Mitchell Warns Insurers to Mind Surging Drug Use During Pandemic

Even though the number of opioid prescriptions in the United States had dropped by more than a third, the number of drug overdoes has surged this year, recent studies show.

Mitchell, the San Diego-based claims administrator and pharmacy benefit manager, said Tuesday that this means auto and workers’ compensation insurers need to keep a close eye out for “overprescribing” physicians, escalating dosages and any out-of-network dispensing.

Mitch Freeman, Mitchell’s chief clinical officer, said it can be difficult to close a bodily injury claim if the patient starts to abuse the painkillers he is prescribed.

“Many times, with two claims that look very similar, you have one who returns to work and one that lasts much longer in claims duration and doesn’t recover,” Freeman said. “It has been shown that the longer the worker is taking opioids the longer the claim will last.”

In its annual pharmacy clinical trends report, Mitchell noted the American Medical Association in June told the Centers for Disease Control and Prevention that the prescription opioid epidemic has ended. The organization asked for revisions to CDC opioid prescribing guidelines, including an to end “arbitrary” dosage limits.

In a report released in July, the AMA noted a 37% decrease in opioid prescriptions from 2013 to 2019.

The AMA said illicit drugs — not prescription opioids — are now the dominate cause of fatal overdoes. It lamented that insurers and pharmacy benefit managers are denying patients access to needed opioid analgesics because of the CDC guidelines.

“The nation’s opioid epidemic has never been just about prescription opioids, and we encourage CDC to take a broader view of how to help ensure patients have access to evidence-based comprehensive care that includes multidisciplinary, multimodal pain care options as well as efforts to remove the stigma that patients with pain experience on a regular basis,” wrote Dr. James L. Madara, AMA’s executive vice president, in the June 12 letter to the CDC.

But Mitchell says the pandemic has accelerated drug use and abuse issues. A mapping program published by the University of Baltimore indicates that during the period from March 19 to May 19 — which corresponds to the period when stay-at-home orders were in place in many states — the number of suspected drug overdoes increased 18% compared the period from Jan. 1 to March 18.

An analysis by the White House drug policy office found that drug fatalities increased more than 11% in the first four months of 2020 compared the previous year.

“Stress and anxiety are often catalysts for increased drug and alcohol use, and the pandemic and subsequent lockdowns have caused increases in anxiety, stress and difficulties managing mental health,” the Mitchell report says. “Although many of these studies look at the beginning of the pandemic, we expect the numbers to increase as the pandemic stretches on.”

CDC data shows that synthetic opioids such as fentanyl now cause the majority of fatal drug overdoses in the United States. Excluding methadone, synthetic opioids caused 39,535 out of a total 52,488 overdose deaths reported in the 12 months ending in March 2020, according to Oct. 4 CDC report.

Freeman said while few of those synthetic opioid overdoses are caused by prescribed drugs, studies have show that most people who become addicted to opioids start out with a prescription.

Freeman said insurers should be especially concerned because orthopedists, who are treat injured workers and auto accident victims, prescribe a large portion of the opioids that are dispensed legally. According to the National Institutes of Health, orthopedists — one of eight prescriber groups — prescribed 42% of opioids prescribed for chronic pain, 47% of opioids prescribed for neck pain and 55% of opioids prescribed for burns.

Many times the drugs are prescribed to patients after surgery, Freeman said. Oftentimes, he said physicians prescribe opioids so that the patient may take two pills every few hours, as often as needed for pain. Those “default” prescriptions lead to many patients receiving more pills than they need, he said.