Analysis of anti-narcotic therapy across a self-insured population
Oram T, Goldberg B, Botham R, and Gatia R. Analysis of anti-narcotic therapy across a self-insured population. J Manag Care Spec Pharm 2019; 25:S94.
J Manag Care Spec Pharm
BACKGROUND: Per the FDA, the opioid epidemic is the “most profound crisis facing the United States.” Opioid addiction is a chronic medical illness for which abstinence based treatments have a 90% relapse rate. The Drug Addiction Act of 2002 requires physicians treating opioid abuse to undergo additional training, obtain a special waiver, and provide counseling and referral to psychosocial therapy, if needed. Buprenorphine allows for stabilization of opioid receptors and can be an effective tool to treat opioid addiction. As of 2015, The American Society of Addiction Medicine stated that there is not sufficient evidence on outcomes to make a recommendation on buprenorphine taper duration. OBJECTIVE: To assess buprenorphine/naloxone use in a self-insured population, identify utilization trends, and assess appropriateness of therapy based on current recommendations. METHODS: A retrospective evaluation of buprenorphine/naloxone utilization was conducted analyzing all members with at least one buprenorphine/naloxone product (Suboxone, Zubsolv, or Bunavail) claim from 1/1/2017-9/30/2018. Primary outcomes assessed included duration of therapy, use of opioids during therapy, rate of therapy completion, and avg. cost per prescription. Secondary outcomes included new or existing therapy during review period, usage of prescription opioids prior to or after therapy, avg. dosage/day, and concurrent Benzodiazepine use. Medical data was not available, limiting insight into counseling/other psychosocial therapy and non-prescription opioid use. RESULTS: The avg. length of buprenorphine/naloxone therapy for all members analyzed was 10.4 months with 13% extending more than 5 years. 7.5% of members used prescription opioids during therapy while 15.8% used a benzodiazepine. Therapy was completed by 20.3% of members treated with an avg. duration of 24.9 months, though 14.5% used a prescription opioid after completion. The avg. dose was 16mg/day with 52.7% experiencing a dosage decrease during therapy. The avg. cost was $253.28/Rx, of which employers paid 72.2%. CONCLUSIONS: Treatment of opioid use disorders requires a multifaceted approach which includes long-term maintenance therapy of a buprenorphine/naloxone product. Drug therapy alone is not the answer. Substituting one pill for another does not address the underlying addiction component. There must be a mental health component, lifestyle modification, and strategy for weaning off buprenorphine. Tapering must be highly individualized, and when the member is ready as forced tapering is associated with high relapse rates and mortality.