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If You Want A Pragmatic Understanding of the Opioid Epidemic You May Want to Listen to This

This post follows up on last week’s primer on how abuse of prescription pain medications has led to what’s now recognized as a true national crisis. The new podcast Embedded provides a riveting inside look at how the use of one particularly powerful prescription painkiller, Opana, impacted life in a small Indiana town.

Pain Meds and The Opioid Epidemic: 10 Things To Know

There’s a lot in the news these days about what’s referred to as the opioid crisis or epidemic.

Just yesterday for instance —  highly respected healthcare consultant (and close friend) Joe Paduda, fresh off of speaking at a national drug summit in Atlanta, wrote an insightful but grave piece on the impact of opioid abuse for Managed Care Matters. Joe nets out the massive increase in the death toll stemming from prescription pain killers (opioids) and how the increased use of heroin has been driven by users who started with prescription opioids .

And, in an article appearing in Thursday’s Wall Street Journal (The Accidental Deadly Drug Prescription) a Baltimore physician writes how doctors and patients alike are unaware of the threat of accidental death posed when opioids interact with other frequently prescribed drugs.

Got me thinking. Despite all the news, despite being in a healthcare related field and working with prescription drug plans, and despite having had family, friends, and colleagues at work touched by this crisis, I realized I don’t really know nearly enough about the overall issue. I wanted to better comprehend the basics and so I dug in a little bit to get a better grasp. Thought I’d share in case you’re in the same boat as me.

Here are 10 things about the growing pain med problem that may help you better understand:

1.) Per the National Institutes for Health (NIH), Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain by diminishing the effects of a painful stimulus. In other words, they reduce the patient’s perception of pain.

2.) Medications in the opioid class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs.

 3.) Hydrocodone products are the most commonly prescribed for a host of painful conditions, including dental and injury-related pain.

 4.) Morphine is often used before and after surgical procedures to alleviate severe pain.

 5.) Codeine is often prescribed for mild pain. In addition to their pain relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea. (In other words, just about anyone could have been prescribed an opioid at one time or another.)

 6.) Addiction may develop due to the euphoric response some people experience when taking opioid medications. The drugs affect the brain regions involved in reward. Those who abuse opioids may look to step up and intensify their experience by taking the drug in ways other than those prescribed or switching to heroin after becoming addicted because heroin may be less expensive and or more easily accessible.

 7.) Over the course of almost two decades overprescribing of opioids has led to a huge increase in the frequency of opioid addiction. This in turn has led to the steep rise in overdose deaths and increased heroin use. Use of hydrocodone has more than doubled and consumption of oxycodone has increased by nearly 500%. The number of deaths due to opioid overdose death nearly quadrupled.

 8.) This acceleration in the prescription and use of opioids was fueled in large part by the combination of the introduction of OxyContin in 1995, more aggressive identification and treatment of pain, and, an overall increase in emphasis on Pain Management as a treatment modality.

 9.) The group with the highest death rate from opioid prescription pain meds is the 45-to-54 age group — more than four times the rate for teenagers and young adults. The rate of overdose deaths for adults ages 55 to 64 has soared sevenfold.

 10.) Everyday 46 Americans die from using prescription painkillers.

I guess my take away is for me to tune in more. And, encourage our team and our clients and their employees to tune in more.  Maybe at one time it seemed mostly just on the streets. Not any more. It’s at the office; it’s at home; and it’s over the roads. From classrooms to locker rooms to board rooms, pain med addiction has become a real and costly issue that in some way shape or form has touched most of us.

“Who’s Exempt from the ACA Individual Mandate to Have Health Insurance?”

During several recent meetings this question was posed a number of times by curious employees and a few their employers. It seems many folks are still unclear about the exemptions. Many also were unclear on the amount of the penalties.

Below is a summary on exemptions and individual penatlies published recently in a Kaiser Health News article addressing these FAQs:

Who’s Exempt from the Requirement to Have Insurance?

 The list of possible exemptions is a long one. You may be eligible for an exemption if:
• Your income is below the federal income tax filing threshold.
• The lowest priced available plan costs more than 8.05 percent of your income.
• Your income is less than 138 percent of the federal poverty level (about $16,105 for 2015 coverage for an individual) and your state did not expand Medicaid coverage to adults at this income level as permitted under the health law.
• You experienced one of several hardships, including eviction, bankruptcy or domestic violence.
• You are a member of an Indian tribe, health care sharing ministry or a religious group that objects to insurance.
• You are in jail.
• You are an immigrant who is not in the country legally.

Many also asked about the penalties. More from the KHN article:

Penalties: How Much?

For 2016, the penalty will be the greater of $695 or 2.5 percent of income.
Although much of the discussion is often about the flat dollar penalty – $325 in 2015 — many people will be paying substantially more than that. A single person earning more than $26,550 would not qualify for the $325 penalty ($26,550 – $10,300 = $16,250 x 2 percent = $325.) So the 2 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose modified adjusted gross income is $35,000, the penalty would be $494 ($35,000 – $10,300 = $24,700 x 2 percent = $494. That same individual would have paid $249 in penalties for 2014.

The penalty is capped at the national average price for a bronze plan, which the IRS announced was $2,484 for an individual and $12,240 for a family of five or more in 2015.

To read about other ObamaCare FAQ’s go to FAQ: What Are The Penalties For Not Getting Insurance?

Health Insurance Literacy: Too Complex for Some?

We can all agree that our healthcare system is difficult to understand. Have you considered the confusion for people who have never had health insurance, or perhaps have not had it for a really long time? According to Drew Altman, president and CEO of the Kaiser Family Foundation, health insurance literacy is something that we as a society should work to improve. Here are some key points regarding the new insurance marketplace and ACA that Altman asks us to consider:

  • 37% of enrollees don’t know the amount of their deductible
  • only 46% of enrollees say they are getting a subsidy, when the official numbers indicate 85% are actually getting them
  • many enrolled have no understanding of basic insurance terms like premium, deductible, copayment, coinsurance, maximum annual out-of-pocket spending, provider network, covered services, annual limits on services or excluded services
  • people with lower incomes are less likely to understand the key elements of insurance (the people who need coverage the most understand it the least)

confusedamericans-randdotorg

Altman also points out that people gaining new coverage are also expected to understand the intricacies of provider networks in the plans they choose, particularly if they have a health problem requiring specialty care. Otherwise, they’ll face high out-of-pocket costs when they visit out of network provider specialists. Understanding how drug coverage works is also important when dealing with tiers. Most of us understand that brand-name drugs cost much more than generics — but what about the folks who don’t know that? We all have a role to play to improve health insurance literacy. Unfortunately, as Altman points out in his article that appeared recently on WSJ’s Washington Wire, A Perilous Gap in Health Insurance Literacy, many of us get tested on our knowledge every time we access our health care plan.

Here are two info graphics that can help you get started with improving the health insurance literacy of the people you know:

We are the 90 by CommunicateHealth.com

The Facts about Health Literacy by Healthcare IT News

 

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