By Nicole D. Prysby, J.D.
A July 2019 OIG report reviews efforts made by eight states related to their oversight of opioid prescribing and their monitoring of opioid use. Efforts include the creation of laws, regulations, or policies; use of data analytics; outreach; creation of programs; and other actions.
The Office of the Inspector General at HHS has released a review of its recent analysis into efforts taken by state to combat the epidemic of opioid abuse and overdose deaths. The report covers Nebraska, Nevada, New Hampshire, Tennessee, Texas, Utah, Washington, and West Virginia and looks at five categories of potential state action: policies and procedures, data analytics, outreach, programs, and other actions (OIG Report, No. A-09-18-01005, July 2019).
The OIG undertook the analysis because of the disproportionate impact of the opioid crisis on Medicaid beneficiaries, who are prescribed painkillers at twice the rate of non-Medicaid patients and have a significantly greater risk of overdose. In 2016-2019, the Centers for Medicare & Medicaid Services (CMS) issued a number of guidance documents related to opioids. CMS monitors the use of opioids in Medicaid through the Medicaid Drug Utilization Review Program and through program integrity desk reviews. For this review, the OIG analyzed date from eight states: Nebraska, Nevada, New Hampshire, Tennessee, Texas, Utah, Washington, and West Virginia and looked at five categories: policies and procedures, data analytics, outreach, programs, and other actions.
The report presents findings by category for the eight states reviewed:
- Policies and procedures. All states reviewed have laws, regulations, or policies related to opioid prescribing. For example, West Virginia’s Opioid Reduction Act of 2018 requires prescribers to discuss the risks of opioid use and alternatives to opioid therapy, such as physical therapy, acupuncture, and massage therapy. The states set limits on the dosage that may be dispensed. Most states also require prescribers to check the Prescription Drug Monitoring Program database before prescribing opioids.
- Data analytics. All states perform data analytics related to opioid prescribing and monitoring of opioid use. For example, Nevada uses data analytics to identify the top 10 opioid prescribing providers, to monitor these providers.
- Outreach. State outreach efforts range from optional opioid-related training for providers to media campaigns designed to provide information and strategies regarding safe use, safe storage, and safe disposal of opioids.
- Programs. All state have opioid-related prevention, detection, and treatment programs, although the criteria used to identify at-risk beneficiaries varies. For example, in Utah, one factor is four or more pharmacies accessed for controlled medications in a 12-month period; in Texas, one factor is four or more emergency room visits resulting in an opioid prescription.
- Other actions. States have initiated a variety of other actions to address the opioid epidemic. Utah’s Coalition for Opioid Overdose Prevention was formed to prevent and reduce opioid abuse, misuse, and overdose deaths through a coordinated response. Nevada started a Law Enforcement Assisted Diversion program and a Specialty Courts program, which aim to provide people with a chance to get treatment rather than end up incarcerated. Washington’s Governor’s Executive Order 16-09 brought together multiple agencies to address the opioid crisis.
The report contains no recommendations.
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