The opioid crisis has been declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States--115 deaths per day. This is twice the number of opioid-related overdose deaths that occurred just 6 years earlier in 2010. Identifying patients who are at risk of overdose or abuse is key to addressing this national crisis. Opioids include narcotics intended to manage pain from surgery, injury, or illness. They can create a euphoric effect, which makes them vulnerable to abuse and misuse (i.e., taking opioids in a way other than prescribed). Although opioids can be appropriate under certain circumstances, the Office of Inspector General (OIG) and others are concerned about fraud, abuse, and misuse of opioids, as well as drug diversion--the redirection of prescription drugs for an illegal purpose, such as recreational use or resale. These concerns about fraud, abuse, misuse, and diversion include opioids obtained under Medicare Part D, the optional prescription drug benefit for Medicare beneficiaries. In 2017, it covered 45 million beneficiaries. There is also growing concern about abuse of both prescription fentanyl and illicitly manufactured fentanyl. Fentanyl-related overdose deaths have drastically increased in recent years. Fentanyl is 30 to 50 times more powerful than heroin and is sometimes mixed with other drugs, such as cocaine or heroin, which increases the risk of overdose. In addition to these concerns, opioid use carries a number of health risks. Side effects from using opioids may include respiratory depression, confusion, increased tolerance, and physical dependence. For seniors, long-term use of prescription opioids also increases the likelihood of falls and fractures. Prescribers play a crucial role in ensuring that beneficiaries receive appropriate amounts of opioids. To help inform prescribers, the Centers for Disease Control and Prevention (CDC) published guidelines on prescribing opioids to patients with chronic pain. The guidelines recommend that prescribers use caution when ordering opioids at any dosage and avoid increasing dosages to the equivalent of 90 mg or more of morphine a day for chronic pain. In addition, because long-term opioid use often begins with the treatment of acute pain, the guidelines recommend that prescribers order opioids for the lowest effective dose and duration, noting that more than 7 days of opioids is rarely needed to address acute pain. The Centers for Medicare & Medicaid Services (CMS) also initiated a number of actions to address opioid misuse and inappropriate prescribing. For instance, through its Overutilization Monitoring System, CMS routinely identifies Part D beneficiaries who are potentially overutilizing opioids and who may be in need of case management. It then provides each Part D sponsor with a list of these beneficiaries for follow up. CMS also expects Part D sponsors to implement controls at the point of sale to prevent unsafe dosing. In addition, CMS is taking steps to implement the Comprehensive Addiction and Recovery Act of 2016 (CARA) for 2019. CARA provides Part D sponsors the authority to restrict at-risk beneficiaries to selected pharmacies or prescribers ("lock-in") for their opioid prescriptions. This data brief is part of a larger strategy by OIG to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse. It provides 2017 data on the extent to which Medicare Part D beneficiaries receive extreme amounts of opioids or appear to be "doctor shopping" and compares these data to OIG's previous analysis of 2016. This data brief is being released with a toolkit that provides detailed steps for using prescription drug data to analyze patients' opioid levels and identify patients who are at risk of opioid misuse or overdose. OIG is also conducting a series of reviews on opioid utilization in Medicaid. In addition, OIG has ongoing reviews about key opioid initiatives at the Department of Health and Human Services (HHS or the Department), including access to buprenorphine for opioid use disorder; controls on opioid treatment programs, the Food and Drug Administration's oversight of programs to address opioid abuse, and a review of grants for prescription drug monitoring programs.
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