The Opioid Crisis: A U.S. Problem and the Response of Clinicians and CMS

According to the International Narcotics Control Board (2016), if the amount of opioids prescribed per year were averaged out over each person living in America, everyone would get about a two-week supply—a rate that’s considerably higher than anywhere else in the world.

How Can Clinicians Make a Difference?

• Ensure that all who interact with the patient are working as an informed team member.
• Assure patient engagement in options, protocols, and plans in pain management.
• Precautionary pain prescribing: PDMP check, urine test, benefit-risk discussion, start low/go slow, reassessment.
• Have conversations about limits and risks of opioids in chronic pain management.
• Counsel patients and caregivers regarding secure storage and proper disposal of unused opioids.
• Emphasize that substance use disorders are treatable chronic neurologic conditions, requiring the sustained, multifaceted approach typical in managing any chronic disease.
• Reduce stigma: Understand, emphasize, and reinforce the chronic disease nature of addiction.
• Remain alert for early signs of opioid use disorder and candidates for naloxone co-prescription.
• Keep current on use of office-based treatments for opioid use disorder (e.g., buprenorphine, suboxone).
• Keep current on cognitive behavioral treatments for opioid use disorder.
• Promote individual and community awareness of treatment needs, services, and access. (National Academy of Medicine, 2017)

How Has CMS Responded?

Besides removing the pain questions from the HCAHPS survey, which may have been sensitizing patients and physicians to pain issues, CMS and HHS worked together to define 4 priority areas:

1. Implement more effective person-centered and population-based strategies to reduce the risk of opioid use disorders, overdoses, inappropriate prescribing, and drug diversion
2. Expand naloxone use, distribution, and access, when clinically appropriate
3. Expand screening, diagnosis, and treatment of opioid use disorders, with an emphasis on increasing access to medication-assisted treatment
4. Increase the use of evidence-based practices for acute and chronic pain management

(Centers for Medicare & Medicaid Services, 2017)

References:

Centers for Medicare & Medicaid Services. (2017). Opioid Misuse Strategy 2016. CMS. Retrieved from https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

International Narcotics Control Board. (2016). Narcotics Drugs 2016. Retrieved from https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/narcotic_drugs_reports.html

National Academy of Medicine. (2017). First do no harm: Marshaling clinician leadership to counter the opioid epidemic. Washington: National Academy of Medicine. Retrieved from https://nam.edu/first-no-harm-nam-special-publication/