Opioid epidemic meets opposition from doctors, legislators and insurance companies, and gets attention from local news media

Phillip Chang (UK photo)

To fight the opioid epidemic, Kentucky doctors, legislators and health-insurance companies are working to limit the prescription of painkillers.

At the annual convention of the Kentucky Medical Association over the weekend, a University of Kentucky trauma surgeon told other physicians how he and his colleagues got a wake-up call about the problem and "how they were able to halve the amount of opiates given to trauma patients without increasing their pain levels," the Lexington Herald-Leader reports in an editorial.

Dr. Phillip K. Chang, now UK's chief medical officer, had what he calls an “eye-opening moment” in 2013, when a young man he treated for injuries in a vehicle crash became addicted to the painkiller he had prescribed. He says many physicians have had similar epiphanies, and addiction “could happen to our family, our neighbors, ourselves.”

Author Sam Quinones was interviewed at the KMA meeting.

Topics related to the opioid epidemic dominated the KMA's weekend convention. Journalist Sam Quinones discussed his book, Dreamland, about the 30-year history of the epidemic. “We believe it is important to know the issue from a historical perspective,” KMA President Nancy Swikert said in a press release. “Knowing how we got to where we are on this issue will help us address it going forward.” She said this was the first time the annual meeting “has had breakout groups to address an important public-health issue.”

The Herald-Leader gives a capsule history: "Two developments of the 1990s spurred this crisis: Pain was added as a vital sign by the hospital accrediting commission. And the pharmaceutical industry targeted physicians with aggressive and misleading marketing of opioids, flooding Kentucky with powerful painkillers, many of which were diverted into the black market." Meanwhile, the federal Medicare and Medicaid centers began asking patients about pain control, "creating a financial incentive to over-prescribe painkillers."

Chang told Kentucky Health News and WKYT-TV last year that the UK trauma team adopted a protocol to treat acute pain (as opposed to chronic pain): Use a non-narcotic first, and only prescribe a narcotic if the non-narcotic doesn't relieve the patient's pain. "Rather than eliminating pain, Chang aims to keep pain 'tolerable' — a standard that Medicare should adopt," the Herald-leader editorial said.

Chang told the Herald-Leader last week that UK patients are “super receptive” when educated about the risk of opioids. He said the trauma team is integrating art, music and touch therapies into treating acute pain, and has achieved the same level of pain relief with half the amount of painkillers. "Such success among trauma patients certainly could be replicated in other populations," the editorial said.

The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is "a game-changer," and the newspaper said the law "creates opportunities for doctors to educate their patients about non-addictive options."

Insurance companies can play a role, too. Anthem Blue Cross and Blue Shield announced last week that prescribed opioids for its members in Kentucky dropped 12 percent in the past year. The insurer said it limits to seven days its coverage of opioids for patients newly starting opioids, requires prior authorization by a health-care provider, and directs patients most at risk for opioid-use disorder to one pharmacy.

All those steps have helped reduced opioid prescriptions, the company said in a press release. "The primary goal of the quantity limits was to prevent inadvertent addiction and opioid-use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines," it said.

In March, the CDC recommended that opioid prescriptions last three to seven days, and that prescribers should avoid high doses and warn patients of the risk.

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” Deb Moessner, president of Anthem Blue Cross and Blue Shield in Kentucky, said in the release. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

Attorney General Andy Beshear recently announced a program that will help residents in four counties safely dispose of prescription drugs at home, noting that 80 percent of heroin users begin their addiction through prescription drug abuse and that misuse often starts when a person has access to unused painkillers.

The Kentucky Opioid Disposal Program will distribute 50,000 "drug deactivation pouches," called Deterra, to residents in Floyd, Henderson, McCracken and Perry toward this effort. One pouch can dispose of  45 pills, six ounces of liquid or six opioid patches -- and altogether have the potential to dispose of more than 2 million unused opioids, says the news release.

The initiative is being partially funded with settlement funds from drug companies, along with funds from the nonprofit A Stronger Kentucky Inc., chaired by his father, former Kentucky Gov. Steve Beshear.

The CDC reported in July county-by-county figures for dispensing of opioids in 2015 and 2010. The amount in Kentucky went down, but some counties went up, and the figures are available from Kentucky Health News at www.uky.edu/comminfostudies/irjci/OpioidVitalSigns2017Kytable.xlsx.

Lisa King of The Sentinel-News in Shelbyville used the data as the basis for a story saying that opioid prescriptions declined 20 percent over the five-year period, and also looking at some other counties. But in interviews with pharmacists, she also found a possible reason that the number could now be going up. She wrote:

"Raschelle Cox at Shelbyville Pharmacy said that even though prescription numbers may be down, there are still a lot being written. 'In the two years that I’ve been here, I haven’t noticed any decrease,' she said. Cox added that . . . there are a couple of medications used to treat neuropathy from diabetic nerve pain, that people have been using instead of opiates, that have just recently been declared as narcotics. 'Now Gabapentin is controlled as of July 1,' she said. 'We sell a lot of it.' Roanya Rice, director of the North District Health Department, said a trend is also underway of using drugs other than narcotics."