On December 15, 2020, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) released a report that found that almost 6,000 Medicaid beneficiaries received high, potentially harmful amounts of opioids through Medicaid in six Appalachian states in just one year. Those nearly 6,000 patients did not have cancer or sickle cell disease and were not in hospice care treatment. More than 450 of the 6,000 patients were at serious risk of prescription opioid misuse or overdose.
In conducting the review, HHS OIG used claims data from Alabama, Kentucky, Ohio, Tennessee, Virginia, and West Virginia and identified the beneficiaries that are enrolled in Medicaid who received at least one opioid in 2018. From there, HHS OIG determined the beneficiaries’ morphine equivalent dose and also identified nineteen prescribers whose opioid prescribing to those beneficiaries who were at a serious risk of misuse or overdose stood out as compared to other prescribers.
According to the report, in 2018, 1 in 10 Medicaid beneficiaries in the six states received a prescription opioid and nearly 12% of those patients were a minor child (18 years old or younger). Additionally, as indicated above, more than 450 patients (463 to be exact) were at serious risk of opioid misuse or overdose and nineteen health care providers exhibited questionable prescribing practices. Of those 450 patients, 362 beneficiaries (roughly 78%) received “extreme amounts of opioids.”
The report also found that almost 20% of beneficiaries who received high amounts of opioids had at least one prescription for fentanyl – ranging from 10% of beneficiaries in Tennessee to a whopping 30% of beneficiaries in West Virginia.
With respect to the nineteen prescribers with questionable prescribing practices, while they represent only 2% of the total 890 prescribers who ordered opioids for beneficiaries at serious risk, they ordered opioids for 20% of the 462 beneficiaries at serious risk and ordered 87% of the 2,334 opioids prescriptions those 20% received in 2018.
HHS OIG is concerned that the continuing COVID-19 pandemic may be putting Medicaid beneficiaries at a higher risk of opioid abuse. Specifically, HHS OIG believes that the measures taken to address the COVID-19 pandemic may have contributed to the dramatic increases in opioid-related overdoses and deaths in these States, including relaxed rules surrounding telehealth and the prescription of opioids. These changes may have unintentionally increased the risk of doctor shopping and inappropriate opioid prescribing in 2020, while the shelter-in-place and social distancing orders implemented throughout the country may have resulted in increased isolation, a potential trigger for opioid misuse. Individuals with opioid use disorder could be particularly hard hit by COVID-19 as COVID-19 is known to increase the risk of fatal overdose among people taking opioids.
The agency has encouraged individual states to analyze their own prescription drug data to help identify patients who may be at risk of opioid misuse or abuse and work to promote responsible and appropriate opioid prescribing practices. With respect to these six specific states, HHS OIG is working with law enforcement to bring resources and expertise through the Appalachian Regional Prescription Opioid Strike Force.