Drugs killing more White Americans

Stronger anti-abuse efforts needed to stem death spike

A recent study by a 2015 Nobel Prize winner has raised eyebrows: We’re seeing an increase in deaths of mid-life White Americans, partly due to our epidemic of drug addiction.

A professor of clinical psychology goes a step further in an op-ed. Richard Friedman points the finger at healthcare providers who’ve increased prescribing addictive pain medication to patients who may not need such strong narcotics.

Several years ago the manufacturer of OxyContin weakened the drug’s addictive properties. Many Oxy addicts then turned to illicit drugs. Heroin addiction thus is spiking, taking its toll in rural and suburban America more than in large urban areas.

Insurance fraud also is a large financier of prescription abuse. False prescriptions by doctors, pharmacists and addicts are putting narcotics into the hands of addicts, the Coalition wrote in Prescription for Peril. Strong state prescription drug monitoring programs are necessary to help stem the epidemic. The new morbidity study supports everything we say.

News stories routinely profile law-abiding middle-class men and women being investigated for doctor shopping and prescription addiction. The latest morbidity study adds a new wrinkle: An increase in the deaths of mid life White middle-class Americans — and not because of famine or war.

Nearly all states have databases that track prescription drug use by patients, and prescribing patterns by medical providers. A key goal is to head off abuse of drugs that often are charged to insurers as false claims. Yet only some prescription monitoring programs are fully funded and functional. The rest have leaks that can let addicts all-too-freely obtain painkillers and other drugs.

More states are working to plug the gaps. In fact 13 states recently began requiring physicians and pharmacists to check their state’s database before prescribing and dispensing narcotic drugs for new patients who claim acute or chronic pain. Providers also must regularly check while patients are being treated.

Workers-comp and health insurers have skin in the game — they pay billions a year in false prescriptions. Their involvement in state anti-abuse efforts also should be encouraged. Overdose deaths from prescription opioids have quadrupled in the U.S. since 1999, says the Centers for Disease Control. So have opioids prescribed and sold in the U.S. All the while, Americans still report the same amount of pain.

The feds are pumping a cool $20 million into preventing overdose deaths from painkillers and other addictive meds. The cash influx goes to 16 states from the CDC.

Medicare drug abuse also is growing. A new U.S. Senate bill would move pushback efforts several steps forward as well.

So fraud fighters, insurers and health policymakers must encourage and support these programs. Stronger state prescription monitoring programs are needed. Monitoring programs should be allowed to communicate with other. And all medical providers and pharmacists should be required to check the system before prescribing or filling scripts for addictive narcotics.

This is the least we must do so future studies produce encouraging drug-use and mortality results.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Kentucky database weeding out doctor-shoppers

Painkiller use falls, showing progress against epidemic addictive meds

pillsKentucky is one of the nation’s most over-medicated states. A seemingly boundless supply of painkillers and other addictive prescription meds are keeping tens of thousands of residents in a medicated fog.

At least 1,000 Kentuckians die each year from overdoses — more than die in traffic accidents.

Sadly, Kentucky for years has been America’s poster state for prescription pills runamuck. Poverty plays a leading role. And insurance fraud from false prescriptions finances much of the drug trouble. Greedy pain clinics, pharmacies, crime rings and desperate addicts are all part of the action.

The state has struggled to halt the epidemic. And now Kentucky may have the makings of a success formula, a new study suggests …

Doses of the popular painkiller hydrocodone have dropped 9.5 percent since 2011. Another heavily abused pain pill oxycodone fell 10.5 percent. All told, that’s about 27 million fewer doses coursing through Kentuckians’ bloodstreams.

So what’s behind the fall-off?

Keeping close tabs on prescription trafficking by pain docs and other medical providers is pushing more crooked docs off the streets.

Look to a database that monitors traffic in opioid and other scripts. The prescription monitoring program is known by its acronym Kasper. A 2011 law requires docs who prescribe painkillers to register with Kasper, which tracks their drug-delivering patterns. State officials can quickly spot and halt over-prescribers who Kasper identifies.

More than 24,000 medical providers have registered, and are being tracked. This compares with 7,545 providers before the law passed.

And only licensed docs can own and run pain clinics under the law. That’s helping weed out sleazy lay profiteers who install puppet docs as stooge clinic owners.

Kentucky has shuttered 20 clinics since the law passed, and four others have received cease-and-desist orders. The state also disciplined 64 docs for prescription violations in the last year, compared to 53 in 2011.

Ten other states also have mandated that prescribers and pharmacists check prescription databases prior to prescribing and dispensing certain addictive drugs.

The Kentucky experience strongly suggests other states should follow this lead to curb a national addiction problem that taking its toll on patients, insurers and society.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

Opiods a gateway for rising heroin addiction

More people getting stuck on both heroin, insurer-paid painkillers

Heroine use and overdose deaths are exploding.

And guess what — the gateway drugs for many addicts are prescription opioids such as pain killers, muscle relaxers and other junk. Much of which insurers finance through patient doctor-shopping schemes and false prescriptions by crooked medical providers and pharmacists.

For the big picture, check out a new study released by the Centers for Disease Control.

“Heroin use has increased across the United States among men and women, most age groups, and all income levels. The greatest increases have occurred in groups with historically lower rates of heroin use, including women and people with private insurance,” CDC says.

Heroin overdose deaths have nearly quadrupled since 2002, and use has spiked 63 percent. Tellingly, the largest increase in heroin came from people who abuse addictive painkillers. There’s an explosion of people with multiple addictions, the study says.

The addiction chain often starts when people get hooked on prescription drugs. Maybe they have chronic pain from a back injury after slipping on the factory floor. Or whiplash from an auto crash, or an injured skiing knee that refuses to heal properly.

All too often crooked medical providers make it easy to spoon out false prescriptions that insidiously feed growing addiction. And all too often the prescriptions are financed by expensive insurance claims. In fact the new generation of multi-addicts have insurance, CDC says. It’s a big fraud market, with more than two million abusers in the U.S.

Heroin also is getting cheap and easy to obtain. Thus the addictions feed on each other. Heroin use intensifies your urge to steal insurer-paid opioids. And opioid craving intensifies your urge for heroin. And so the twin addictions spiral — with great personal, societal and financial costs. Let’s also add cocaine to the mix, by the way.

Another roadway to heroin addiction: In some respects, fraud fighters have done such a good job of drying up street access to prescriptions that addicts turn to the welcoming arms of heroin dealers.

Mexican drug cartels send large volumes of the heroin up north, so the opioid addiction chain helps feed the lawlessness they spawn.

The job of fraud fighters has just gotten more complicated. We’ll need a more comprehensive approach that includes heroin. Going after painkillers in a vacuum isn’t an option.

Street-level enforcement increasingly may require more partnering with heroin crime fighters.

Treatment and prevention strategies will need to tackle multiple addictions. Injured workers may come through the front door with ravenous cravings for muscle relaxers and heroin. HHS has several strategies that decisionmakers should closely consider. Insurers also will need to take a larger view of their roles — from combating fraud and opioid abuse to taking down their evil twin, heroin.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

Stymying opioid abuse driving users to heroin

Policymakers must dry up drug sources and heal addicts

A new metric is helping measure progress in America’s efforts to blunt abuse of painkillers and other addictive prescription drugs.

Heroin users.

Ongoing law-enforcement efforts to shut down pill mills are putting a dent in availability. And restrictions imposed on doctors are discouraging more from pushing pills.

One of the most-abused painkillers — OxyContin — also was reformulated to resist abuse. It’s harder to crush or snort. Abuse of the once hyper-addictive pill has dropped dramatically, says a study in the New England Journal of Medicine.

Prescription overdose deaths plummeted 23 percent in Florida between 2010 and 2012, notes a CNN story this week.

Insurers also benefit, because their payouts finance billions of dollars worth of opioid prescriptions a year.

All good, except the lockdown of opioids is driving addicts to heroin. Overdoses are spiking, which is canceling out many of the gains in clamping down on prescription abuse.

Squeezing drug sources — whether doctors, pill mills or heroin dealers — is a worthy though incomplete strategy. If one drug dries up, another will take its place as long as addictive demand remains intact.

Vermont is going after prescription opiate demand. The state has opened five regional drug treatment centers around the state. After addicts “graduate” from a center, they’re treated by doctors and therapists in the addicts’ community.

The centers are overwhelmed by addicts seeking a way out. Convincing local doctors to treat addicts also is difficult. Still, Vermont’s model bears a close look as it evolves.

Policymakers are trying many creative solutions around the U.S. Quashing this scourge requires us to keep looking two ways at once: block the drug sources, and stymie the addictive urge.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

Latest wave of painkiller addiction may be worst

Silver bullet is development of less-addictive med

“History shows both that it’s possible to overprescribe and misuse powerful narcotics, and that it’s possible to undertreat pain and addiction to them. Balancing the competing needs and risks is a continuing struggle.”

drug imageWhile a bit of simplification, this quote by health economist Austin Frakt nicely sums up the challenge the U.S. faces in curbing mass addiction to prescription painkillers. On one side are pain sufferers and drugmakers. On the other side are insurers, regulators and law enforcement. In the middle are tens of thousands of addicts, black marketeers, fraudsters, and the physicians and pharmacists who enable this crime wave.

Frakt provides a historical snapshot of opioid addiction in a recent column in the New York Times. [link] There have been three major waves of addiction in the US. since opium became the drug of choice in the 1900s. Each time a major public-policy initiative served as a catalyst to end the epidemic.

It likely will take more than a single initiative to end the current wave, considering Americans consume:

• 99 percent of the world’s hydrocodone, the opioid in Vicodin;
• 80 percent of the world’s oxycodone (OxyContin and Percocet); and
• 65 percent of hydromorphone (Dilaudid), Frakt writes.

These three painkillers are killing more Americans than any other drug.

The current wave of drug addiction was spurred in part by naive doctors in the 1980s who touted drugmaker propaganda that these drugs were harmless.

Yet there’s some hope, after thousands of deaths and a price tag in the billions. State drug-monitoring systems and better education of patients and doctors are helping ease drug diversion, as are tougher laws and better treatment and rehab.

Reducing drugmakers’ influence on physicians and policymakers also will help. The magic bullet, though, would be development of an effective non-addictive painkiller.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Medical marijuana as a strategy to reduce prescription drug deaths

New study contains strong evidence that painkiller alternatives can save lives and insurers money

After visiting a medical marijuana outlet in Colorado in May, I wrote about the possibility of medical marijuana replacing addictive opoids to help chronic pain sufferers.

A new study says that states that allow medical marijuana consistently had fewer overdoses than other states.

Medical marijuana states reported an overdose death rate of nearly 25 percent less than states without the laws, according to an analysis of data from the John Hopkins Bloomberg School and the Philadelphia Veterans Affairs Medical Center. The correlation between death rates and the availability of marijuana for medical purposes seems very strong.

Hopefully, this new evidence will spur Congress to allow researchers to test of efficacy of marijuana as pain medication. Good studies are lacking because of current law outlawing the possession of pot makes it nearly impossible for researchers to conducted this needed study.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Should marijuana replace addictive opioids?

Studies still needed, but insurers must solve prescription-drug pandemic

Could marijuana replace OxyContin as the painkiller of choice?

As legal pot spreads across America, insurers might want to consider this alternative.

I had the honor last Friday of serving as keynote speaker for the annual conference of the Rocky Mountain chapter of IASIU held just outside of Denver. It was a well-attended meeting with good speakers and interesting topics — including one on the impact of legal marijuana on insurance.

With a few hours to kill before my plane departed, I decided to check out Colorado’s latest burgeoning industry and visit a marijuana dispensary to satisfy my curiosity (and impress my hip friends back home).

The dispensary in Boulder is called The Farm. It was a medical marijuana retailer before the state legalized recreational pot for adults on January 1. Entering the store, ID was required and scanned for validation.

“You wouldn’t believe how many underage kids try to use fake IDs to get in here,” the young woman behind the counter told me. After validation, she handed me a plastic chip with a number on it. She encouraged me to look around while waiting for my number to be called.

The store’s main section looked like a traditional jewelry store with several showcases of shiny merchandise. Instead of diamonds, glass bongs were featured. It was certainly more upscale — and expensive — than the head shops I recall from the 1960s and 70s.

A locked side room contained the featured merchandise on display. Only perhaps a half-dozen customers at a time were allowed in the room, where marijuana products were displayed along the walls and underneath glass display cabinets.

If more studies conclude marijuana is effective and relatively safe for pain relief, then insurers and government programs should consider getting out front to replace the widely destructive — and expensive — use of opiods.

I told the clerk I wasn’t buying but wanted to see what was available and just look around. He was accommodating and knowledgable of the many products available, from dozens of varieties of marijuana to edibles to oils.

As I wandered around, I noticed the clientele wasn’t anything like I imagined. One guy looked like a corporate middle manager. Another could’ve been a truck driver, and a middle-class, middle-aged woman also perused. None looked like the potheads I’d expected. Overhearing their conversations, I learned that all sought relief for some ache or pain. One had back problems and another customer had arthritis.The corporate guy was picking up a package I surmised was for a family member, perhaps wife or parent, who had cancer.

Different types and strains of marijuana are suggested for different ailments, the clerk told me. Some marijuana even is sold without the key ingredient that gets users high — and his clients attest that it’s still effective.

I’d always thought that medical marijuana was more of an excuse for stoners to get high legally, but new evidence out this week challenges that assumption.

If more studies conclude marijuana is effective and relatively safe for pain relief, then insurers and government programs should consider getting out front to replace the widely destructive — and expensive — use of opiods. Prescription abuse kills Americans by the thousands, and is creating the largest generation of heroin users this country has seen. Prescription drug diversion also imposes a huge dollar drain on insurers and government health programs.

Twenty-one states and DC now allow marijuana for medical use. I’d love to see a group of insurers or a state Medicaid program conduct a pilot program in one state to test pot vs. opiods such as the painkiller oxycodone..

I’m still not sold on the idea of legal recreational marijuana, but medical marijuana might help curb one of our nation’s most pressing problems of prescription drug abuse.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Best practices aim to best drug diversion

Lawmakers gaining tool to review state efforts

State legislators now have a useful best-practices blueprint to help close gaps in dealing with the scourge of prescription abuse. This national epidemic wrecks lives and costs insurers billions of dollars annually.

The National Conference of Insurance Legislators released a report on best practices  at its summer meeting this month in Philadelphia. The valuable document will reinforce how states deal with this national epidemic.

Legislators can compare their state’s actions to the Best Practices report to see where new laws might fill gaps in the state’s enforcement efforts. This also might uncover best practices to add to the NCOIL document. This was the Coalition’s message to the assembled legislators in working with legislators on a report that will be out in the fall.

Among the Coalition’s recommendations that NCOIL adopted:

  • Enhanced interstate data-sharing among state prescription drug monitoring programs (PDMP):
  • Greater access to authorized users of the PDMPs;
  • Mandated use of PDMPs by medical providers and pharmacies;
  • Real-time reporting of prescriptions;
  • Regulation of pill mills; and
  • Proper funding of state PDMPs.

Auto, workers compensation and health insurers are defrauded by illicit prescriptions for painkillers, muscle relaxers and other narcotic prescription meds. Drug diversion steals tens of billions of dollars a year through insurance scams. Insurance fraud thus is a major financier of this crime.

Addicted doctor shoppers ply pharmacies with false prescriptions. Shady pain clinics dole out thousands of pills to addicts, and pharmacies often are complicit in a thriving black market for the insurer-paid drugs.

Several insurers — including auto and workers comp carriers — also gave presentations about the need to combat drug diversion, and applauded NCOIL’s efforts.

The report clearly had the attention of one state legislator. The best practices create a prime opening to instruct states looking for thoughtful solutions to this complex and costly problem. The report is unique in its comprehensive approach. This was the message of Vermont state Rep. Bill Botzow during the workers compensation committee discussions at the meeting.

A prosecutor also also sees the report’s value. Prescription abuse is a critical issue in his suburban Philadelphia county, he said.

We’ve seen efforts to strengthen state laws and regulations targeting diversion of addictive prescription narcotics. But, this is the first time that legislators can weigh in with a sweeping review of their own state’s efforts. This new legislative weapon comes none too soon.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

An overdose of problems, a trickle of solutions

A multifaceted approach is needed to fix N.Y’s prescription epidemic


Overdoses of addictive prescription painkillers have increased sevenfold in New York City, says a recent study by Columbia University.

The prescription abuse epidemic is spreading throughout the state. People of all ages, income levels and races are getting addicted.

The New York Alliance Against Insurance Fraud this week called for a multifaceted approach to tackle the problem. The NYAAIF works to increase public awareness about insurance fraud and its consequences.

Corrupt doctors prescribe painkillers for addicted patients, fraudulently billing insurance companies for the unneeded medicine and doctor visits. Demand for painkillers has boosted the drugs’ street price, attracting organized criminals and growing the black market. Healthy patients become addicted to painkillers by careless doctors who overprescribe, or by people taking a friend’s pills without a prescription, thinking that medicine won’t harm them. Prescription abuse is killing people — sometimes teenagers — with overdoses.

New Yorkers aren’t waiting.

Last January, legislation enacted created a statewide database to track prescriptions and prevent doctor-shopping.

The surge in addictions has led to increased pharmacy robberies, thefts, shoplifting and healthcare fraud schemes. So NYPD is placing GPS chips in pill bottles to track stolen inventories. Physicians also must be educated to recognize drug dependency. Consumers need better information to recognize the signs of drug abuse in the home, workplace and schools.

But the road is long and reducing prescription abuse will take many weapons. This problem can’t wait, prescription overdoses are taking lives.

About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

Drug diversion and the poor

BLOG_prescriptionBabiesLast week I participated in an expert panel meeting at the Centers for Disease Control & Prevention on the issue of prescription drug abuse and its impact on Medicaid programs.

The new director of the CDC has deemed drug diversion one of six public-health issues that CDC has embraced for study and action in 2012. The meeting included some very smart people from CDC, mostly medical experts, plus representatives from a handful of state Medicaid programs and a few private payers.

Drug diversion is a huge problem for Medicaid. A third to a half of all prescription drug deaths in the U.S. are Medicaid recipients. Eighty percent of babies born addicted to prescription drugs are born to mothers on Medicaid. The prescription rate among patients on Medicaid is more than twice that of the private sector. No doubt many of those pills end up on the street.

One of the most effective tools Medicaid programs have to curb diversion is requiring patients to use only one physician and one pharmacist for their prescriptions. Such “lock-in” requirements help stem doctor shopping.

But there are two problems with such programs. First, they don’t exist in many states because doctors and pharmacists sometimes don’t like them and their lobbies help to either kill lock-in legislation or weakened the bills.

Second, lock-in programs don’t catch Medicaid patients who intentionally avoid detection by paying for their illicit prescriptions in cash. Prescription monitoring programs (PMPs) — in which doctors and pharmacists log prescription activity into a state database — can catch such transactions.

But surprisingly, all but one state Medicaid program are denied access to PMP data mostly because of privacy concerns. That’s a huge missed opportunity to catch drug abusers early, and save taxpayer dollars and perhaps a few lives.

PMPs, health regulators and state legislators need to consider giving Medicaid programs access to drug data so they can become full partners in combating fraud and abuse involving prescription drugs.

About the author: Dennis Jay is executive director for the Coalition Against Insurance Fraud.