Segment 1: Nonmedical Use of Opioids: The Scope of the Problem

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Moderator J David Haddox, DDS, MD, vice president for health policy at Purdue, discusses the scope of the opioid problem with the panel, which consists of Jeffrey Dunn, PharmD, MBA, senior vice president and chief clinical officer at VRx Pharmacy Services; Peggy Johnson, current principal at MMJ Advisors and past chief pharmacy officer at Horizon Blue Cross and Blue Shield of New Jersey; and Burton VanderLaan, MD, FACP, medical director at Priority Health.

Haddox begins by providing an overview of the opioid problem at the national level. Based on results from the National Survey on Drug Use and Health, in 2014, slightly less than 4% of the noninstitutionalized civilian population aged 12 and older, or about 4.3 million individuals in any given month, admit to current nonmedical use of prescription pain medicines. In 2013, the same survey estimated that about 20 million adults have a substance abuse disorder, including those who have been diagnosed and those who have not been diagnosed. Opioids are among the top drugs in terms of volume, add Johnson and Dunn. VanderLaan agrees that the opioid problem is significant and that the volume of use is substantial, further remarking that about 10% of substance abuse in mental health admissions is accounted for by abuse of opioids. The challenge, according to Dunn and Haddox, is balancing appropriate treatment for pain while curbing inappropriate use.

In terms of the populations at highest risk for nonmedical use of opioids, Johnson notes that adolescents are at risk due to their current developmental state. Haddox adds that the adolescent brain is still developing and not finally mature until around 26 years of age. In Michigan, white males between the ages of 35 and 55 are a group that may be at particular risk, remarks VanderLaan. Other predictors include licit or illicit drug use and behavioral issues, adds Dunn.

The opioid abuse problem is multifactorial, and the involvement of all stakeholders—including payers, providers, and regulatory agencies—is needed to effectively address the problem. Dunn remarks that data portability is important and that allowing payers to access state databases will facilitate more effective monitoring of all of the prescriptions that patients are receiving.

Fatal overdose is one of the possible consequences of opioid abuse. According to data from the CDC, there has been an increase in fatal overdoses involving opioids, notes Haddox. Among fatal overdoses involving opioids, other drugs—including benzodiazepines, muscle relaxants, sedating antihistamines, and sedating antidepressants—frequently were involved.