A statewide crackdown on opioid prescribing appears to be working, even before enforcement plans that would penalize doctors who dole out too many addictive painkillers.
New opioid prescriptions have declined 33% since 2016 for Minnesotans who receive health benefits from the state’s programs for the poor and disabled, the Minnesota Department of Human Services announced Friday.
And prescriptions at dosages that exceed the new state guidelines have been cut in half.
“Opioids remain an important tool to treat pain, but only when the benefits outweigh the risks,” said Human Services Commissioner Jodi Harpstead.
Opioid prescribing levels have been lower in Minnesota than other states in the grip of a nationwide overdose epidemic, but the consequences have been severe in this state. Opioid-related overdose deaths surged from 54 in 2000 to 422 in 2017, though they declined to 331 in 2018.
Many of those deaths involved illicit heroin, or fentanyl — a potent opioid that is often abused. But health officials have reported that many addictions started with common painkillers such as oxycodone and hydrocodone prescribed for treatment after surgeries or injuries.
Minnesota created a prescribing work group in response, which set guidelines and dosage levels for opioids. The guidelines cover the acute phase after surgery or an accident; the short-term recovery phase after that; and the long-term chronic phase for patients who continue to suffer pain. Doctors received their first personalized reports earlier this year to compare their prescribing levels with state averages and are receiving updates now.
Doctors with excessive prescribing rates risk being removed from the state’s Medical Assistance and MinnesotaCare programs — though any such removals are probably a year or two away. The data reported Friday do not include patients covered by private health insurance.
The hope is that punitive action won’t be needed and that doctors will adjust, much the way homeowners do when a bill from Xcel energy shows that they are using more electricity than their neighbors, said Tom Moss, DHS’ interim assistant commissioner for health care. “This is exactly what we were hoping to see. It’s showing that Minnesota’s medical providers are really stepping up to the opioid issue.”
Some patients who suffer chronic pain have been wary of the state’s effort, fearing that doctors will no longer prescribe opioids that have been their lifelines. State officials have acknowledged concerns over this population of chronic-pain patients who are already dependent on opioids.
Several pleaded their case in recent e-mails and testimony to the work group.
A Duluth woman with chronic lower-back pain complained that her activity levels and happiness declined after her doctor started reducing her opioid dosage in 2016 in response to government prescribing guidelines. “I live in fear of my medications being lowered again or taken away with no resources to help,” she wrote.
Other patients complained of difficulties finding doctors willing to prescribe opioids, or of existing doctors trying to dump them because they no longer wanted to be responsible for their prescriptions. “My cat gets better pain management than I do after surgery,” said one man, who complained that one doctor cut off his opioids without offering alternatives.
The work group is now creating performance improvement training for doctors with high opioid prescribing rates.
The goal is to target doctors who blatantly disregard safety and prescribing guidelines, not doctors who stand by their existing opioid-dependent patients, said Dr. Chris Johnson, an Allina Health physician and chairman of the work group. He said he hopes the state’s data monitoring also is sensitive enough to pick up doctors who just dump opioid-dependent patients or cut off their opioids without providing other options for pain relief.
A leading critic of opioids, Johnson said he was pleased to see the prescribing and death numbers declining, but added he wants more accountability from a health care system that created the addiction crisis two decades ago by overusing opioids and then failing to react when overdose deaths first started to rise.
“Almost all physicians were conspicuously silent and others outright complicit,” Johnson said. “I would hope we would not simply congratulate ourselves that things are improving.”