any employer that cares about the health, wellness, and productivity of its employees should be alarmed by these facts.

At Grand Rounds, we have a track record of improving this situation. Most patients taking opioids are doing so for a diagnosis of chronic pain. Historically, Grand Rounds has been very successful in helping these patients find effective health care beyond opioids. In fact, looking across our entire book of business, we observe a significant change in treatment plan or diagnosis for 64% of patients who come to us with chronic musculoskeletal complaints.

As an example of the impact such a change in diagnosis or treatment plan can have, consider this quote from a member after Grand Rounds helped her with her chronic hip and back pain:

“I have been off of [opioids] for a year now, and I am only taking half of a pill of Ibuprofen when I need it… On top of that, I am busier than ever. I can stand for hours and look at things. I can go up and down stairs. It is wonderful. I truly don’t know where I would be without Grand Rounds…Before Grand Rounds…I was going down a black hole and each day I was getting worse and worse. I guess I would be crippled in a chair and barely making it through life. But I’m here. I have my life back. I can’t imagine my life without Grand Rounds…”

Although dramatic stories like this are encouraging, the real opportunity to impact the opioid epidemic lies in steering patients away from dangerous prescribers and towards high-quality physicians before they are ever prescribed opioids. Employing such a strategy at the population level would prevent thousands of patients from ever becoming exposed to opioids in the first place. In the field of epidemiology, this is referred to as “primary prevention” and is widely recognized by the CDC and addiction medicine experts as the most important strategy for reversing the opioid epidemic.

Next week, in the second part of this blog series, you’ll hear from one of our data scientists about how Grand Rounds has improved its physician quality algorithm to support a primary prevention strategy around opioids, and to prevent addiction from taking a larger toll on large employers and their member populations.

Source

  1. CDC.gov
  2. Frazier W, Cochran G, Lo-Ciganic W, Gellad WF, Gordon AJ, Chang CH, Donohue JM. Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid. JAMA. 2017;318(8):750–752. doi:10.1001/jama.2017.7818
  3. http://www.painpolicy.wisc.edu/opioid-consumption-data
  4. CDC.gov
  5. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82
  6. Hser Y-I, Evans E, Grella C, Ling W, Anglin D. Long-term course of opioid addiction. Harv Rev Psychiatry. 2015;23(2):76-89. doi:10.1097/HRP.0000000000000052.
  7. Rice, J. B., Kirson, N. Y., Shei, A., Cummings, A. K. G., Bodnar, K., Birnbaum, H. G., & Ben-Joseph, R. (2014). Estimating the Costs of Opioid Abuse and Dependence from an Employer Perspective: a Retrospective Analysis Using Administrative Claims Data. Applied Health Economics and Health Policy, 12, 435–446. http://doi.org/10.1007/s40258-014-0102-0
  8. Ballantyne, Jane C. ““Safe and effective when used as directed”: the case of chronic use of opioid analgesics.” Journal of medical toxicology 8.4 (2012): 417-423.
Share:

➞ Back to Blog

Share

Gus Crothers

Gus Crothers

Dr. Crothers joined Grand Rounds after completing his Medical School and Family Medicine residency training at Tufts University School of Medicine and Cambridge Health Alliance in Boston, MA. While in his residency, Dr. Crothers designed an area of concentration for his training that focused on primary care leadership and innovation. In this work, he participated in local and regional primary care improvement and research initiatives, culminating in a research fellowship at the Robert Graham Center of the American Academy of Family Physicians, where he studied participation rates of primary care physicians in addiction medicine. In addition to his passion for broad-spectrum primary care, Dr. Crothers has a special interest in substance-use-disorders and maintains an active primary care and addiction medicine practice.