Cigna Creates Online Initiative To Drive Patient-Provider Conversations Regarding Pain and Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna

Dr. Lustig

Dr. Stuart Lustig, M.D., M.P.H
National Medical Executive for Behavioral Health
Cigna

Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic.

MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study?

Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention.

The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.

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Opioids Are Primary Driver of Deaths for Young Non-Hispanic White Males

MedicalResearch.com Interview with:

Christopher J. Ruhm, PhD Frank Batten School of Leadership and Public Policy University of Virginia Charlottesville, VA

Dr. Ruhm

Christopher J. Ruhm, PhD
Frank Batten School of Leadership and Public Policy
University of Virginia
Charlottesville, VA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I have been interested for some time in understanding the extent to which the rise in drug fatalities can explaining the rising mortality rates of midlife whites that have been experienced since the turn of the century. The primary findings are as follows:

  1. The rise in drug mortality is sufficiently large to explain the entire growth in mortality rates and years of potential life lost experienced by 22-56 year old non-Hispanic whites (NHW) from 1999-2015. This does not imply that there are not other sources of concern related to this decline in life expectancy but indicate a key role of drug deaths.
  2. The growth in drug deaths is particularly pronounced for males in their 20s and 30s, in contrast to some earlier research focusing on NHW in their 40s and 50s.
  3. Deaths involving illicit opioids are the primary driver for young NHW males, with more equal contributions of illicit and prescription opioids for some what older NHWs. These results also indicate that prior studies focusing on persons in their 40s and 50s may provide a misleading picture of the pattern of deaths for the group experiencing the greatest increases.

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Reducing Opioids Near End of Hospital Stay May Limit Outpatient Use

MedicalResearch.com Interview with:

Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh

Jason Kennedy

Jason Kennedy, MS
Research project manager
Department of Critical Care Medicine
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Most previous studies of opioid use in health care have focused on the outpatient setting. But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital.

We analyzed the medical records of 357,413 non-obstetrical adults hospitalized between 2010 and 2014 at 12 University of Pittsburgh Medical Center (UPMC) hospitals in southwestern Pennsylvania. The region is one of the areas of the country where opioid addiction is a major public health problem. We focused on the 192,240 patients who had not received an opioid in the year prior to their hospitalization – otherwise known as “opioid naïve” patients.

Nearly half (48 percent) of these patients received an opioid while hospitalized.  After discharge, those patients receiving hospital opioids were more than twice as likely to report outpatient opioid use within 90-days (8.4 percent vs. 4.1 percent). Patients who receive an opioid for most of their hospital stay and patients who are still taking an opioid within 12 hours of being discharged from the hospital appear more likely to fill a prescription for opioids within 90 days of leaving the hospital.  Continue reading

More Opioids Prescribed By Doctors Who Received Free Pharmaceutical Lunches

MedicalResearch.com Interview with:
“Big Lunch Extras Reading” by Big Lunch Extras is licensed under CC BY 2.0Scott E. Hadland, MD, MPH, MS
Assistant Professor of Pediatrics | Boston University School of Medicine
Boston Medical Center
Director of Urban Health & Advocacy Track | Boston Combined Residency Program
Boston, MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Numerous pharmaceutical companies have received media attention for their role in promoting opioid prescribing through speaker programs and other marketing plans in which large-value payments are given to a small number of doctors to promote opioids.

In our study, we sought to tell the other side of the story. We wanted to identify whether low-value marketing, including industry-sponsored meals, which are commonplace in the US, were associated with increased opioid prescribing.

We found that 1 in 14 doctors received opioid marketing from pharmaceutical companies in 2014, and those that received marketing prescribed 9% more opioids the following year. With each additional meal a doctor received, he or she prescribed more and more opioids the following year. Our sample included 43% of the active physician workforce in the US, suggesting how widespread and far-reaching this effect might be.

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Do Blacks Still Get More Opioid Prescriptions?

MedicalResearch.com Interview with:

Matthew A. Davis, MPH, PhD Assistant Professor Department of Systems, Populations and Leadership University of Michigan

Dr. Davis

Matthew A. Davis, MPH, PhD
Assistant Professor
Department of Systems, Populations and Leadership
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The premise for the study was based on prior work that demonstrated that the likelihood of being prescribed an opioid differs according to a patient’s race and ethnicity.  Collectively this work has shown that Non-Hispanic Whites are more likely to receive opioids than other groups for pain.

We decided to look at trends in the prescribing of different pain medications over the last 16 years to see if we could detect any differences in prescribing patterns among racial and ethnic groups.  To do so we used national health data for a large sample of Americans who live with significant pain.

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Can Opioid Users Be Transitioned To Extended-Release Naltrexone?

MedicalResearch.com Interview with:

Dr. Maria Sullivan MD PhD Senior Medical Director of Clinical Research and Development Alkermes

Dr. Sullivan

Maria Sullivan, M.D., Ph.D
Senior Medical Director of Clinical Research and Development
Alkermes

MedicalResearch.com: What is the background for this study?

Response: Extended release injectable naltrexone is approved for the prevention of relapse to opioid dependence after detoxification and when used with counseling. It is recommended that patients abstain from opioids for a minimum of seven to 10 days prior to induction onto XR-naltrexone to avoid precipitating opioid withdrawal. This requirement of detoxification represents a substantial clinical challenge, particularly in the outpatient setting.

There is currently no single recognized best method for opioid detoxification prior to first dose of extended-release naltrexone (XR-naltrexone). A number of induction regimens have been explored, including the use of low doses of oral naltrexone to shorten the transition period from dependence on opioids to XR-naltrexone treatment. The goal of the study was to help establish an outpatient regimen to transition subjects from physiological opioid dependence to XR-naltrexone treatment and mitigate the severity of opioid withdrawal symptoms.

We hypothesized that low-dose oral naltrexone, combined with buprenorphine and psychoeducational counseling, would assist with the transition of patients with opioid use disorder onto XR-naltrexone. In this 3-arm trial, we examined the utility of oral naltrexone, buprenorphine, and a fixed regimen of ancillary medications (oral naltrexone + buprenorphine vs. oral naltrexone + placebo buprenorphine vs. placebo +placebo), to determine whether any of these regimens was associated with higher rates of induction onto XR-naltrexone.

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When it comes to Opioids, More May Be Less

MedicalResearch.com Interview with:
Peter Grace PhD
Professor in the Department of Critical Care Research
University of Texas MD Anderson Cancer Center.
He was a NHMRC Postdoctoral Fellow
University of Colorado Boulder in the lab of Prof Linda Watkins

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Opioids are effective for managing pain after surgery. However, we previously showed that opioids like morphine can have unexpected long-term effect when used to treat nerve pain in rats: just 5 days of morphine treatment shortly after nerve injury doubled the duration of pain (Grace et al., 2016; PNAS). Our current study shows that something similar happens in post-operative pain. When we gave daily morphine for a week after exploratory abdominal surgery (laparotomy), the postoperative pain lasted more than twice as long compared to rats that didn’t receive morphine at all.

We also showed that the prolonged pain was correlated with immune signaling in the spinal cord, similar to what we showed in our previous study (Grace et al., 2016; PNAS). Importantly, this suggests that the long-term pain caused by morphine could be blocked while retaining short-term analgesia by inhibiting immune activation.  Continue reading

Double-Edge Sword of Drug Epidemic

MedicalResearch.com Interview with:
Christine Marie Durand, M.D
.
Assistant Professor of Medicine
Johns Hopkins Medicine 

MedicalResearch.com: What is the background for this study

Response: Most Americans know that the United States faces an epidemic of deaths due to drug overdose.  And many are also aware that there is a critical shortage of organs available for transplant.  Perhaps less widely known is that today, more than 1 in every 8 deceased organ donors died from a drug overdose.  The objective of our study was to look at the outcomes of patients who received transplants with organs donated after an overdose.

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Most Opioid Overdose Patients Can Be Discharged After Brief ER Visit

MedicalResearch.com Interview with:

Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia

Dr. Scheuermeyer

Frank Scheuermeyer MD MHSc
Clinical Associate Professor
Department of Emergency Medicine
St Paul’s Hospital and the University of British Columbia 

MedicalResearch.com: What is the background for this study?

Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome.

Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose.

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LUCEMYRA, First Drug for Opioid Withdrawal Symptoms, Receives FDA Recommendation

MedicalResearch.com Interview with:
http://usworldmeds.com/
Mark Pirner, MD, PhD
Senior Medical Director
US WorldMeds  

MedicalResearch.com: What is the background for this study? Would you briefly explain how lofexidine works?

Response: LUCEMYRA (lofexidine) was studied in two phase 3 pivotal randomized, double-blind, placebo-controlled clinical studies, and a phase 3 open-label study. Clinical pharmacology studies included evaluation of drug-drug interaction studies that demonstrated lofexidine can be safely administered concomitantly with methadone, buprenorphine or naltrexone.

LUCEMYRA is an alpha 2 adrenergic receptor agonist that reduces the surge of norepinephrine signaling in the brain which results from abrupt opioid withdrawal, and thereby reduces the severity of opioid withdrawal symptoms.  Continue reading