Grand Rounds Blog

 

Opioid use disorder (OUD) — the medical term for addiction to opioid substances such as prescription painkillers or heroin — is an increasingly alarming epidemic. Overdoses involving opioids killed 28,647 Americans in 2014, and the rate of opioid overdose has tripled since 2000.1 Recent studies estimate that 2.4 million Americans meet criteria for OUD (equivalent to about 1 in 100 American adults!) and many more use opioids recreationally, putting themselves at significant risk for addiction, overdose, and related morbidities.

Opioid epidemic

Although the root causes of America’s opioid epidemic are multifaceted, physician behavior and practice patterns play a significant role.2 As a testament to the role of physician behavior, consider that Americans consume 80% of the global supply of all opioids despite comprising less than 5% of the global population, and the vast majority of these opioids are prescribed.3 Research also shows that opioid prescribing patterns vary significantly across geographies and that increasing rates of opioid prescriptions are correlated with increasing rates of opioid overdose deaths.4 Additionally, there is an established link between prescription opioid misuse and heroin use.5

The Larger Societal Impact

Although once a problem concentrated in America’s urban-poor population, OUD has spread to all corners of American society and currently exerts a significant toll on the middle class and the actively employed population. The demographic shift of this epidemic poses a significant threat to the productivity of the American economy — opioid usage (by prescription or otherwise) is associated with decreased employment, increased health care utilization, poor workers’ compensation claims outcomes, higher rates of disability, slower return to work following injury, and decreased self-reported ratings of quality of life and overall health.6 In addition to its devastating consequences to individuals, OUD is estimated to have a societal cost of $55.7 billion annually.7 For these reasons, American employers and insures are increasingly interested in addressing the opioid epidemic not only for the overall wellbeing of their covered populations, but also out of concern for their bottom lines.

Opioid epidemic

Data-Driven Approach to Addressing OUD

At Grand Rounds we believe there’s an opportunity to address the epidemic by influencing patient and physician behaviors. Specifically, by encouraging patients to see high-quality physicians who demonstrate clinical judgement and responsible opioid usage, we can promote primary prevention of OUD among our customers’ employees and their dependents. We agree with experts in the field that prioritizing a primary prevention strategy is key to combating the opioid epidemic, especially given the unique features of opioid addiction as a chronic disease that make treatment particularly resource intensive.

Through our unique, data-driven approach to assessing physician quality, we can identify key drivers behind the opioid epidemic. These include opioid prescription patterns, use of evidence-based, multidisciplinary treatments for chronic pain, appropriate rates of surgical interventions, and appropriate health care utilization rates.

These data insights, combined with our technology platform and personalized care approach, help us to guide patients to high-quality doctors and health care settings and reduce the risk of inappropriate opioid exposure. The insights also offer employers actionable strategies to effectively address the many challenges associated with the opioid epidemic — through primary prevention and promoting evidence-based interventions.

Opioids have long been a public health crisis and a complicated, scary problem for patients, employers and insurers alike. Furthermore, the issue is polarizing and tends to yield oversimplified responses with unintended consequences. By taking a data-driven, expertise-informed view of patient and physician behavior, Grand Rounds offers hope for employers, insurers and, most importantly, patients as we collectively work toward ending this epidemic.

Sources

  1. Mortality Weekly Report, “Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014,” MMWR. Morbidity and Mortality Weekly Report 64 (50);1378-82.
  2. Beauchamp, Gillian A., et al. “Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.” American Journal of Public Health 104.11 (2014): 2023-2029.
  3. Laxmaiah Manchikanti, M. D., M. A. Bert Fellows, and M. D. Hary Ailinani. “Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective.” Pain Physician 13 (2010): 401-435.
  4. Bohnert AB, Valenstein M, Bair MJ, et al. “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths.” JAMA. 2011;305(13):1315-1321. doi:10.1001/jama.2011.370.
  5. Compton, Wilson M., Christopher M. Jones, and Grant T. Baldwin. “Relationship between Nonmedical Prescription-Opioid Use and Heroin Use.” New England Journal of Medicine 374.2 (2016): 154-163.
  6. 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.
  7. Howard G. Birnbaum et al., “Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States,” Pain Medicine 12, no. 4 (2011): 657–667, doi:10.1111/j.1526-4637.2011.01075.x.

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