Welcome to this month’s Comp Medical News recap. Local efforts to expand health coverage under Medicaid and care for addiction, plus new opioids research and a doctor lamenting the time when physicians were “artisans” are your headlines for June 2016.
First, Louisiana’s health care system is making big strides:
Louisiana Begins Medicaid Expansion Enrollment
The Department of Health and Hospitals today (June 1st) began the task of enrolling 375,000 people across the state into a Medicaid expansion project under the Affordable Care Act. The expansion was a major campaign promise from Governor John Bel Edwards and stands to provide health coverage to the state’s most vulnerable populations. The Department’s goal is to have at least half of the estimated 375,000 eligible persons signed up, coverage card in hand, by July 1st. The increase in coverage statewide could benefit workers’ comp insurers in cases when a claimant lacking health insurance seeks treatment via workers’ comp for injuries that may not be work-related. Louisiana will have 204 Medicaid application “sister sites” where people can apply in person. View a list of those sites and their locations here.
Read more about the expansion efforts from NOLA.com | The Times-Picayune here.
CVS and Walgreens Stores will Sell Naloxone without Rx in Louisiana
CVS and Walgreens announced late last month that it will begin stocking and selling naloxone (often referred to by the brand name Narcan) in its stores without a prescription. Naloxone is a drug that can be injected or sprayed into the nostrils to reverse an opioid overdose. Law enforcement officials, firefighters and emergency medical technicians have already received expanded access to the antidote in Louisiana and other states in the face of surging overdose emergency calls, but opioid users and their families previously needed a prescription in order to have naloxone on hand. Local public health officials applauded the move, noting that the national opioid crisis cuts across all demographics and expanding access to naloxone could help those users unable or unwilling to consult a physician about their overdose risk.
Read more from The Advocate here.
The opioid news continues with new research in three areas: back pain, genetic testing and surgery, plus a new device for users in treatment:
Meta-Analysis Finds No Benefit from Opioids for Low Back Pain
Recommended doses of opioid analgesics (range 40.0-240.0-mg morphine equivalents/day) did not provide clinically meaningful pain relief (> 20 points on a 0-100 point pain scale) in people with chronic low back pain, Andrew J. McLachlan, PhD, of the University of Sydney, and colleagues reported online in JAMA Internal Medicine. Further, in half of 13 randomized clinical trials reviewed, at least 50 percent of participants withdrew because of adverse events or lack of response. The authors noted that the results show that the popular conception of opioids as more powerful and/or effective than other analgesics is false.
Read more from MedPage Today here.
Opioid Rx for Low Risk Surgeries High, Likely Unnecessary
Adults that had not previously had significant exposure to opioids were prescribed over time an increasing mean opioid morphine equivalent for postoperative pain, despite the fact that they had undergone low risk surgeries like carpal tunnel release, gallbladder removal, inguinal hernia repair and knee arthroscopy. The study authors evaluated a cohort of 155,297 patients from the Clinformatics Data Mart Database. Within seven days after surgery, 80 percent of patients filled a prescription for an opioid, with 86.4 percent of prescriptions for either hydrocodone-acetaminophen or oxycodone-acetaminophen. The authors, publishing in JAMA, were surprised by the amount of opioids prescribed per day for procedures that are considered relatively minor and, therefore, “are unlikely to be associated with a lot of postoperative pain for most people.”
Read more via Pain Medicine News here.
Genetic Testing Could Determine Addiction Risk
Two companies — Proove Biosciences and Innovative Medical Testing have launched tests to add genetic information to a clinician’s toolbox to determine the likelihood of a patient becoming addicted to opioids. Currently, prescribers assess factors like personal and family history, plus environmental and social factors, to make decisions about the appropriateness of opioids. Both companies’ tests are already being used at clinics around the country, however, academic geneticists have remained skeptical of the tests’ utility, given that there is no data on actual predictive capability.
Read more via MedPage Today here.
FDA Approves the First Implant for Medication-Assisted Opioid Addiction Treatment
The FDA recently approved Probuphine, the first buprenorphine implant for the maintenance treatment of opioid dependence. Probuphine is designed to provide a constant, low-level dose of buprenorphine for six months in patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program. Previously, buprenorphine (often called “bupe”) for the treatment of opioid dependence was only approved as a pill or a film placed under the tongue or on the inside of a person’s cheek until it dissolved. While effective, a pill or film may be lost, forgotten or stolen.
The new device is a step forward for medication-assisted treatment (MAT), which President Obama has publicly promoted as an important tool in the fight against the nation’s opioid crisis. According to an NPR report, the device doesn’t work for everyone. During the study on Probuphine, 12 percent of patients who had implants relapsed. But the relapse rate for the pill version of the drug was 28 percent. The implant is also far more expensive than pill-based buprenorphine treatment, but is expected to be almost on par with monthly MAT injections.
Finally, a doctor urges the world to rethink the trend toward cookbook medical care:
Doctor Yearns for a Return to the Physician as Artisan in New Book
In his recent book, The Finest Traditions of My Calling, Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.
Read an interview with Dr. Nussbaum from NPR here.
Image Credit: Sober Nation