While they're not the typical sufferers one thinks of when one hears about the rampant abuse of opioids in the country today, Medicare beneficiaries should be included in the picture — and they could be getting the short end of the stick when it comes to help.
Kaiser Health News reported that a research letter published by JAMA Psychiatry said that the beneficiaries of Medicare have the highest, and the fastest-growing, rate of "opioid use disorder." One out of every thousand patients covered by commercial insurance plans is a sufferer, but among Medicare patients, that number swells to 6 out of every 1,000.
The letter said that Medicare beneficiaries could be falling through the cracks when it comes to treatment, too. While 2013 saw a high level of opioid prescription painkillers for Medicare patients, doctors were far less often prescribing buprenorphine-naloxone, which is the only effective drug therapy for opioid use disorder covered by Medicare Part D.
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Researchers looked at Medicare Part D claims for 2013, counting the numbers of prescriptions issued for Schedule II opioids and for buprenorphine-naloxone. Doctors prescribing the latter amounted to less than 2 percent of prescribers — 381,575 of them — who were responsible for 56,516,854 Schedule II opioid claims. And for every 40 family physicians prescribing pain killers, researchers found that just one family physician prescribed buprenorphine-naloxone.
The letter also said that northeastern states, including Maine, Massachusetts and Vermont, had the highest ratio of claims for buprenorphine-naloxone in the nation. That ratio was more than 300 times the national average.
Although more than 300,000 Medicare patients struggle with opioids, the study said, they also face an uphill battle in receiving treatment. Buprenorphine-naloxone, as the only drug approved for Medicare's prescription drug program, shuts out other effective treatments, such as methodone. That cuts access for patients who need it — and Medicare patients need it. Hospitalizations thanks to opioid use or abuse among beneficiaries has risen 10 percent annually from 1993 to 2012.
And it's harder for doctors to prescribe it; the hoops they must jump through to do so include an eight-hour class, a waiver and an additional special Drug Enforcement Administration number in addition to the regular DEA registration number they must have. In addition, prior authorization must be granted before a patient can get the treatment. It's easier for doctors to prescribe the opioids that cause the problem than to offer patients help once the problem has occurred.
A different study from The Journal of the American Medical Association reported that, in 2014, just 2 percent of doctors had even gone through all the requirements to be able to prescribe the drug. More than half the counties in the country did not have a health provider who was able to prescribe buprenorphine-naloxone.
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