Like many others that have come before it, this is an article about how we can combat the opioid epidemic. But if the educational tips here help even one person think more carefully about opioid alternatives, it has accomplished what it set out to do. In fact, educational initiatives continue to make a difference, one small step at a time.

One recent study put into perspective how small steps toward opioid education can make a big impact. The study, funded in part by the National Institute on Aging, part of the National Institutes of Health, explored the impact of simple notification letters sent to prescribers of patients who died of an overdose linked to a controlled substance. The letters identified the patient, shared stats about the number and types of prescription drug deaths seen in the region, and discussed safe prescribing strategies. Physicians who received these letters reduced the number of opioids prescribed by 9.7% in the three months following the intervention. "Behavioral ‘nudges’ like these letters could be a tool to help curb the opioid epidemic," said NIA Director Richard J. Hodes, M.D.

Prescriber and patient education is critical in addressing the overuse of opioids and other high-risk medications. Improving medical literacy is a big part of supporting the injured worker and ensuring the best treatment options are prioritized and high-risk options are avoided. Claims administrators can support this initiative, ensuring not only that communication is provided, but that the right type of communication comes at the right time based on what’s occurring during the claim.

An active approach to education about the use of opioids must occur from the start of a claim. Informative, consultative communications to prescribers, injured workers and pharmacies should be triggered at different steps throughout the claim, including:

• At the pharmacy… Using pharmacy cards for each injured worker, messaging can instruct the dispensing pharmacy to provide guidance about the use of opioids. 
• At the second fill… Data demonstrates the importance of addressing opioid use early; communication should be built into the process to ensure the physician is notified as soon as a second opioid fill is provided, allowing them to explore alternatives to continued use.
• At a critical MED level or when seeing signs of chronic opioid use… If morphine equivalent dose (MED) exceeds clinical guidelines and puts the injured worker at risk, or if chronic opioid use is suspected, real-time alerts should prompt communication to help a claims team, healthcare providers and patients work together to explore alternative measures. Weaning, education, non-drug pain management therapies, and other options are all possibilities that can better meet overall patient safety objectives and support a path toward recovery.
• At another high-risk alert… Beyond those tied to chronic opioid use, real-time notifications should also be created for other high-risk and high-cost concerns. Letters of education specific to high-risk drug combinations, duplicative therapy, brand drug use and other scenarios can offer recommendations tailored to each situation.
• At the request of a peer… Sometimes a letter communication has to be followed by intervention. With complex pharmacy management (CPM) and peer-to-peer conversations, we can have conversations about the unique needs of an injured worker based upon their complete medical history. We can assist prescribers in addressing inappropriate long-term opioid use, which often includes a reduction or discontinuance of opioid use through a tapering protocol. Appropriate weaning protocols help the patient avoid terrible side effects or the risk of lapsing back into opioid use that can come with overly aggressive weaning plans. 
• At the notice of surgery… When surgery is approved, claims administrators should provide preemptive nurse intervention to assess the injured worker’s situation and educate them about responsible and safe prescription drug use. The injured worker can learn about well-being exercises and drug alternative therapies to help with post-operative pain. 

Combating the opioid epidemic must be done in concert with prescribers and injured workers. Whether it’s a warning provided on a pharmacy benefit card, a letter sent automatically based on an alert, or a phone call made because of continued high-risk prescribing, ensure your program includes the educational checks and balances necessary to address opioid overutilization. With these measures in place at Sedgwick, we have seen results such as average MED and drug costs decreased by nearly 50% for claims managed by CPM in 2017. These small steps can make the biggest difference for the injured workers we care for each day.

Dr. Paul Peak, AVP Clinical Pharmacy