Publications

Michigan Physician Survey–perspectives on opioid prescribing policies, medication assisted treatment

Over the last decade, there has been a startling increase in the number of deaths attributed to opioid overdose. Between 1999 and 2016, the number of overdose deaths in Michigan increased seventeen fold—from 99 to 1,699. In 2017, more deaths were due to overdose than car accidents State of Michigan (2019). Get the facts about opioids.

In 2017, Michigan enacted legislation intended to deter over prescribing. Key provisions include a seven-day limit on opioid prescriptions for acute pain and mandatory use of the Michigan Automated Prescription System (MAPS). The seven-day limit was put in place to both reduce the supply of prescription opioids in circulation, as well as require more oversight of patients receiving opioids for acute pain. The MAP system was mandated in order to track all opioid prescriptions to individual patients, regardless of source.[footnote]Department of Licensing and Regulatory Affairs and the Michigan Department of Health and Human Services (2019). Michigan opioid laws: Frequently asked questions.

In 2017 and 2018, the Michigan Department of Health and Human Services (MDHHS) encouraged expansion of Medication-Assisted Treatment (MAT) programs. Specifically, MDHHS provided more than $7 million for MAT training, rate incentives, and program expansions in rural areas. Additionally, MDHHS recently announced a tuition reimbursement program for training physicians who become waivered to provide buprenorphine.

Whether these policy reforms and additional resources will have an impact on opioid use depends in part on physician support. Physicians need to be key partners in the implementation of changes in opioid prescribing and in providing supportive treatment approaches. In order to understand the likelihood that these policies will succeed, CHRT’s latest Michigan Physician Survey asked primary care providers (PCPs) about their views on these initiatives.

To see the full brief, click here.

Uncoordinated prescription opioid use in Michigan

Prescription opioids such as morphine, oxycodone, and hydrocodone provide pain relief to patients with chronic pain. However, these drugs also pose safety risks to patients. Opioid use can cause respiratory depression, resulting in overdose or death.

As prescription opioids have been used more extensively for pain control in the past two decades due to changing practice guidelines, overdose deaths surged in both Michigan and the United States. Notably, the majority of opioid-related disabilities and deaths result from patients taking opioids as prescribed, rather than from deliberate abuse or misuse. Furthermore, opioid-related deaths are frequently associated with concurrent use of prescribed antidepressants or benzodiazepines like Valium and Zanax.

Pain control is an essential part of patient care, and opioids are one of the primary pain treatments available. While most opioids are used and prescribed appropriately, a small number of patients receive numerous prescriptions from separate prescribers within a short period of time. This lack of coordination increases patients’ risk of accidental overdose and death. This issue brief analyzes accidental deaths from opioid overdoses in Michigan, uncoordinated opioid prescribing among privately insured Michigan patients in 2013, and policy options to improve safe prescribing in the state.

Key Findings

  • Uncoordinated opioid prescribing is a critical patient safety issue in Michigan, particularly for patients who receive a large volume of opioids from multiple prescribers. It is essential that patients receive appropriate pain control, which may include the use of opioids, but pain treatment should not jeopardize patient safety.
  • Accidental overdose deaths involving opioids (including prescription drugs and heroin) increased sixfold in Michigan between 1999 and 2013 (from 81 to 519 deaths). These opioid-related deaths represented 38 percent of all accidental drug deaths in 2013, up from 23 percent in 1999.
  • Accidental overdose deaths involving prescription opioids represented 43 percent of total opioid deaths in 2013. The remaining 57 percent of deaths were from heroin, which is noteworthy since some patients first become addicted to prescription drugs and then turn to heroin, the strongest form of opioid.
  • In 2013, over 600 privately insured Michigan patients in the study group were defined as having uncoordinated opioid prescriptions (0.3 percent of all patients using prescription opioids). These patients filled at least ten opioid prescriptions from four or more providers within three months. As a result, they ran a higher risk of accidental overdose and death because their providers may not have been aware of all their opioid prescriptions.
  • In October 2015, the Michigan Prescription Drug and Opioid Abuse Task Force released its findings and recommendations.

Key recommendations to address these issues include:

  • Expanding provider education on safe opioid prescribing;
  • Requiring providers to have a bona-fide relationship with patients before prescribing controlled substances;
  • Launching a public awareness campaign;
  • Increasing access to the lifesaving overdose reversal drug naloxone;
  • Exploring the possibility of limiting criminal penalties for people who report or seek medical attention for overdoses; and
  • Improving the state’s database of controlled substance prescriptions and increasing its use by providers and pharmacists.

Read Full Brief Here