This statistic floored me

[Cecropia]

https://www.bloomberg.com/news/articles/2017-06-21/opioids-given-to-almost-1-in-4-medicaid-patients-study-finds

 

Nearly one in four people on Medicaid, the U.S. health program for the poor, received powerful and addictive opioid pain medicines in 2015, according to research by a drug-benefits management firm. [...]

Among Express Scripts Medicaid members prescribed the pain pills, 28.5 percent received more than a month’s worth of the drugs.

 

Almost 30% received a months' worth?!?  Every day a person takes them, their risk of addiction rises... Check out the graph on this page:

https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/

Note that at just 10-15 days in, you've already rolled the dice to be part of the 15% who get hooked for 3 years+.  The curve flattens out after that.

 

I can't believe that the opioid abuse crisis has been well-known since 2007, especially among doctors, and we have this level of prescriptions being dished out today.  How can that be responsible or acceptable?  Who knows how many patients are receiving full disclosure of the risks of these drugs before being sent out the door with their month-long(!) prescription.

 

[Dh and I both have extended family issues with addiction, so we have seen what it does to families and take a special interest in this topic (our histories are not involving opioides, but still... we would be very hesitant to ever try them for fear of being more susceptible than a person from an addiction-free background)]

[Liz CA]

The challenge has been to create analgesics that have similar potency and molecular structure as opioids but very little to no potential for abuse.

 

I remember when OcyContin was released and we were told the potential for abuse was small. Now we know different. Also, addicts typically find innovative ways to get to their drug of choice. In substance abuse facilities, a med by the name of Suboxone helps opioid addicts in the withdrawal period but they have to watch the patient orally taking the pill and not crushing it to snort it since it contains some opiate substances. The first of these drugs did not contain another drug called naloxone (an opioid antagonist) and was frequently crushed and snorted or heated and inhaled right there in the facility. With the addition of naloxone, crushing of the pill would activate the opioid antagonist and render the rest useless for getting high.

Edited June 27, 2017 by Liz CA

[displace]

The stats may be skewed. Medicaid also covers people with very severe and chronic disabilities.

 

There are many legitimate diagnoses that require pain meds. I'm not saying there aren't better ways and there aren't things that can be done better.

[JenneinCA]

How many of those people are dealing with acute pain?

 

I broke my ankle and received big doses of opioids (Dilaudid) in the hospital and then meds (Percocet) to take at home. And then an offer for more if I needed them even after that. Personally the side effects (severe consitpation and generally feeling loopy) were bad enough that I was willing to tolerate the pain to avoid them. But there are people out there that those side effects would not be enough to deal with the pain.

 

I have a hard time telling someone that they must live with pain because of a possibility of addiction.

[Ottakee]

The stats may be skewed. Medicaid also covers people with very severe and chronic disabilities.

 

There are many legitimate diagnoses that require pain meds. I'm not saying there aren't better ways and there aren't things that can be done better.

I was going to say this as well. I am sure there is prescription drug abuse but often people getting these meds are severely disabled.

 

I do worry about the amount/type of pain meds handed out after some surgeries, etc.

 

I also think that there needs to be development of better meds that aren't as addicting.

[kiana]

My mother is one of those people who is on Medicaid and prescribed more than a month of opioids.

 

She is disabled from conditions that result in severe and chronic pain, and the opioids are the only thing preventing her from being bedridden at the moment. 

 

Even if she were to become addicted, frankly, I would rather deal with that than have her fade out of life in a nursing home, because she would be completely unable to live on her own (or in my place) without the pain medication. 

Edited June 27, 2017 by kiana

[Liz CA]

My mother is one of those people who is on Medicaid and prescribed more than a month of opioids.

 

She is disabled from conditions that result in severe and chronic pain, and the opioids are the only thing preventing her from being bedridden at the moment. 

 

This is the "other side" of opioid addiction. Quality of life plays a big role.

 

[displace]

https://www.bloomberg.com/news/articles/2017-06-21/opioids-given-to-almost-1-in-4-medicaid-patients-study-finds

 

 

Almost 30% received a months' worth?!? Every day a person takes them, their risk of addiction rises... Check out the graph on this page:

https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/

Note that at just 10-15 days in, you've already rolled the dice to be part of the 15% who get hooked for 3 years+. The curve flattens out after that.

 

I can't believe that the opioid abuse crisis has been well-known since 2007, especially among doctors, and we have this level of prescriptions being dished out today. How can that be responsible or acceptable? Who knows how many patients are receiving full disclosure of the risks of these drugs before being sent out the door with their month-long(!) prescription.

 

[Dh and I both have extended family issues with addiction, so we have seen what it does to families and take a special interest in this topic (our histories are not involving opioides, but still... we would be very hesitant to ever try them for fear of being more susceptible than a person from an addiction-free background)]

No...

 

Among Express Scripts Medicaid members prescribed the pain pills, 28.5 percent received more than a month’s worth of the drugs.

 

This means that, of the people prescribed the pain meds, almost 30% of them had more than a months worth. Not 30% of Medicaid patients. So, if 3 in 100 people got opioids, only one of those got more than a months worth.

 

ETA - ignore if that's what you were trying to say.

 

The article is pretty horrible for figuring out anything. Even mild Tylenol with codeine might be considered in the study. And it only covers 14 states?

Edited June 27, 2017 by displace

[Liz CA]

No...

 

Among Express Scripts Medicaid members prescribed the pain pills, 28.5 percent received more than a month’s worth of the drugs.

 

This means that, of the people prescribed the pain meds, almost 30% of them had more than a months worth. Not 30% of Medicaid patients. So, if 3 in 100 people got opioids, only one of those got more than a months worth.

 

ETA - ignore if that's what you were trying to say.

 

The article is pretty horrible for figuring out anything. Even mild Tylenol with codeine might be considered in the study. And it only covers 14 states?

 

I did not spend a lot of time reviewing the stats but it sounds like there are some confounding variables.

 

[displace]

I haven't read the original research paper. I admit I just read the article linked.

 

It didn't prompt me to read the paper though.

[displace]

ETA - but the titles of these news outlets state 1 in 4 patients are on opiates? I still can't find the study.

[Liz CA]

ETA - but the titles of these news outlets state 1 in 4 patients are on opiates? I still can't find the study.

 

Yeah...one in four of what demographics?

[displace]

Maybe this? Which makes no sense...

 

http://www.medicaidinnovation.org/_images/content/5._Addressing_the_Opioid_Epidemic_in_Medicaid_Managed_Care_for_Women_and_Newborns_.pdf

[displace]

Yeah...one in four of what demographics?

It just says on news article titles... 1 in 4 Medicaid patients.

 

But then doesn't state that in the news article.

 

And the study I found is super different.

 

I'm frustrated but so confused. I'm not sure if I want to keep looking or give up.

 

I have a feeling there is no study. Just numbers spit out by a prescription company.

[Ottakee]

For express shipping they ship 3 months of pills at a time for long term condition.

 

My mother is one who has severe bone lose in her joints and is in a power chair and can only take 1-2 steps at a time....just enough to transfer to toilet, to bed, etc.

 

Like someone else mentioned quality of life is important.

[mamaraby]

Quality of life is definitely an issue. I wouldn't want people to have to love with pain because of the potential for abuse. However, as the wife of a LEO, opioid addiction definitely worries me. Overdose deaths are soaring in our area, fentanyl has popped up, and I worry about dh's exposure after what happened to that officer in Ohio.

[Crimson Wife]

ETA - but the titles of these news outlets state 1 in 4 patients are on opiates? I still can't find the study.

What percent of Medicaid patients experience either surgery or a bone fracture each year? My special needs child has Medicaid as secondary insurance and received some sort of heavy duty pain meds last year after the operation for her cochlear implant. I gave them to her for the first 3 days and then she had healed enough to switch to ibuprofen.

 

 

Sent from my iPhone using Tapatalk

[Epicurean]

I know I'm biased, but I'm at the point now where I'm just so over the hysteria about addiction.

 

There will always be addicts. Their problems, which we can never eliminate from society, should not cause such an uproar that it becomes almost impossible for people who really need pain medication to get it. And that's what we've come to.

 

I have chronic pain. I am the best case scenario for pain medication because I have a well documented, easy to understand reason for chronic pain. But I can't get a doctor to prescribe me anything for longer than two weeks because they're afraid of being investigated. When I called the pain clinics in my state (all of them) it was $400 - $700 for one consultation and they warned over the phone that they do not prescribe pain meds (without me asking). Only physical therapy or steroid injections. Guys. What else is a pain clinic for, if not to prescribe pain medication? I don't have Medicaid, so I know this is a bit of a tangent, but often I feel like:

 

A) the fear of becoming addicted is overblown

B) the outrage over pain med scripts are by people who haven't lived with chronic pain

 

I just think many people don't realize how awful it is to wake up in pain, feel pain all throughout the day, and go to bed in so much pain you can't sleep. And then so it all over again. Even if addiction was as likely as some people seem to think, I'd rather be addicted than love this way. The choice is not between pain meds and no pain meds. It's between pain meds and a quality of life so low that many people turn to suicide.

[Jean in Newcastle]

There are non-narcotic pain solutions. I think that they should be a first resort instead of a last one. I actually take naltrexone for my pain (among other things) which rules out any opioids but I am fine with that. I realize that opioids have their place but I think that it's been too easy to just pop those pills.

 

 

Sent from my iPhone using Tapatalk

[Farrar]

I don't know that the risk of addiction is overblown... I'm trying to find a statistic that floored me recently, which was that some really high number of patients (maybe a quarter? a third?) suffered some level of addiction or withdrawal after a standard amount of prescription opioids for a surgery of some kind. And... I can't find it. But I remember just going, whoa, that's scary.

 

Well... I couldn't find that one, but I did find this one...

https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

 

Probably upwards of 60,000 deaths from overdoses this year. That's a 19% increase. And it's only getting worse.

[Tap]

I work in pharmacy.....

 

Opioids are Wayyyyy over prescribed for things that have pain associated, but not pain at a level that is debilitating.  

 

I had a Medicaid person get 12 percocet for a UTI yesterday.  Really? 12 Percocet for a UTI?  Yep, there is pain. Yep, it hurts. And Yep, for most people (I realize there are people with complicating factors, she isn't one) the pain from a UTI will be gone within 24 hours of an antibiotic. There are other non-narcotic pain meds that doctor could have chosen if they felt they needed prescription strength relief. She and I talked about the med.  She didn't have a reason for the Percocet (no allergy to other meds etc) she just told the doctor that is what she wanted, so he wrote it. 

 

We see Percocet for Strep throat.  Percocet for a broken toe.  Percocet for minor cuts (didn't require stitches).  Percocet for dental procedures. ETC  Things that 10 years ago, a doctor would have told the patient to take a couple Tylenol or Advil for, are now being treated with opioids .  Things that have pain....that someone can just tolerate for a day or two are now often treated with opioids. Unused tablets are sitting in patients cupboards, and those unused are part of what is feeding the epidemic. They get diverted to other patients. They get stolen. They get taken for recreation. They get sold for quick cash. 

 

People with private insurance quite often give us prescriptions from dental procedures and tell us to put the pain med on hold and they will let us know if they decide they need it.  People who have Medicaid in our state have  zero copays....always have us fill every prescription.   

 

I am not saying that doctors are more willing to write pain meds for Medicaid patients, but Medicaid patients definitely fill more scripts for pain meds than other patients. A few factors in this, are that Medicaid patients use the ER more than others.  Medicaid patients in our state don't pay a copay for the ER and some have a harder time getting into primary care doctors. ER doctors are more likely to write for pain meds in general that PCPs due to the nature of their job.  So, Medicaid patients see doctors who write a higher amount of pain meds overall. 

 

[Cecropia]

ETA - but the titles of these news outlets state 1 in 4 patients are on opiates? I still can't find the study.

 

http://lab.express-scripts.com/lab/insights/government-programs/a-nation-in-pain-the-medicaid-opioid-crisis

 

Direct link to report (pdf) http://lab.express-scripts.com/lab/insights/government-programs/~/media/44e8de2c68b84ad9b122a1715ee1375a.ashx

[Liz CA]

There are several aspects to this.

1. An addict who wants to get a little high or get that feeling of bliss but has no medical reason to take opioids. Trading Oxys and Percocet and creating a deadly mix of opium derivatives that can quickly lead to cardiac arrrest.

2. Those who are in dire need of pain meds and find it harder to get something that works for them.

3. Non -opioid options are preferable for many reasons - not just addiction potential - but the many other effects, i.e. gastrointestinal issues and narrow margin of safety, however, some of the other options carry a) side effects considered worse by some than opiates or b) prove ineffective for some people's pain.

 

I agree that quality of life is a high priority.

 

Commenting on Tap's post: Doctors are hyper-concerned that we should not suffer a twinge of pain. After surgery, I was feeling fairly well - of course I had a little pain as one would expect when your abdomen now has a zipper - but not while I was lying in bed. A nurse was flabbergasted when I requested to be taken off meds. She appeared several times during her shift asking if I was in pain yet. Every time I said "No, not if I am not moving much. And even if I move I can do so carefully and stand up with a few twinges but it's a lot better than vegetating on drugs." She gave me a rather incredulous look. I had already been on pain meds for 1.5 days and figured this was enough.

Again - for some people life would be hell if they had nothing to counteract the pain but I agree that it is not indicated in some instances.

Edited June 27, 2017 by Liz CA

[Guest]

It doesn't surprise me. I was shocked at the prescriptions made for me when I had a day surgery and two plastic surgeries to remove and repair a cancer excision. Without expressing any complaint or fear of pain, I was prescribed more than 80 doses of opioids.

 

Add the broken arm a few years earlier, and I had more than 100 doses...all paid by insurance.

 

I took one dose after the cancer excision. For all the rest, I used 3 Tyleinols total.

 

I'm not saying there is not a legitimate use for these painkillers. But seriously, I ended up with almost 100 doses...for what? I didn't need them at all. It was all prescribed on spec.

 

I wonder if people demand them and that is how this happens. And if that is the case when it is paid insurance, how should we expect it to be different for Medicaid patients?

 

My dh had an interesting conversation about this the other day...I'll try to put that into another post in the coming days. He spoke with a person who has a lot of insight into health care issues. It was ...illuminating.

[displace]

http://lab.express-scripts.com/lab/insights/government-programs/a-nation-in-pain-the-medicaid-opioid-crisis

 

Direct link to report (pdf) http://lab.express-scripts.com/lab/insights/government-programs/~/media/44e8de2c68b84ad9b122a1715ee1375a.ashx

Thanks for the links!

[SKL]

They put my dad on Oxycontin for pain after a surgery.  It takes a very long time to wean off of that, and the weaning process is painful.  My dad hated starting it and was very religious about following the rules to get off of it.  Nobody sets out wanting to be an addict.

 

I hope they come up with something non-addictive, the sooner the better.

[Ottakee]

I work in pharmacy.....

 

Opioids are Wayyyyy over prescribed for things that have pain associated, but not pain at a level that is debilitating.

 

 

People with private insurance quite often give us prescriptions from dental procedures and tell us to put the pain med on hold and they will let us know if they decide they need it. People who have Medicaid in our state have zero copays....always have us fill every prescription.

 

I agree that sometimes they are way over prescribed.....esp. minor issues that will resolve in a day or 2.

 

I disagree though that medicaid patients always fill all prescriptions. I have 3 kids on disability medicaid and I often put some meds on hold, esp ones we might not need like the pain meds. We have done many surgeries where we didn't get any pain meds filled as I knew we were likely not to need them.

 

The no co-pays thing can be a blessing/problem though. My girls are on one med that is $10/month for the regular generic taken two a day. Last time we saw a doctor we got a script for the XR version for $100/month as it was only taken once a day. The doctor thought it would be easier to only have to take it once a day. Nice thought but my girls take meds twice a day and have their entire lives so I called the doctor and asked to go back to the twice a day form as even though they have no personal copay my taxes (and everyone else's out there) were paying more for something when a cheaper version was just as easy and effective.

Edited June 27, 2017 by Ottakee