The epidemic of opioid drug abuse, which increasingly is claiming children’s lives, has plenty of blameworthy causes. Here’s a new one: health insurers which steer patients to cheaper, more addictive painkillers while playing Scrooge for less addictive but pricier alternatives.
Pro Publica, a Pulitzer Prize-winning investigative journalism site, and the New York Times get credit for their expose of penny-wise and pound-foolish prescription management practices.
By analyzing “Medicare prescription drug plans covering 35.7 million people in the second quarter of this year,” the news organizations say they saw repeated patterns in which insurers and the spin-off businesses that run their drug payment plans (so-called pharmacy benefit mangers or PBMs) easily and quickly approve opioids for patients in pain, medications that cost relatively little. They throw up all kinds of obstacles, however, to doctors and patients who try to use less potent but more expensive drugs, including patches containing Butrans (a lesser opioid) or lidocaine. They also drag their feet on approving payments for addiction-fighting medications like Suboxone.
Big Insurance defends itself, saying it has restricted the number of doses of opioids that individual patients can receive and is helping to crack down on abuse by assisting in the monitoring of drugs’ prescribing and distribution.
But patients, doctors, and critics have assailed the industry for forcing pain sufferers, effectively, to ignore their well-rooted fears and to use cheaper, more addictive, and powerful drugs, including oxycodone (sold under the brand name OxyContin) and morphine.
The Pro Publica-New York Times investigation describes in detail the bureaucratic ordeals, including repeated rejections and appeals, patients and physicians must endure when they try to get Big Insurance of PBM approvals for opioid alternatives. Patients often throw in the towel and take opioids, even as they know they may increase their medical risks, because their diagnosed and demonstrated conditions cause them so much pain and suffering that they need medications. The inducement to start taking opioids, in itself, can be key. That’s because published medical research suggests that 1 in 5 patients prescribed these painkillers for just a 10-day initial period will still be taking them a year later.
In my practice, I see not only the significant harm that patients can suffer while seeking medical services but also the huge damages that can be inflicted on them by dangerous drugs.
It’s heart wrenching to see statistics and cases like those in a New York Times story that reported that:
At the children’s hospital in Dayton, Ohio, accidental [opioid drug] ingestions have more than doubled, to some 200 intoxications a year, with tiny bodies found laced by drugs like fentanyl. In Milwaukee, eight children have died of opioid poisoning since late 2015, all from legal substances like methadone and oxycodone. In Salt Lake City, one emergency doctor recently revived four overdosing toddlers in a night, a phenomenon she called both new and alarming. … Eighty-seven children died of opioid intoxication in 2015, according to the Centers for Disease Control and Prevention, up from just 16 in 1999. By comparison, gunshot wounds kill four or five times as many children each year. But at hospitals like Primary Children’s in Utah, drug overdoses now outstrip gun injuries among young people.
In light of these startling developments, it’s good to see news organizations dig and find important information about why the opioid epidemic has blown up. Drug overdoses, the New York Times previously has found, caused 64,000 American deaths in 2016—more people than were killed by peak car-related deaths in 1972 or by peak gun deaths in 1993. The opioid drug epidemic’s toll reaches much further, including a staggering economic debilitation of American workers, leading to a 20 percent or so drop in men’s workforce participation and 25 percent of women’s.
The nation needs to attack this epidemic even harder than it has. CVS has taken a good step in limiting the amount and strength of opioids that can be prescribed to members of its PBM taking the painkillers for the first time. It’s good to know that New York state officials have demanded more of an accounting from PBMs about how they’re fighting opioid abuse, as Pro Publica and the New York Times have reported. Uncle Sam should join in asking tough questions and taking appropriate tough actions, too.
Regulators and lawmakers should be leading this battle, of course, and not be just chasing after journalists’ excellent digging. There’s great need for urgency by us all, the New York Times and Pro Publica remind: That’s because this epidemic is metastasizing. Prescription painkillers opened a huge gate, and now the nation is battling not only abuse of these medications but also super potent and dangerous illicit street drugs, including heroin and fentanyl, a synthetic that is relatively easily made and is flooding our shores from overseas.
