U Is For Underestimated

A little Medication With That?

"Underestimated, under-identified, under-diagnosed and under-treated" are the terms the National Council on Alcoholism and Drug Dependence (NCADD) has used to describe the substance abuse epidemic among older Americans. An estimated 4 out of 5 elders currently being treated for the abuse of prescription drugs have been identified as alcohol dependent. The same agency estimates nearly half the residents of nursing homes are alcoholics. Of these, four in five abuse other substances. The agency projects opioid abuse will double to 3.5 million by 2020. As they reach retirement age, Baby Boomers are expected to represent a tsunami of substance abusers, due in part, to more permissive attitudes toward substance use.   

     "Overprescribed," by the way, was not among the terms NCADD used, nor did the Centers For Medicare And Medicaid Services (CMS.) The agency refers to prescription drug "over-utilization," and has proposed new protocols: "to protect Medicare beneficiaries and the Medicare Trust fund from the harm and damaging effects associated with prescription drug abuse." I would go much farther, and say, "use." 

What fascinates me about addiction and obsessive behavior is that people would choose an altered state of consciousness that's toxic and ostensibly destroys most aspects of your normal life, because for a brief moment you feel okay. -Moby

     In any case CMS wants Part D beneficiaries with "potential opioid or acetaminophen overuse, identified (presumably by medical providers.) Next would be to implement "appropriate controls" on these drugs for identified beneficiaries." -This seems to me punishing patients for using medications their physicians are eager to prescribe. It utterly circumvents the question of responsibility in marketing pharmaceuticals, both to medical professionals and the public. 
     The agency says it will employ data analysis to identify prescribers and pharmacies that may be engaged in fraudulent or abusive activities. Hmmmm, this would be a monumental task, considering how widespread the exploitive tactics are. CMS wants to use its data to guide its anti-fraud efforts, share results with Part D plan sponsors, law enforcement agencies, pharmacy and physician licensing boards, alluding to joint efforts to combat fraud and abuse.A key provision of the proposed rules would require Part D prescribers to enroll in Medicare. CMS believes this will ensure Part D drugs are prescribed only by qualified individuals ... fine, in theory. Additionally CMS seeks authority to revoke a physician's or eligible professional's Medicare enrollment if:

• The agency determines he or she has a pattern of prescribing Part D drugs that is abusive (i.e., it represents a threat to the health and safety of Medicare beneficiaries or otherwise fails to meet Medicare requirements.) 
• The DEA has revoked or suspended a physician's DEA Certificate of Registration.
• The licensing or administrative body for any state has curtailed a physician's or professional practice's ability to prescribe drugs.

Yet another proposed rule would provide CMS, its antifraud contractors, and other oversight agencies the ability to request and collect information directly from pharmacy benefit managers, pharmacies, and other downstream entities that contract or subcontract with Part D sponsors to administer the Medicare prescription drug benefit. The provision is designed to improve the investigative process, according to CMS.
Approximately a year ago CMS implemented the OMS (Overutilization Monitoring System) to combat Part D fraud and abuse. The agency reports a substantial reduction in the number of acetaminophen and opioid overutilizers in Medicare Part D."  We're waiting, but breathing all the while, for outcomes. Patient-oriented solutions ... that's another topic altogether. 

There is some hope that less expensive rehabilitation is becoming available. A drug in the form of a patch shows promise -- it is a Naltrexone patch. Naltrexone is already in use to treat alcohol addiction. In pill or injectable form, and under a number of brand names, it acts to prevent recidivism. It is also, interestingly, an opiate receptor antagonist, in other words, an individual who uses opiates will not become euphoric. It helps people addicted to opiates rapidly detoxify.

Be mindful my friend, of accountability, as it relates to choice. Preventing a problem is so much better than solving a problem through the backdoor.