Medicare places few limits on opioid painkiller prescriptions, even in the face of recent U.S. government guidelines, researchers report.
Yale University scientists say Medicare plans for people 65 and older are untapped resources for curbing the unnecessary use and abuse of drugs such as oxycodone (OxyContin) and hydrocodone (Vicodin).
“People are looking for any way to control the increase in opioid-use disorder. This is one strategy,” said study first author Dr. Elizabeth Samuels. She’s a postdoctoral fellow in Yale’s National Clinical Scholars Program.
A previous study involving private insurers showed that certain practices can help curb use of addictive painkillers, the researchers said. Such measures include requiring prior authorization from insurers and setting quantity limits.
For this study, Samuels and her colleagues analyzed the “formulary files” — lists of allowable medicines — of the Centers for Medicare and Medicaid Services in 2006, 2011 and 2015. They zeroed in on Medicare coverage for all opioids except methadone.
In 2006, two-thirds of opioids were prescribed with no restrictions. That dropped to one-third by 2015, but too many of these drugs were still prescribed without limitations, the researchers found.
The risk for overdose increases with high doses of the powerful painkillers. Also, it’s widely believed that many Americans who became addicted to painkillers and heroin were initially prescribed opioids for pain relief, the researchers said.
In 2016 the U.S. Centers for Disease Control and Prevention released new guidelines for prescribing opioids. Doctors were urged to prescribe addictive painkillers at the lowest dose possible and preferably just for short-term pain relief, among other recommendations.
But Medicare is often the standard for other insurers, the study authors noted.
Despite some improvements in prescribing practices, the researchers said restrictions like those supported by the CDC accounted for just 13 percent of Medicare-covered prescriptions in 2015.
Meanwhile, Medicare coverage of opioids increased slightly between 2006 and 2015. “An increasing number of opiates were added to the formulary list,” Samuels said in a university news release.
The study was published Oct. 9 in the Annals of Internal Medicine.
The U.S. National Institute on Drug Abuse has more on opioids.
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