This article first appeared on KevinMD.com. You can read it here.

After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.

While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get to the root of this national public health emergency, providers must focus on diminishing the risk of addiction before patients take their first dose.

How can providers best help patients reduce the probability of addiction when prescribing opioids? There are five key strategies providers should consider as a first line of protection against dependence and addiction.

Pair patients with chronic pain management coaches. Ideally, this step should be considered before an opioid is prescribed. Pain management coaches use digital therapy and motivational interviewing to help patients manage their pain without turning to opioids. When patients are prescribed a short-term dose of opioids, pain management coaches can be used to help transition patients off opioids by teaching techniques to manage pain without turning to opioids.

Partner with behavioral health experts who can identify patients who are most at risk of addiction. To avoid an opioid addiction before it starts, providers must understand the factors that increase patients’ risk of becoming addicted. These include behavioral health conditions such as depression and post-traumatic stress disorder—conditions that contribute to the experience of pain. Look for tools that can help identify patients’ behavioral health risk factors at the point of care, and establish partnerships with behavioral health professionals that help ensure patients also have access to pyschosocial treatment as needed. Some behavioral health solutions enable patients to participate in their treatment virtually, providing access to care for rural patients for whose availability to local behavioral health resources presents greater challenges.

Follow best practices on dosing limits. Ensure the morphine milligram equivalent dose and duration of treatment prescribed follow CDC and Centers for Medicare & Medicaid Services (CMS) best practices. Consider non-opiate alternatives before prescribing opioids, and carefully evaluate whether long- or short-acting opioids should be used based on CDC and evidence-based guidance.

It’s also important to collaborate with payers and pharmacists to gain visibility into patients’ past history of opioid use and evidence of previous substance abuse prior to writing a prescription. Patients who are at high risk of becoming addicted to opioids include those who have faced challenges with addiction in the past and who frequently visit the emergency department for pain relief. This information could help determine whether opioids are prescribed and, if so, the specific dose and duration of treatment.

Proactively engage patients in their treatment. Educate patients on the use of non-opioid medications that are just as effective as opioids.  When opioids are necessary, talk to patients who have been prescribed opioids for the first time on how they work, the risks of opioid use, and how to use opioids appropriately to reduce the risk of addiction. Consider this being much like informed consent before any medical procedure. Look for ways to engage patients not only in managing their use of opioids, but also in managing their physical and behavioral health, before, during and after using opioids.

Offer 24/7 access to healthcare professionals for patients who have been prescribed opioids. Doing so will provide a critical resource for patients who need help understanding their opioid prescription or feel as if they have a problem managing their response to their medication. Know your state’s Good Samaritan laws to ensure users of opioids that it is safe for them to seek care. Consider a hotline for opioid-using patients, staffed by nurses or an outside service to give patients and providers instant access to expert guidance.

Best practices for a complex challenge

As the opioid crisis continues to evolve, understanding the factors that place patients at highest risk of addiction before opioids are prescribed is key. Taking proactive measures to evaluate whether opioids are truly needed and how to best manage patients’ use of and response to these highly addictive drugs is critical to helping patients avoid serious health complications and live healthy, vibrant lives.

Today, much of the conversation around opioid use focuses on ways to more tightly control access, including limits on usage and the mandatory use of databases that can alert physicians to patients’ opioid histories. But for those suffering from Opioid Use Disorder (OUD), combatting addiction is a difficult feat, particularly due to treatment barriers, lack of qualified providers, and waitlists for evidence-based treatments.

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I have had the privilege of wearing many hats in a variety of industries throughout my career, including as an entrepreneur, executive, board member, educator, inventor and investor in technology, healthcare, biotechnology and life sciences.

I have seen the development of ideas and innovations that never had the opportunity to come to fruition. There are a number of contributing factors that impact these advancements. However, one of the most frequent causes is that inventors and researchers do not have the proper experiences, training and education to advance their ideas and work from the research setting to the patient or consumer.

In addition to my role as chief innovation officer and chief medical officer of medical and digital innovation at Magellan Healthcare, I also serve as a faculty member at the Yale School of Medicine. It is through my role at Yale that I have the opportunity to lead a unique training program for substance abuse researches from across the country in entrepreneurship starting next spring. The work of these scientists focuses on the prevention and treatment of substance abuse disorders leading to innovative options for improved care. Unfortunately, many of these innovations never reach the market because today’s scientists do not have the training in how to commercialize their ideas.

The training program, called Innovation to Impact: Translation Support and Education, is made possible through the funding of a $1.25 million grant by the NIH National Institute on Drug Abuse (NIDA). Students will participate in a free five-day boot camp on entrepreneurship and product development and will also have access to an extensive network of new venture mentors, seed funding for new ventures and training in how to promote a culture of entrepreneurship locally.  This will also help start what we hope will be an active community hosted virtually as well.

In addition to my work in developing apps and software programs designed to combat substance use disorders, I have also been teaching entrepreneurship for many years. This program is a logical next step to not only advance these innovations, but significantly help people with substance abuse disorders.

Open to researchers across the country who are focused on basic science, epidemiology, prevention, treatment and policy, the program will help advance innovations that impact the substance use field. This work is of the upmost importance as we face a national crisis on substance abuse. I also believe the future innovations of these researchers will soon impact our work at Magellan and the customers and members we serve.

Magellan makes it a priority to advance innovation, as evidenced by its support of my participation in this initiative with the NIH as well as dedicated resources through various innovation initiatives to help develop and commercialize new product ideas or services. It is rare that you find a private sector company like ours that is committed to allowing its executives to undertake educational activities when they fit within our massive transformative purpose of “leading humanity to healthy, vibrant lives.” I’m excited to continue to focus on collective entrepreneurial spirit with an amazing team at Yale to share our lessons with others and bring new ideas to light.

Every day in the news we hear about the devastating impact of the opioid crisis across the country. While we need to confront this complicated crisis, we also need to examine the larger issue of substance use disorders (SUD) that impact millions of Americans.

This past September, I had the honor to represent Magellan Health at the first meeting of the Substance Use Disorder Treatment Task Force, founded by Shatterproof. The mission of the task force is, “To fundamentally improve substance use disorder treatment in the United States, in terms of both quality and patient outcomes.” It also addresses the underlying cause of our country’s current substance use crisis, and lack of access to quality and evidence-based treatment. The task force has been created to expand access to quality treatment for the estimated 21 million Americans with SUD.

This task force is unique in that it convenes public and private healthcare companies, advocates and former government officials to take the lead in developing a tactical plan with measurable goals for payers to follow and implement. I am proud to be joined by so many colleagues and experts across the industry.

Our first focus is to implement the recommendations outlined in the November 2016 Surgeon General’s Report on Alcohol, Drugs, and Health. Secondly, we will utilize methods outlined in a 2006 report from the Institute of Medicine which recommends the need for a group of government regulators, accrediting organizations, consumer representatives, providers and purchasers to come together to develop a common, continually improving set of quality measures, specifically for mental health and substance use disorders.

The work of this task force aligns nicely with our efforts at Magellan, helping lead individuals to healthy, vibrant lives. Working with individuals with SUD, from both the behavioral health and the pharmacy benefits management perspective, we are in a unique position to help address these issues. I believe we can make significant contributions on this task force and for the benefit of our customers, members and providers with whom we work.

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.