Estimates suggest that 2.9 million surgical patients become persistent opioid users each year.
The opioid crisis was of significant concern before COVID-19 and it's only been exacerbated by the pandemic. The resulting health and economic consequences of coronavirus have added another layer of stress, anxiety, fear and worry about job security to most people's lives. According to the Centers for Disease Control and Prevention, this environment is especially challenging for high-risk individuals including drug users and those undergoing treatment as well as those with depression, living alone or having personal/marital issues. The void of connection, isolation and limited access to drug treatment and recovery programs has resulted in a surge of substance abuse and opioid overdoses.
Although we are likely not near the end of this pandemic, states have begun their reopening process. As a result, many Americans are beginning to schedule elective surgeries that were largely postponed or stopped because of COVID-19. Centers for Medicare & Medicaid Services has provided recommendations on how states that meet certain criteria can begin re-instituting elective surgeries. The White House's plan for Opening Up America Again includes resuming outpatient elective surgeries as a Phase One priority and inpatient elective procedures are to resume in Phase Two.
This wave of non-emergent surgeries will likely have an unfavorable impact on the opioid crisis in the U.S. as many patients will require post-surgery pain relief which can increase the risk of dependence and exposure to these highly addictive drugs. Unused opioid pills also create increased risk. Each year, more than 1 billion unused pills are made available and 90% of unused pills remain in the home in unsecured locations. Thirty-two percent (32%) of all opioid addicts report their first opioid exposure was through leftover pills.
Estimates suggest that 2.9 million surgical patients become persistent opioid users each year. This creates significant costs for employers. The use of postoperative opioids is associated with higher direct health care costs, greater use of medical services and increased length of stay and readmissions due to opioid-related adverse events. When opioids are prescribed post-surgery, the average additional cost per patient is $5,100 to $7,000.
The first 72 hours following surgery, when pain is most severe and inflammation is highest, are critical in successfully treating postoperative pain. Opioids are frequently prescribed to reduce this pain and discomfort.
Today, most employers do not realize that non-opioid postoperative pain management alternatives are available, along with new innovative treatments currently in development. In fact, Medicare has taken the lead on making certain these non-opioid alternatives are reimbursed separately from provider surgical bundles that rely on opioids because they are inexpensive. This removes the cost burden to providers that would otherwise discourage their use.
The Midwest Business Group on Health recommends employers follow Medicare's lead and ensure covered populations have similar access. In the surgical setting, here are steps employers can take to mitigate one of the key entry points to opioid addiction:
- Incent providers to use non-opioid pain management alternatives
- Direct members to facilities/providers that utilize innovative non-opioid postoperative pain management treatments
- Educate care managers, employees and their families, to narrow the pathway to addiction
- Deploy value-based benefit design strategies to help patients avoid unnecessary surgeries in the first place
The challenges of COVID-19 are not going away anytime soon, but that doesn't render employers helpless in pushing back on escalating health care costs associated with the overuse of opioids. Employers should work with their carrier/third-party administrator to change their reimbursement strategy and ensure innovative non-opioid postoperative pain management alternatives are readily accessible.
Acting today can save lives tomorrow by impacting unnecessary opioid exposure, improving the time it takes to return-to-work and reducing total health care spend.
Dawn Weddle is director of member engagement at Midwest Business Group on Health.
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