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Medications used to reverse opioid overdoses or limit the “high” created by opioids can help prevent narcotic-related deaths, but workers compensation experts say injured workers who obtain those medications should receive help to wean them off opioids.
“If a patient is at such high risk of overdose that the physician thinks they need Evzio or Probuphine, a better approach would be (to) eliminate the opioids,” said Phil Walls, chief clinical and compliance officer at Tampa, Florida-based pharmacy benefit manager Matrix Healthcare Services Inc., which does business as myMatrixx.
A U.S. Food and Drug Administration committee voted in favor last month of approving Probuphine, a long-acting, rod-shaped drug implant that would be used to combat opioid addiction. The implant would supply a sustained-release six-month supply of buprenorphine, an opioid that does not produce the euphoric feeling that patients experience from other opioids, such as oxycodone or hydrocodone.
Buprenorphine is often used in tablets or as a film to help patients wean off of more addictive opioids since it also blunts the “high” feeling that users can experience with other narcotics, sources say.
Meanwhile, CVS Health Corp. announced this month that it would make naloxone, an opioid overdose reversal medicine, available at its Ohio pharmacies without a prescription. CVS said in a Feb. 2 statement that naloxone is already available without a prescription in several other states, including Arkansas, California, Indiana, Minnesota, Mississippi, Montana, New Jersey, New York, North Dakota, Pennsylvania, Tennessee, Utah and Wisconsin.
Walgreen Co. also plans to dispense naloxone without a prescription in 35 states and Washington, according to a Feb. 9 statement from the Deerfield, Illinois-based pharmacy. The company said it will begin providing nasal and injection forms of naloxone in New York, Indiana and Ohio this month, and plans to roll the program out to other states by the end of 2016.
Walgreens said in its statement that it “is available and eager to work with regulators to help update rules to allow for dispensing of naloxone without a prescription” in states that currently require one.
Experts say recent actions from the FDA, CVS and Walgreens represent an effort to stem a nationwide epidemic of opioid and heroin abuse.
The U.S. Centers for Disease Control and Prevention says that 18,893 people died from opioid painkiller overdoses in 2014.
An opioid action plan announced by the FDA this month recommended increasing the availability and use of naloxone, using medications such as buprenorphine to help wean addicted patients off opioids and promoting responsible prescribing of opioids by physicians.
“There's still great effort and a long way to go to wean people off the use of long-term opioids,” said Dr. Jacob Lazarovic, chief medical officer at third-party administrator Broadspire Services Inc. in Sunrise, Florida.
Such efforts recognize “that this is a multidimensional issue and that it is our civic duty to stop the overdose deaths in whatever manner possible,” Mark Pew, senior vice president at Duluth, Georgia-based medical management company PRIUM, said in an email.
Sources say they don't expect to see an uptick in payments for naloxone under workers comp claims. That's because employers and insurers typically are required to pay for an injured worker's medications only if they have a prescription from a treating physician.
However, they believe it's likely that Probuphine will appear in workers comp claims, just as other forms of buprenorphine have been used by injured workers in the past.
Dr. Lazarovic said Probuphine could help reduce or prevent opioid addiction among workers comp patients.
“I think buprenorphine is an important tool in helping people get off opioids,” Dr. Lazarovic said.
But while sources say medical interventions are needed to prevent deaths from opioid addiction, they're also worried that those medications could create an atmosphere for patients to continue using opioids.
“I feel like the effort now in medicine is more to treat the addiction problem than to prevent it,” said Dr. Teresa Bartlett, senior vice president of medical quality at Sedgwick Claims Management Services Inc. in Troy, Michigan.
“My biggest fear ... is that naloxone will be considered a 'mull-igan,' ” Mr. Pew said. “In other words, if you have an antidote, does that mean your behavior doesn't matter any longer because there's always a way to reverse the effects of your addiction?”
Sources say they're concerned that naloxone and Probuphine could be misused by patients. Mr. Walls of myMatrixx said other opioids, such as oxycontin, were touted for having a low abuse potential when they entered the market, and they are commonly abused today.
“Even though Probuphine should be difficult to abuse, I doubt if it's impossible to abuse,” he said.
Mr. Walls also said that naloxone places patients into immediate opioid withdrawal after it's administered. That means patients who overdose on opioids must still receive emergency treatment, even if they use naloxone to prevent an overdose death.
Dr. Bartlett noted that while buprenorphine blunts the euphoric “high” that opioid users can experience, it does not stop a person's craving for that “high.”
“This could lead to actually more potential for overdose because they may take more and more of the drug to try to attain the high,” she said.
Sources agree that Probuphine and naloxone could be useful in preventing opioid-related deaths. But they advise workers comp claim payers to search for ways to get injured workers off opioids if those patients need to keep precautionary medications on hand.
“Rather than trying to come up with something that's going to stop the overdose, change the drug,” Mr. Walls said.
Express Scripts said that workers comp “payers should determine whether (patients are) responding well to opioid therapy or if they need additional monitoring” when weighing whether a claimant needs intervention.