Battling the opioid epidemic

As part of Blue Cross Blue Shield of Michigan’s efforts to tackle the opioid epidemic, we’ve ramped up our efforts to communicate about the topic in our various health care provider-focused communications. Check out the column by Dr. Duane J. DiFranco in Hospital and Physician Update, and the following items below:

What clinical practices can do to minimize drug diversion

Making sure that opioids don’t end up in the wrong hands plays a key role in fighting opioid misuse and abuse. And physicians have a unique opportunity to prevent and report drug diversion.

The Centers for Medicare & Medicaid Services is offering assistance with a booklet that can help doctors prevent and report the diversion of prescription drugs.

The booklet, A Prescriber’s Role in Preventing the Diversion of Prescription Drugs, offers the following advice:

• Exercise caution with patients who use or request combination or “layered” drugs for enhanced effects (for example: antipsychotics with opioids or benzodiazepines).
• Document thoroughly when prescribing narcotics or choosing not to prescribe.
• Protect access to prescription pads.
• Keep a Drug Enforcement Administration or license number confidential unless disclosure is required by state law.
• Write prescriptions clearly to minimize the potential for forgery.
• Move to electronic prescribing so that paper prescriptions aren’t required.
• Adhere to strict refill policies and educate the office staff about them.
• Ask patients to bring in any unused portion of narcotics if they’re not using them.
• Use state prescription drug monitoring programs, where available, to monitor patient prescribing before refilling or adding new medications.
• Refer patients with extensive pain management or prescription controlled medication needs to specialized practices.
• Communicate with pharmacists or other health care providers, as well as pharmacy benefit managers, and collaborate with them when you observe suspicious behaviors.
• Collaborate with pharmacy benefit managers and managed care plans to determine the medical necessity of prescriptions for controlled substances.

Prescribing opioids for chronic pain

The Centers for Disease Control and Prevention has published several resources that can provide guidance to doctors when prescribing opioids. These include:

• Guideline for Prescribing Opioids for Chronic Pain — A guideline designed to help improve communication between providers and patients about the risks and benefits of opioid therapy, and to reduce opioid abuse and misuse.
• Applying CDC’s Guideline for Prescribing Opioids — A training video about the guideline.
• Tapering Opioids for Chronic Pain — A pocket guide to help doctors determine whether a patient’s prescription for opioids should be reduced to a lower dosage or discontinued.

Reminder: Include key information in opioid requests

When it’s necessary to prescribe opioids, it’s important to submit all opioid requests with the following information:

• Recent chart notes
• Diagnosis
• Documentation of trial and failure of alternatives
• Treatment plan

This will help prevent delays in processing these claims. For more information, see the article in the September Record.