Tuesday, June 20, 2017

Ky. leads nation in opioid-addiction diagnoses for privately insured people, and in the rate of doctors prescribing medication for it

By Melissa Patrick
Kentucky Health News

Kentucky doctors diagnosed more cases of opioid addiction for privately insured people than in any other state in the nation last year, and the state had the nation's highest rate of medication-assisted treatment for addiction.

The findings are in a study, "America's Opioid Epidemic: Data on the Privately Insured Population," by Amino, a health-care transparency company that uses large sets of data to help people find low-cost care.

Looking only at privately insured patients "shows how pervasive this crisis has become" and that opioid use isn't just a problem for people on Medicaid, the report says.

Nationwide, the researchers found a six-fold increase in the number of patients diagnosed with opioid-use disorder between 2012 and 2016, rising from 241,000 to 1.4 million.

The American Society of Addiction Medicine estimated that in 2015, "about 2 million people in the U.S. had a substance use disorder with prescription painkillers and about 591,000 had a heroin-use disorder," Terry DeMio reports for The Cincinnati Enquirer.

The Amino report said its estimates were probably low, especially among the privately insured, because people are hesitant to get treated for addiction and physicians are hesitant to make the diagnosis because of the stigma attached to it, especially for those who get insurance through their employer.

Dr. Will Lopez, a senior medical director in Cigna's behavioral-health business, told DeMio that opioid-use disorders increased after doctors started prescribing more painkillers in the 1990s, when pain level started being considered a fifth vital sign.

"From the start of this problem, it went across all economical statuses," Lopez said.

Treatment with buprenorphine is highest in Kentucky

Addiction is often treated with substitute drugs, and Kentucky has the highest share of physicians prescribing medication-assisted treatment.

MAT medications include buprenorphine, methadone and naltrexone, which are prescribed along with counseling and behavioral therapies to treat opioid-use disorders and to prevent overdoses.

Click on table to view a larger version
Kentucky has nine of the top 10 counties in the nation for doctors using MAT to treat opioid-use disorder. They include Breathitt, Lee, Wolfe, Perry, Boyle, Floyd, Menifee, Bourbon and Rowan counties. All but Boyle and Bourbon counties are in Eastern Kentucky.

DeMio notes that the Northern Kentucky counties of Boone, Campbell and Kenton were not among the counties with high rates of physicians prescribing MATs, though these counties have been "hit hard by the heroin epidemic."

That could indicate illicit trade in MAT drugs in Eastern Kentucky, but there are other possible causes. Dr. Mina "Mike" Kalfas, a certified addiction expert at Christ Hospital's outpatient clinic in Fort Wright, told DeMio that this was because the region has too few MAT providers, leaving many who need the medication unable to get it here. This is a problem nationwide.

The federal Substance Abuse and Mental Health Services Administration reported in 2016 that "Half the people who could use treatment are not able to get it, in large part because they can't afford it or can't find providers." SAMHSA offers a burprenorphine physician-finder online.

The report adds that opioid-use disorders are linked to many serious health conditions. It found that patients with opioid addictions were nine times more likely to have hepatitis C and almost six times more likely to have chronic pain. They were also eight times more likely than people without addiction to have alcoholism, almost seven times as likely to have contemplated suicide, and were more than twice as likely to have anxiety and depression.

Kalfas told DeMio that many of these dual diagnoses make sense because of what heroin and synthetic opiates do to a user's brain. "The depression, suicidal thoughts, loss of joy, are consequences of chronic opioid use, because they experience a decrease in endorphins over time," Kalfas said. Endorphins are natural hormones that activate the body's opiate receptors.

Hepatitis C is linked to intravenous drug use because it is spread through the sharing of syringes. Kentucky has passed legislation for syringe-exchange programs that allow IV drug users to swap their dirty needles for clean ones to decrease the spread of diseases like hepatitis and HIV. As of June 16, the state had 24 operating syringe exchanges and nine that are approved, but not yet operational, according to the Cabinet for Health and Family Services website.

As for chronic pain, DeMio writes, "When states cracked down on the prescription of addictive painkillers, or opioids, used in an attempt to conquer chronic pain, drug cartels moved heroin into the market, and people who'd been cut off prescriptions along with others who'd been using the drugs sold on the streets started using heroin."

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