Reduce Over-Prescription of Prescription Drugs - Revision history

BasilSavitsky: /* Promising Practices */

2025-01-28T23:52:15Z

Promising Practices

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	=Promising Practices=		=Promising Practices=

	Alternative Payment Models (APMs) are payment systems that reward healthcare providers for the quality of care they provide, rather than the volume of services they provide. APM are advanced by the the Health Care Payment Learning & Action Network (HCPLAN) in its APM Framework whose core principles have influenced payers and purchasers, and forms the basis of the annual Measurement Effort. For example Anthem use the framework to set value-based payment goals, and at least 12 state Medicaid agencies use it to set value-based purchasing requirements in contracts with managed care organizations. <ref>https://hcp-lan.org/apm-framework/</ref> APMs are being explored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. <ref>https://www.cms.gov/priorities/innovation/key-concepts/alternative-payment-models-apms#:~:text=Defining%20key%20terms:,Medicare%20Part%20D%2C%20or%20Medicaid.</ref>		*'''Alternative Payment Models (APMs)''' are payment systems that reward healthcare providers for the quality of care they provide, rather than the volume of services they provide. APM are advanced by the the Health Care Payment Learning & Action Network (HCPLAN) in its APM Framework whose core principles have influenced payers and purchasers, and forms the basis of the annual Measurement Effort. For example Anthem use the framework to set value-based payment goals, and at least 12 state Medicaid agencies use it to set value-based purchasing requirements in contracts with managed care organizations. <ref>https://hcp-lan.org/apm-framework/</ref> APMs are being explored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. <ref>https://www.cms.gov/priorities/innovation/key-concepts/alternative-payment-models-apms#:~:text=Defining%20key%20terms:,Medicare%20Part%20D%2C%20or%20Medicaid.</ref>

	==Sources==		==Sources==

BasilSavitsky: /* Promising Practices */

2025-01-28T23:50:31Z

Promising Practices

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	~~SAFE Solutions is an ever-growing platform. Currently~~, ~~limited information is readily available for this section~~. ~~SAFE Project is dedicated to providing communities with~~ the ~~most relevant~~ and ~~innovative materials~~. ~~We will continue~~ to ~~regularly monitor~~ and ~~make updates accordingly~~ with ~~community input and subject matter expert collaboration~~. ~~Please check back soon~~.		Alternative Payment Models (APMs) are payment systems that reward healthcare providers for the quality of care they provide, rather than the volume of services they provide. APM are advanced by the the Health Care Payment Learning & Action Network (HCPLAN) in its APM Framework whose core principles have influenced payers and purchasers, and forms the basis of the annual Measurement Effort. For example Anthem use the framework to set value-based payment goals, and at least 12 state Medicaid agencies use it to set value-based purchasing requirements in contracts with managed care organizations. <ref>https://hcp-lan.org/apm-framework/</ref> APMs are being explored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. <ref>https://www.cms.gov/priorities/innovation/key-concepts/alternative-payment-models-apms#:~:text=Defining%20key%20terms:,Medicare%20Part%20D%2C%20or%20Medicaid.</ref>

	==Sources==		==Sources==

BasilSavitsky: /* Promising Practices */

2024-11-27T18:52:25Z

Promising Practices

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	'''Prescription Drug Monitoring Programs (PDMPs)''' can give a physician or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help identify patients at high-risk who would benefit from early interventions. The CDC recommends that state-run electronic databases should be used to track the prescribing and dispensing of controlled prescription drugs to patients. <ref>https://www.cdc.gov/drugoverdose/pdmp/</ref> While PDMPs are now available in all 50 states, requirements vary from state to state. <ref> https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp</ref> See SAFE Solutions ~~article on PDMPS for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Prescription_Drug_Monitoring_Program_(PDMP)</ref>~~		SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

	*Arizona - ~~quarterly report cards are prepared and distributed by the state's PDMP~~. ~~Each card details a provider’s prescribing history~~, including their ranking compared to the “average” prescriber of the same specialty and a summary or graphical representation of their prescribing history. The Arizona PDMP saw evidence that more prescribers were querying the PDMP and adjusted their prescribing habits after Arizona PDMP began issuing prescriber report cards. In Pinal County, for example, the percentage of prescribers meeting the “outlier” criteria for ~~total dosage units fell 26 percent, and prescriber PDMP usage increased 14 percent in just one year~~.

	*Kentucky prescription data is ~~configured~~ to count the number of prescriptions and dosage units dispensed for the previous 90 days. Data categories on the report card include (a) the average for all Kentucky prescribers, (b) the average for prescribers within the selected specialty, and (c) the number for the requesting prescriber. Under consideration for enhancements to the report are the inclusion of the ~~number of dosage units per prescription, morphine milligram equivalent (MME) calculations for a patient,~~ and ~~comparisons by a specific medication~~.

	*Ohio's PDMP created a "Practice Insight Report" providing a brief summary to each provider of their prescribing patterns. This report card included 4 different sections: (a) top 25 patients by number of other prescribers visited in past 12 months, (b) top 25 patients by MME, (c) top 10 medications prescribed in the previous 12 months for the prescriber’s entire practice, and (d) a listing of the prescriber’s patients issued a controlled substances prescription in the previous 12 months. Ohio also developed the "safety checkpoints" approach to minimize inappropriate prescriptions but still allow people who need them to be able to get them--with ~~some added precautions. <ref>https://www.pharmacy.ohio.gov/Documents/Pubs/Newsletter/2019/State%20Board%20Newsletter%20(February%202019)~~.~~pdf</ref>~~

	*West Virginia doctors are ranked based on how much they prescribe.

	==Sources==		==Sources==

BasilSavitsky: /* Introductory Paragraph */

2024-11-27T18:37:24Z

Introductory Paragraph

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	Reducing prescription of opioids contributes to reducing risk in two major ways. First, it reduces the number of people who are beginning to use prescription opioids for legitimate prescribed reasons but who may begin to develop a dependence on opioids or a strong desire to keep using them when the specific medical need ends. Second, reducing the prescription of opioids will limit the number of excess pills that are often diverted for inappropriate use. Interventions which healthcare providers can implement to limit the supply of prescription opioids in circulation include:		Reducing prescription of opioids contributes to reducing risk in two major ways. First, it reduces the number of people who are beginning to use prescription opioids for legitimate prescribed reasons but who may begin to develop a dependence on opioids or a strong desire to keep using them when the specific medical need ends. Second, reducing the prescription of opioids will limit the number of excess pills that are often diverted for inappropriate use. Interventions which healthcare providers can implement to limit the supply of prescription opioids in circulation include:

	*Decrease supply by changing prescribing practices, reducing both dose and quantity.		*Decrease supply by changing prescribing practices, reducing both dose and quantity. (The focus of this article)
	*Provide non-opioid alternatives for effective chronic pain management, and work with payers to adequately reimburse for effective pain management modalities.		*Provide non-opioid alternatives for effective chronic pain management, and work with payers to adequately reimburse for effective pain management modalities. (See SAFE Solutions article titled "Improve Professional Training on Opioids and Alternative Pain Management Approaches." <ref>https://www.yoursafesolutions.us/wiki/Improve_Professional_Training_on_Opioids_and_Alternative_Pain_Management_Approaches</ref>
	*Be diligent in follow-up on diversion/prevention opportunities.		*Be diligent in follow-up on diversion/prevention opportunities. (See article titled, "Reduce Criminal Diversion of Prescription Drugs." <ref>https://www.yoursafesolutions.us/wiki/Reduce_Criminal_Diversion_of_Prescription_Drugs</ref>
	*Partner with pharmacists and check their state's Prescription Drug Monitoring Program before prescribing opioids.		*Partner with pharmacists and check their state's Prescription Drug Monitoring Program before prescribing opioids. (See "Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)." <ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Prescription_Drug_Monitoring_Programs_(PDMPs)</ref>

	=Key Information=		=Key Information=

BasilSavitsky: /* Key Information */

2024-11-24T18:42:16Z

Key Information

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	The rate of pain reported by Americans has not changed much over time, and yet the number of painkiller prescriptions has increased 300 percent since 1999. <ref>https://web.archive.org/web/20150905120932/www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse</ref> At the same time, the number of deaths due to prescription opioid overdoses has quadrupled. <ref>http://www.nytimes.com/2007/05/10/business/11drug-web.html</ref> The rise in availability of prescription opioids began with the prescription of OxyContin. OxyContin (oxycodone) was released by Purdue Pharmaceuticals in 1996 and marketed as having a lower abuse potential than other narcotics. This enticed physicians to prescribe the oxycodone-based narcotic for common conditions, such as back aches and knee pain, in addition to the original intended recipients, cancer patients and the terminally ill. By 2010, 1 in every 5 pain-related doctor's visits in the United States resulted in a narcotic prescription. It was soon discovered that snorting or injecting the powder from crushed OxyContin tablets produces a high similar to heroin and "by 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug." <ref>http://www.planagainstpain.com/resources/usnd/</ref> Purdue Pharmaceuticals knew the drug had a high potential for abuse, but continued to market it as a time-released drug with low risk of abuse. In 2007, Purdue Pharma pleaded guilty in federal court to criminal charges for misleading doctors and patients and paid out over $600 million in fines. According to Dr. Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, "For years the sole focus was on reducing non-medical use, reducing abuse....They were trying to stop kids from getting into grandma's medicine cabinet. Nobody was asking why does every grandma now have opioids in her medicine cabinet." <ref>Searching for Relief: the Opioid Epidemic in the United States. http://www.planagainstpain.com/resources/usnd/</ref>		The rate of pain reported by Americans has not changed much over time, and yet the number of painkiller prescriptions has increased 300 percent since 1999. <ref>https://web.archive.org/web/20150905120932/www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse</ref> At the same time, the number of deaths due to prescription opioid overdoses has quadrupled. <ref>http://www.nytimes.com/2007/05/10/business/11drug-web.html</ref> The rise in availability of prescription opioids began with the prescription of OxyContin. OxyContin (oxycodone) was released by Purdue Pharmaceuticals in 1996 and marketed as having a lower abuse potential than other narcotics. This enticed physicians to prescribe the oxycodone-based narcotic for common conditions, such as back aches and knee pain, in addition to the original intended recipients, cancer patients and the terminally ill. By 2010, 1 in every 5 pain-related doctor's visits in the United States resulted in a narcotic prescription. It was soon discovered that snorting or injecting the powder from crushed OxyContin tablets produces a high similar to heroin and "by 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug." <ref>http://www.planagainstpain.com/resources/usnd/</ref> Purdue Pharmaceuticals knew the drug had a high potential for abuse, but continued to market it as a time-released drug with low risk of abuse. In 2007, Purdue Pharma pleaded guilty in federal court to criminal charges for misleading doctors and patients and paid out over $600 million in fines. According to Dr. Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, "For years the sole focus was on reducing non-medical use, reducing abuse....They were trying to stop kids from getting into grandma's medicine cabinet. Nobody was asking why does every grandma now have opioids in her medicine cabinet." <ref>Searching for Relief: the Opioid Epidemic in the United States. http://www.planagainstpain.com/resources/usnd/</ref>

			Physicians, dentists, and other healthcare professionals have a key role to play in preventing patients from developing an addiction to pain medication. Studies have shown that it is possible for people to become addicted to such medications in a matter of days. Reducing over-prescribing is a powerful tool needed to prevent dependence. Prescribing practices could be improved to reduce the prescription of opioids by:
			* providing better education in US medical schools about pain management, opioid abuse, and addiction
			* modifying regulations on direct advertisements by pharmaceutical companies
			* limiting the ways companies influence doctors, such as restricting gifts, vacations, and other forms of compensation.

	'''Insurance Company Practices Contribute to Over-Prescription of Opioids'''		'''Insurance Company Practices Contribute to Over-Prescription of Opioids'''

BasilSavitsky: /* Key Information */

2024-11-24T18:38:30Z

Key Information

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	The rate of pain reported by Americans has not changed much over time, and yet the number of painkiller prescriptions has increased 300 percent since 1999. <ref>https://web.archive.org/web/20150905120932/www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse</ref> At the same time, the number of deaths due to prescription opioid overdoses has quadrupled. <ref>http://www.nytimes.com/2007/05/10/business/11drug-web.html</ref> The rise in availability of prescription opioids began with the prescription of OxyContin. OxyContin (oxycodone) was released by Purdue Pharmaceuticals in 1996 and marketed as having a lower abuse potential than other narcotics. This enticed physicians to prescribe the oxycodone-based narcotic for common conditions, such as back aches and knee pain, in addition to the original intended recipients, cancer patients and the terminally ill. By 2010, 1 in every 5 pain-related doctor's visits in the United States resulted in a narcotic prescription. It was soon discovered that snorting or injecting the powder from crushed OxyContin tablets produces a high similar to heroin and "by 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug." <ref>http://www.planagainstpain.com/resources/usnd/</ref> Purdue Pharmaceuticals knew the drug had a high potential for abuse, but continued to market it as a time-released drug with low risk of abuse. In 2007, Purdue Pharma pleaded guilty in federal court to criminal charges for misleading doctors and patients and paid out over $600 million in fines. "For years the sole focus was on reducing non-medical use, reducing abuse~~," Dr~~. ~~Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing~~. "They were trying to stop kids from getting into grandma's medicine cabinet. Nobody was asking why does every grandma now have opioids in her medicine cabinet." - Searching for Relief: the Opioid Epidemic in the United States. ~~<ref>~~http://www.planagainstpain.com/resources/usnd/</ref>		The rate of pain reported by Americans has not changed much over time, and yet the number of painkiller prescriptions has increased 300 percent since 1999. <ref>https://web.archive.org/web/20150905120932/www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse</ref> At the same time, the number of deaths due to prescription opioid overdoses has quadrupled. <ref>http://www.nytimes.com/2007/05/10/business/11drug-web.html</ref> The rise in availability of prescription opioids began with the prescription of OxyContin. OxyContin (oxycodone) was released by Purdue Pharmaceuticals in 1996 and marketed as having a lower abuse potential than other narcotics. This enticed physicians to prescribe the oxycodone-based narcotic for common conditions, such as back aches and knee pain, in addition to the original intended recipients, cancer patients and the terminally ill. By 2010, 1 in every 5 pain-related doctor's visits in the United States resulted in a narcotic prescription. It was soon discovered that snorting or injecting the powder from crushed OxyContin tablets produces a high similar to heroin and "by 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug." <ref>http://www.planagainstpain.com/resources/usnd/</ref> Purdue Pharmaceuticals knew the drug had a high potential for abuse, but continued to market it as a time-released drug with low risk of abuse. In 2007, Purdue Pharma pleaded guilty in federal court to criminal charges for misleading doctors and patients and paid out over $600 million in fines. According to Dr. Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, "For years the sole focus was on reducing non-medical use, reducing abuse....They were trying to stop kids from getting into grandma's medicine cabinet. Nobody was asking why does every grandma now have opioids in her medicine cabinet." <ref>Searching for Relief: the Opioid Epidemic in the United States. http://www.planagainstpain.com/resources/usnd/</ref>

			'''Insurance Company Practices Contribute to Over-Prescription of Opioids'''

			The over-prescription of opioids is largely a result of the US health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. According to Judith Feinberg of the West Virginia University School of Medicine: “Most insurance, especially for poor people (Medicaid), won't pay for anything but a pill. Say you have a patient that's 45 years old. They have lower back pain, you examine them, they have a muscle spasm. Really the best thing is physical therapy, but no one will pay for that. So, doctors get very ready to pull out the prescription pad. Even if the insurance covers physical therapy, you probably need prior authorization which is a lot of time and paperwork.” <ref> Amanda Erickson (n.d.). Analysis \| Opioid abuse in the U.S. is so bad it’s lowering life expectancy. Why hasn’t the epidemic hit other countries? Retrieved November 24, 2019, from Washington Post website: https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/</ref>

			The US health-care system is different from other countries in other ways, too. There is pressure to address pain, and a pervasive attitude that everything is fixable. As a result, doctors in the United States are much more likely to provide painkillers than doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time. <ref>Amanda Erickson (n.d.). Analysis \| Opioid abuse in the U.S. is so bad it’s lowering life expectancy. Why hasn’t the epidemic hit other countries? Retrieved November 24, 2019, from Washington Post website: https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/</ref>

	'''Useful Statistics'''		'''Useful Statistics'''

BasilSavitsky: /* Available Tools & Resources */

2024-11-24T18:25:36Z

Available Tools & Resources

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	'''SAFE Project:'''		'''SAFE Project.''' See the wiki titled "Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)" for more detailed information on improving PDMPs which are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Prescription_Drug_Monitoring_Programs_(PDMPs)</ref>
	*See the wiki titled "Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)" for more detailed information on improving ~~Prescription Drug Monitoring Programs (~~PDMPs) which are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Prescription_Drug_Monitoring_Programs_(PDMPs)</ref>

	'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>		'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>

BasilSavitsky: /* Promising Practices */

2024-11-24T18:14:58Z

Promising Practices

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	*Kentucky prescription data is configured to count the number of prescriptions and dosage units dispensed for the previous 90 days. Data categories on the report card include (a) the average for all Kentucky prescribers, (b) the average for prescribers within the selected specialty, and (c) the number for the requesting prescriber. Under consideration for enhancements to the report are the inclusion of the number of dosage units per prescription, morphine milligram equivalent (MME) calculations for a patient, and comparisons by a specific medication.		*Kentucky prescription data is configured to count the number of prescriptions and dosage units dispensed for the previous 90 days. Data categories on the report card include (a) the average for all Kentucky prescribers, (b) the average for prescribers within the selected specialty, and (c) the number for the requesting prescriber. Under consideration for enhancements to the report are the inclusion of the number of dosage units per prescription, morphine milligram equivalent (MME) calculations for a patient, and comparisons by a specific medication.

	*Ohio's PDMP created a "Practice Insight Report" providing a brief summary to each provider of their prescribing patterns. This report card included 4 different sections: (a) top 25 patients by number of other prescribers visited in past 12 months, (b) top 25 patients by MME, (c) top 10 medications prescribed in the previous 12 months for the prescriber’s entire practice, and (d) a listing of the prescriber’s patients issued a controlled substances prescription in the previous 12 months.		*Ohio's PDMP created a "Practice Insight Report" providing a brief summary to each provider of their prescribing patterns. This report card included 4 different sections: (a) top 25 patients by number of other prescribers visited in past 12 months, (b) top 25 patients by MME, (c) top 10 medications prescribed in the previous 12 months for the prescriber’s entire practice, and (d) a listing of the prescriber’s patients issued a controlled substances prescription in the previous 12 months. Ohio also developed the "safety checkpoints" approach to minimize inappropriate prescriptions but still allow people who need them to be able to get them--with some added precautions. <ref>https://www.pharmacy.ohio.gov/Documents/Pubs/Newsletter/2019/State%20Board%20Newsletter%20(February%202019).pdf</ref>

	*West Virginia doctors are ranked based on how much they prescribe.		*West Virginia doctors are ranked based on how much they prescribe.

	==Sources==		==Sources==

Charliekapinos: /* Available Tools & Resources */

2024-09-23T17:43:47Z

Available Tools & Resources

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	'''SAFE Project:'''		'''SAFE Project:'''
	*See the wiki titled "~~Improve Prescribing Practices~~" for more detailed information on ~~how healthcare professionals can can help prevent dependence on pain medications by~~ improving ~~education~~, ~~regulating pharmaceutical advertising~~, and ~~limiting industry influence on prescribing practices~~.<ref>https://www.yoursafesolutions.us/wiki/~~Improve_Prescribing_Practices~~</ref>		*See the wiki titled "Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)" for more detailed information on improving Prescription Drug Monitoring Programs (PDMPs) which are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>https://www.yoursafesolutions.us/wiki/Expand_and_Enhance_Prescription_Drug_Monitoring_Programs_(PDMPs)</ref>

	'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>		'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>

Charliekapinos: /* Available Tools & Resources */

2024-09-23T17:43:05Z

Available Tools & Resources

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	=Available Tools & Resources=		=Available Tools & Resources=

			'''SAFE Project:'''
			*See the wiki titled "Improve Prescribing Practices" for more detailed information on how healthcare professionals can can help prevent dependence on pain medications by improving education, regulating pharmaceutical advertising, and limiting industry influence on prescribing practices.<ref>https://www.yoursafesolutions.us/wiki/Improve_Prescribing_Practices</ref>

	'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>		'''The US Department of Health & Human Services''' provides a series of articles within its website for "Help & Resources for the National Opioid Crisis." <ref>https://www.hhs.gov/opioids/index.html</ref>