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Opioid Drugs

Data Shows Medicaid Patients Received Excessive Opioids

— January 5, 2021

Report shows thousands of Medicaid patients received unusually high amount of opioids.

The Office of Inspector General (IG) for the Department of Health and Human Services has issued a new report indicating more than 4,000 patients in the Ohio Valley received high unusually amounts of opioids in 2018 through Medicaid, contributing to the devastating opioid epidemic.  The IG’s office focused on half a dozen Appalachian states with the support of a partnership with law enforcement agencies in the Appalachian Regional Prescription Opioid Strike Force.  Data pulled from these states showed several hundred Medicaid patients in the Ohio Valley received high amounts of opioids.

“Even legitimate use of prescription opioids could cause harm and that’s why it’s so important that people only get prescription opioids when absolutely necessary and if they do get them that they are at the lowest dose for the shortest period of time possible that is consistent with good medical care,” Hilary Slover, team leader for the IG study, said.  “We have done this before in Ohio, and in Ohio we saw a decline in the number of beneficiaries at serious risk and the number of providers with questionable prescribing practices since May 2017.”

Data Shows Medicaid Patients Received Excessive Opioids
Photo by Sharon McCutcheon on Unsplash

Data was collected from the Transformed Medicaid Statistical Information System (T-MSIS) for the specified six states in the region, including Alabama, Kentucky, Ohio, Tennessee, Virginia, and West Virginia.  The office announced it found, “Nearly 6,000 beneficiaries in the 6 Appalachian States received high amounts of opioids and did not have cancer or sickle cell disease and were not in hospice care treatment.  Among those beneficiaries, more than 450 were at serious risk of prescription opioid misuse or overdose.  Nineteen prescribers stood out by prescribing opioids to more beneficiaries at serious risk.”

The opioid crisis has gotten worse amid the coronavirus pandemic.  Many individuals have turned to substances to manage symptoms of stress, anxiety, and depression related to these unprecedented times, and those who are unable to receive proper care have turned to illicit replacements on the streets.  The overdose fatality rate has increased across the U.S.

Those with opioid use disorder (OUD) who test positive for COVID-19, which tends to result in respiratory distress, could be at higher risk of death.  Coupled with COVID-19, lung capacity may be too low to support sufficient breathing.  Previous research found other risks for people with OUD include “decreased access to health care, housing insecurity, and greater likelihood for incarceration.”  At the same time that the overdose risk is rising, however, federal programs have relaxed laws to support increased access to care.  And, while the this has helped eliminate barriers, in some cases, laxed laws have led to unintentional detrimental effects.

“During this time some Medicaid programs have relaxed rules and suspended safeguards like the requirement for face-to-face visits with prescribers to receive opioid prescriptions.  In addition, patients may be experiencing reduced access to in person treatment and recovery support,” Slover explained.  The issue is two-fold – either patients are receiving opioids without being properly evaluated in person, or they cannot receive care because offices are closed without alternative treatment options, and they are turning to other methods to feed their addiction.

The IG’s office is hoping the report will bring these issues to light so prescribers can institute safeguards to reduce the risk of addiction and overdose, especially during the pandemic.


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