The following is an excerpt from the 2018 Magellan Community Impact Report.

It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

No one is exempt from experiencing the effects of the opioid crisis. Magellan’s own Janet Edwards, RN, senior clinical director of Magellan’s Chronic Pain Management program, describes how close to home the opioid epidemic hit her:
It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

“My daughter, Nikki, was 26 when she  died of a Fentanyl overdose. As the mother of a six-year-old and a critical care nurse working in a respected healthcare organization, Nikki was the picture of success. But to handle the pressures of nursing school, a full-time job, and life as a single mother, Nikki sought prescriptions for Adderall and Xanax from multiple physicians. Over time, her addiction to these substances gave way to a new addiction: Fentanyl, which she began to confiscate from the critical care unit where she worked.
Like many others, Nikki didn’t show any signs of addiction. But five years after her son was born, Nikki sat at my kitchen table and admitted that she was addicted to heroin. She was afraid to get help, because she did not want to lose her job or the respect of her peers. She insisted she could recover on her own. Even though I, as a nurse, knew the odds were not good that Nikki could manage her recovery alone, I respected my daughter’s wishes. It’s a decision I will forever regret. Eleven months later, Nikki died of an accidental overdose in front of her son and a friend.”

Following the loss of her daughter, Janet has openly shared Nikki’s story, becoming an advocate for helping prevent opioid addiction. Further, Janet has taken on clinical leadership of Magellan’s Chronic Pain program, which offers alternatives to opioid use.

Meeting opioid users where they are

No matter where or how someone encounters opioids or where they may be in the cycle of use, dependence or addiction, Magellan offers many other ways to address the opioid problem. Our behavioral health products forged from decades of serving the public, our specialty healthcare solutions supported by clinical excellence, and our customized pharmacy programs are ready to answer the call as organizations and individuals look for answers.
Hosting a forum for sharing successes  and discussing solutions

In September 2018, Magellan brought together  national and local leaders in Pennsylvania to  exchange ideas, share successes and  discuss solutions to the opioid  epidemic in our communities.  The free, second-annual  conference featured  keynote addresses and  workshops and highlighted  the proactive efforts of local  organizations. Participants included  national and state officials, county human  services and drug and alcohol leaders, legislative  staff, providers and community stakeholders.

Not staying silent on the silent epidemic

Magellan is actively helping individuals and families on their path to recovery. Further, to educate the public, doctors and other healthcare providers, we offer resources on our Magellan Health OPIOID INSIGHTS microsite. The site includes links to blog posts, videos, resources and published articles.

Hosting a forum for sharing successes and discussing solutions

InSeptember2018, Magellan brought together national and local leaders in Pennsylvania to exchange ideas, share successes and discuss solutions around the challenge we face together in addressing the opioid epidemic in our communities. The second-annual conference featured keynote addresses and workshops and highlighted the proactive efforts of local organizations. Participants at the free one-and-a-half-day conference included national and state officials, county human services and drug and alcohol leaders, legislative staff, providers and community stakeholders.

With the number of opioid-related overdose deaths in the U.S. reaching a record high last year, it’s time for our nation to fully embrace evidence-based treatment options that best support our communities, loved ones, friends and families in their recovery efforts.

One growing approach—often considered as the gold standard of treatment—is medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a holistic, person-centered approach to the treatment of substance use disorders (SUDs). The use of this treatment approach has grown to nearly 40 percent in residential facilities and is increasingly leveraged by primary care providers nationwide—but more still must be done for widespread adoption.

The most pervasive stigma surrounding MAT is that it merely enables patients to replace one addiction with another. It’s a belief held not only by some groups of doctors and clinicians, but also family members and peer support groups—those whose support is critical to successful recovery. When a patient’s core support system of family members and peers doubts the legitimacy of an evidence-based form of treatment, the likelihood that the patient will follow through long-term is diminished.

Pair that with a lack of understanding and comfort from the medical community around how to administer MAT, limited numbers of physicians who are certified to prescribe this treatment that actually do prescribe the treatment, as well as the number of residential facilities that offer MAT, and we get low adoption rates as a result of these barriers.

There’s a better way to treat opioid use disorder

Although abstinence-based therapy works for a small percentage of those suffering from OUD, MAT offers a successful way for people to fight their addictions in an outpatient environment, in the community in which they live, and avoid hospitalization or institutionalization. It helps those struggling with OUD and other SUDs address underlying conditions that may have contributed to substance abuse—significantly improving the chances of recovery. In one study, more than half of patients utilizing MAT reported opioid abstinence 18 months after beginning treatment.

Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction. And even fewer actually prescribe buprenorphine to patients. MAT prescribing is not limited to psychiatrists. In fact, primary care providers provide more access to MAT than any other type of provider.

The impact of limited access to MAT on health outcomes cannot be overlooked. One analysis found only one-third of individuals who experienced a nonfatal opioid overdose received access to MAT. Those who received methadone were linked to a 59 percent decrease in mortality rates after one year, according to the analysis. Additionally, individuals who were treated with buprenorphine were associated with a 38 percent decrease in mortality after a year.

Increasing Access to MAT

The SUPPORT for Patients and Communities Act, signed in October 2018, expands the ability to prescribe MAT by increasing clinician eligibility for certification. This provision is a solid and necessary step toward broadening access to treatment; however to make a true impact on the opioid epidemic, we must break the stigma surrounding MAT.

When it comes to recovery, the potential for relapse is high, especially in the early stages when resolve is fragile. It is important to note that for individuals with co-occurring mental health conditions, chronic pain or other addictions, MAT should be supplemented by treatment for those conditions, such as cognitive behavioral therapy. Building in care management support to assist in navigating the treatment process may reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program. It also helps provide individuals with the tools needed to live addiction-free.

By taking the time to dispel the myths about non-traditional addiction treatment like MAT, we create an environment that more fully supports a return to complete health—physical, mental and emotional. Fighting the stigmas around MAT is an important step toward enabling those suffering from OUD to recover from their addiction and live healthy, vibrant lives.

The following is an excerpt from an article appearing in the American Journal of Managed Care (AJMC)

One out of four patients who receive long-term opioid therapy in primary care settings struggle with opioid use disorder (OUD), according to Centers for Disease Control and Prevention research. While conversations around opioid addiction are beginning to impact physician prescribing patterns, there is still much progress to be made around treatment and recovery solutions for those battling OUD.

One important option that requires greater attention: the need to leverage an integrated team approach in opioid treatment and recovery.

Recent research points to the value of a holistic approach to opioid recovery delivered in a community setting. Such an approach may include relapse prevention medications; group and individual counseling; physician visits for medication management; mental health therapy; and psychiatric treatment for cooccurring disorders. But there are barriers to accessing holistic opioid recovery treatment within the patient’s community. Such barriers can include lack of mental health resources, stigmas associated with certain treatment options, limited availability of specialized providers, difficulties navigating the complexities of substance abuse treatment, and insufficient capacity.

Overcoming the challenges to a holistic approach to opioid recovery is critical to engaging patients safely and comfortably and supporting sustained recovery. The following five elements contribute to a successful integrated approach.

You can read the rest of the article in the American Journal of Managed Care (AJMC).

The following is an excerpt from an article appearing in the American Journal of Managed Care (AJMC)

More than 46 Americans die from prescription opioid overdoses every day, while the number of deaths from prescription opioids has more than quadrupled since 1999. Lack of expertise on how to measure and treat pain is a large factor driving the crisis. In addition, challenges in identifying those who are at risk for opioid abuse or who are already dependent on opioids adds further complexity.

Americans consume 80% of opioid painkillers produced worldwide. Yet the amount of pain reported hasn’t changed since in the past 2 decades, according to the CDC. For physicians, this points to the need to reconsider when to prescribe an opioid—if at all. Providers face intense pressures to adequately treat pain and may not know the data that supports nonopioid therapies.

Breaking the cycle of prescription opioid abuse requires new thinking around pain management and alternative options for helping patients deal with chronic pain. The following are 6 things physicians should consider before prescribing an opioid.

You can read the rest of this article in the American Journal of Managed Care (AJMC)

Opioid addiction has grown over the past fifteen years from a personal issue to a national emergency. A new infographic from Magellan Healthcare reveals the devastation that this epidemic is causing.

• In 2014, there were 18,893 overdose deaths related to prescription pain relievers
• There was a 3,203% rise insurance claims for opioid dependence diagnosis from 2007-2014
• Prescription opioid abuse is costing employers $25,000,0000 a year

The opioid addiction crisis is causing such an unprecedented amount of harm precisely because it is such a complex, multi-faceted issue. Those looking for answers as to how such an epidemic could have happened, will need to examine a swath of individual problems, including:

• The enormous quantity of prescription opiates
• The limited patient knowledge of opiate risk
• That diversion of opiates to family and friends is so common that only 20% of those with opioid abuse problems are actually using opioids prescribed to them
• The struggle to adequately assess patient’s substance use history and risk of addiction when prescribing opiates
• The lack of clear guidance as to who should receive opiates and for how long
• The difficulty in maintaining patient adherence to withdrawal management treatment plans.

New solutions are needed to tackle each of these individual issues. At Magellan Health, we intend to do precisely that. The opioid addiction crisis has already taken a huge toll and it grows worse every day. It is manifesting itself in myriad ways among thousands of communities across the nation. At Magellan Health, we have an unyielding commitment to ending this epidemic.

Magellan Health marked October as Substance Abuse Prevention Month, with its chief medical officer, Dr. Karen Amstutz, releasing the following statement:

“Substance abuse does not discriminate. It pays no mind to gender, race, age or income level. According to the National Institute on Drug Abuse, the abuse of alcohol, tobacco and illicit drugs costs the United States more than $700 billion annually related to crime, lost work productivity and healthcare. Substance abuse, and in particular, our nation’s opioid epidemic, is gripping families and communities all across the country. Chances are, you know someone who is coping with substance abuse, though they might be doing so in silence.

“Magellan Health has worked in the field of behavioral health management for over 40 years, and we believe strongly that the treatment of substance abuse, including opioid misuse and addiction, is possible. Magellan Health advocates for medication assisted treatment (MAT), a well-researched and highly effective approach combining medication to treat the physical effects of opiate dependence, with counseling and recovery support services. Magellan Health is poised to support treatment professionals, legislators, third-party payers and patient advocates in the implementation of prevention efforts, best clinical practices, and elimination of potential barriers to treatment and recovery. Working together, it is important to shine a light on this dark epidemic and provide hope to people seeking to live a healthier, more vibrant life.

“If you or someone you know is dealing with substance, please call the Substance Abuse and Mental Health Services Administration’s Help Line at 1-800-662-HELP (4357). For Magellan’s resources related to substance abuse, please visit http://magellanhealthcare.com/opioids“

Painkillers, Heroin and Addiction: The Opiate Crisis Laid Bare

From East to West, North to South, the Opiate addiction continues, almost unchecked, to claim lives, destroy families and ruin communities.

Opiate Addiction: The Overdose Emergency

Fueled by both prescription painkillers and illegal substances, opiate addiction kills thousands every year. In 2014, for example:

• There were 18,893 overdose deaths related to prescription painkillers
• There were 10,574 overdose deaths related to heroin

Despite those shocking numbers, the problem continues to grow. (It quadrupled in the first decade of this century and continues to explode). In the past twelve months, the Drug Enforcement Agency (DEA) has been forced to issue warnings on new drugs such as Fentanyl, a potent opiate more than 100 times more powerful than morphine and 30-50 times stronger than heroin. While Fentanyl has killed thousands of people over the past few years, many only heard of it recently, when it was attributed to the death of the musician Prince.

Still, by far the most prevalent cause of overdose is prescription painkillers. This encompasses a much broader swath of the Opioid family (Opiates and their synthetic and semi-synthetic variants). The most common culprits are:

• Methadone
• Oxycodone (such as OxyContin®)
• Hydrocodone (such as Vicodin®)³

In 2014, the United States saw nearly 4.3 million people ages 12 or older using prescription painkillers non-medically. To put that into perspective, that is almost 2% of the entire population. According to the Centers for Disease Control, more than 1,000 people are treated in emergency departments for misusing prescription opioids every day. Finally, almost 2 million Americans either abused or were dependent on prescription opioids in 2014.

Painkillers, Addiction and the Economy: What the Opiate Crisis is Costing America

The opiate addiction crisis has an obvious and tragic human cost. Addiction to painkillers and illegal opiates cause death and healthcare emergencies every day. But they also have a profound economic cost that affects people, employers and governments all over the country.

One estimate, conducted in 2011, put the economic cost at $55.7 billion

• Workplace costs accounted for $25.6 billion (46%);
• Healthcare costs accounted for $25.0 billion (45%); and
• Criminal justice costs accounted for $5.1 billion (9%)

Of those figures, the study’s authors offered the following breakdown:

• Workplace costs were primarily driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
• Healthcare costs consisted primarily of excess medical and prescription costs ($23.7 billion).
• Criminal justice costs were largely comprised of correctional facility ($2.3 billion) and police costs ($1.5 billion).

To put that in perspective, the $55.7 billion that opiate addiction erases from the economy is roughly equivalent to the annual Gross Domestic Product of the entire state of Maine. It is greater than that of Alaska, North Dakota, Montana, South Dakota, Wyoming and Vermont.

Medication, Therapy and Shifting Thinking: Opiate Addiction Solutions

Opiate addiction is deadly, it’s costly, but it is anything but simple; especially when it comes to finding solutions or even identifying the root causes of this crisis. Some point to the high availability of opiates compared to the past — the number of prescriptions for opioids (like hydrocodone and oxycodone products) escalated from around 76 million in 1991 to nearly 207 million in 2013 — others point to socioeconomic factors or to the increased focus on pain management in recent decades.

The answer is, most likely, that all of these answers are correct, at least some of the time. Tackling opiate addiction and prescription painkiller abuse will take a multi-faceted approach which recognizes that while opiate addiction and overdoses are the hurdles, there are many different paths to overcoming them.

One such solution is increasing the availability of medication-based treatments for opiate addiction. Both Medication Assisted Treatment (MAT) and Office Based Opioid Treatment (OBOT) offer physician-supervised treatment options that use several medications to treat and even prevent addiction to opioid painkillers. These treatments combine medication with behavioral therapy to help ease a patient away from their opioid addiction over time and have been proven to be highly effective. However, both MAT and OBOT have obstacles to overcome before becoming more widely accepted for use.

There are challenges matching medication providers with supportive counselors as well as a lack of access to prescribing physicians. Furthermore, there is some opposition to MAT and OBOT from providers that support 12-step programs as well as among providers who view such methods as swapping one addiction for another. Both MAT and OBOT have been clinically proven to be an effective tool for overcoming addiction to both prescription painkillers and illegal analogs such as heroin as well as alcohol.

A second option for solving the opiate addiction crisis is to change techniques for pain management entirely. For example, back pain is one of the most common reasons Americans go to the doctor. From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements.

This reliance on surgery is controversial. Although many patients expressed satisfaction with the outcome of surgery, 51% of patients who were using opioids before the surgery still were using the drugs one year later, and among those who were not using the drugs before surgery, 18% were using them a year after their surgery.

An increasingly popular alternative is to channel more people, where appropriate, away from opioids and surgery and into more effective treatments such as physical-therapy. By reducing the number of people being introduced to opiate painkillers, the number of people who develop an addiction is reduced.

Thirdly, there is increased interest in deploying Cognitive Behavioral Therapy (CBT) to improve treatment response as a primary or conjunctive treatment option. CBT is a particularly appealing solution for some as it can be deployed in very innovative ways, both in-person and online and it remains just as effective. CBT can help people with an opiate addiction by teaching the patient to recognize and avoid negative and destructive thought patterns and behaviors.  This teaches the individual to recognize the triggers that cause a craving for drugs, then avoid or manage those triggers. CBT works well in conjunction with other treatments.

Other non-opiate based interventions for pain include mindfulness therapy, the use of non-addicting medications such as non-steroidal anti-inflammatory agents (NSAIDS) and anti-depressants to name a few.

A Pioneer in Substance Use Management

Magellan Health is a pioneer in offering integrated, comprehensive opioid risk and substance use management programs. We have an unyielding commitment to ending the current epidemic. And we are uniquely positioned to bring together behavioral, medical and pharmaceutical programs to positively impact overall population health and reduce cost.

We offer many substance use solutions, including medication assisted treatment (MAT), shown in the monograph as an invaluable tool in the fight against substance abuse. We continue to evolve our MAT program and other offerings to most effectively meet the needs of our customers and those they serve.