Sonoma County has seen a 23 percent reduction in the prescribing of opioid-based pain medications for patients on Medi-Cal, thanks to a new initiative by Partnership HealthPlan of California, the nonprofit managed care giant that administers the county’s Medi-Cal program.
The health plan’s Managing Pain Safety Initiative is focused on curbing the overuse of opioid pain medications such as OxyContin and Vicodin and ensuring that they are used only when medically necessary.
“We’ve noticed there was a trend in long- and short-acting opioid abuse,” said Robb Layne, a spokesman for Partnership HealthPlan.
Between the fourth quarter of 2013 and the fourth quarter of 2014, the health plan saw a 23 percent decline in the share of its members who are prescribed opioids. Overall, the health plan, which serves 14 Northern California counties, has seen a 40 percent drop in the use of long-acting opioid pain medication among its members.
The program provides doctors treating Medi-Cal patients with the guidelines that set “industry accepted levels of appropriate prescribing,” said Layne, adding that medical research shows that prescribing opioid medications beyond a certain point will not improve people’s ability to manage pain and could cause problems.
“After a certain point, there’s a diminishing return on pain reduction and it starts to harm the body,” he said.
According to the plan’s policy procedure for the initiative, dose escalation beyond the 120 milligrams of morphine equivalent per day for chronic noncancer pain should be avoided. The policy states that doses beyond that do not provide more effective long-term relief.
The health plan said deaths due to opioid overdose have quadrupled in the United States in the past 10 years, and are now more numerous than deaths caused by automobile accidents.
For every overdose, there are about 130 people who have become dependent on opioid use and another 825 people who use opioids for non-medical reasons, the plan said.
During the past year, the health plan has held a number of educational events for physicians and worked with several countywide coalitions to standardize prescription practices. Physician guidelines have been disseminated to the 14 Northern California counties served by the health plan.
Doctors at Annadel Medical Group have been responsive to the health plan’s initiative. Partnership patients account for nearly 16 percent of all patients seen by Annadel physicians.
Partnership’s initiative is similar to efforts by other local health care providers.
For the past five years, Kaiser Permanente has also been focusing on the issue of opioid reduction.
“We review the reasons patients need to take opioids, and their risk for drug addiction,” Dr. David Pating, chief of chemical dependency recovery program at Kaiser Permanente San Francisco, said in an email.
Pating said that in 2014, Kaiser had a 40 percent reduction in the use of oxycontin, the most dangerous opioid. He said the provider’s chronic opioid therapy program in Northern California trains primary care and specialty physicians to reduce “over-prescribing, overuse and abuse, and to reduce the volume of dangerous drugs being diverted into communities.”
Pating called opioid overuse and abuse a public health epidemic. Cutting doses must be coupled with programs that give patients relief from pain without putting them at risk of overdose or addiction, he said.