In the 1990s, patient groups, academic journals, and the federal government urged health care providers to do more to address patients’ pain — not just to reduce it, but also to eliminate it. Medical guidelines urged physicians to get patients as close to the zero on the pain scale as possible.
Some big hospital systems, including the Veterans Health Administration, dubbed pain as the “fifth vital sign,” just as important as blood pressure and temperature. And, opioid medication came to market with promises of effectiveness with few side effects and little to no dependence.
In 2016, deaths due to drug overdose from opioids likely exceeded 59,000, the largest annual jump ever recorded in the U.S., according to preliminary data compiled by The New York Times. The number of deaths in 2015 was 33,091 
.
Drug overdoses now exceed car crashes as the leading cause of unintentional death .
While the rate of opioid prescriptions has started to decline, it remains 56 percent higher than it was 20 years ago.
A key to preventing abuse is for patients to have an understanding of the risk factors associated with their medications. You can help promote this understanding by frankly discussing the risks, the realistic benefits of the medication, and expected length of treatment.
Most doctors voice their concerns:
The National Institute on Drug Abuse offers some guidelines for opioid prescriptions :
Treating acute pain with non-opioid medications may be an effective starting place. Research shows opioids are no more effective than non-opioid alternatives, like Tylenol or Advil, or the generic versions, at reducing acute pain.
“Opioid use has become an issue of national concern. While they can be effective in treating acute pain, there is mounting evidence that opioids are less than effective when used for chronic pain — and can actually do more harm than good,” said Norman Montalto, MD, a medical director with Highmark in West Virginia.
Some health systems now are providing behavioral and physical health treatments to minimize patients’ anxiety and reduce any delay in getting the treatment and other services they need. Without professional care coordination, many people drop out of treatment before attending follow-up appointments.
Many physicians now accept alternative, or holistic, medicine as a valid treatment option for pain. In fact, many alternative methods are standard practice at pain treatment centers.
Some of the most common alternative pain treatments are acupuncture, chiropractic manipulations, exercise, behavioral health therapy, relaxation therapy, hypnosis, biofeedback, massage, meditation, or yoga.
In addition to processing and paying pharmacy claims, prescription benefits managers (PBMs) may “flag” individuals who are suspected of abusing or misusing prescription medications. Some of the “flags” are:
PBMs may also track data on doctors who prescribe opioids, monitoring frequency, dosage, and length of therapy.
Many states also are using similar databases to track this information. In Pennsylvania, where the opioid death rate is above the national average, doctors now face sanctions if they don’t check the state database to verify if the individual has opioid prescriptions from multiple doctors. Please see your state law for any requirements applicable to prescribing.
Working with Others
In 2016, Highmark joined forces with axialHealthcare, a national leader in the appropriate use of opioids for pain management. Initiated in West Virginia, this partnership helps physicians better understand their patients’ total prescription and medication use and gain insight into their own prescribing patterns.
The bulk of pain treatment in West Virginia falls to PCPs due to a shortage of pain specialists.
Patients seeking pain treatment often have two choices: Drive several hours to a pain center or rely on a PCP in their area. For those without the resources to drive several hours multiple times a month for treatment, the decision is obvious.
PCPs and specialists outside of the pain-management field sometimes prescribe opioids and may not have information about other treatment options, such as steroidal injections, interventional treatment, nerve blocks, or physical therapy.
axialHealthcare is helping to resolve that problem through the Pain Management Program Portal. The portal gives physicians insights into individual patients along with resources to support decisions about treatment options for patients using opioids. It also includes patient alerts, care pathways, clinical guidelines, and a link to the West Virginia Controlled Substance Monitoring Program.
For doctors to access the portal:
The RIM Score is comprised of 15 evidence-based quality metrics proven to impact patient safety and quality of care around opioid prescribing. Your score is an assessment of your opioid prescribing patterns compared to your specialty peer group, and the RIM Score shown in NaviNet is for the most recent 1-month period*.
Patients don't expect to become addicted to a medication prescribed by a physician. PCPs, states, and insurers like Highmark are working together to make sure that outcome is minimized as much as possible. In making sure doctors have the tools and resources they need to make better decisions about opioids, the goal is to improve pain management for existing patients and prevent addiction for future patients.
*The metrics that make up the RIM Score all have different look-back periods, but the score itself is calculated monthly.
