Welcome to this month’s edition of Comp Medical News, an essential update series. Naloxone, a massive kickback scheme, and public health funding are your headlines leading into December.
First, government regulation and personal struggles remain as two disparate halves in the fight to rein in opioid prescribing practices across the country:
Most Americans Now Cite a Personal Tie to Prescription Opioid Abuse
A new poll from the Kaiser Family Foundation found that over 56 percent of Americans have a personal tie to opioid abuse. That share includes those who say they know someone who died from a painkiller overdose, have been addicted themselves or know someone who has, and those who have taken painkillers not prescribed to them or know someone who has done so. The results show a sharp racial divide, similar to several other surveys on the issue. A full 63 percent of whites say they have a personal connection to the abuse of prescription painkillers compared with 44 percent of blacks and 37 percent of Hispanics. Respondents offered up treatment for addicts and closer monitoring of doctors as key efforts that could make a difference, however, 62 percent would restrict naloxone (a drug that reverses opioid overdoses) to those with a prescription for it. Kaiser’s tracking poll was conducted November 10th to 17th among 1,352 adults. The margin of error for the full sample is +/- 3 percentage points.
Read more from Kaiser Health News here.
Activists Push for Cheaper, More Available Naloxone in Face of Surging Overdose Rates
Anti-drug and harm reduction activists have banded together in an unusual convergence of messages related to the availability of naloxone, an opioid overdose “antidote.” As overdoses from all opioids (both illegal and prescription) in the U.S. have hit highs not seen in decades, people in the hardest hit areas of the country are training each other how to administer and acquire naloxone in an effort to save lives. The training focuses on how to use injectable naloxone, which is less user-friendly to non-medical personnel than the nasal formula. A Reuters report followed a Bullitt County Kentucky mother, whose 25-year-old son is a recovering addict, in her effort to organize the local population.
Read the story here.
CDC Under Pressure to Complete Opioid Guidelines
The CDC announced its intention to develop a set of comprehensive opioid guidelines several months ago, but the agency has been playing it close to the vest since then, only distributing a draft to certain individuals and organizations. However, that has not prevented a tide of criticism from all sides. Pain patient advocacy organizations have stated their concern that further tightening prescribing practices could lead to undertreatment of pain and potentially drive some sufferers to illegal means, while Congress and the health industry are encouraging the CDC and stakeholders to meet a more aggressive timeline. The perceived lack of transparency was criticized by a group of thirteen organizations in a letter to the CDC, most notably including the American Academy of Pain Management and the American Cancer Society. Though several states have their own regulations aimed at curbed opioid abuse, practitioners are likely to use the CDC guidelines, when they are finally published, as the new standard of care.
Read more about this issue from WorkCompCentral (paid subscription required) here.
Next, spending on drugs and tests – chiefly the ineffective ones – garners scrutiny, all as public health spending seems set to continue declining:
FDA Targets Inaccurate Medical Tests, Citing Dangers and Costs
The New York Times reports that the FDA issued guidance to Congress that inaccurate medical tests and treating patients for conditions that they do not actually have is putting a huge burden on the American medical system in the modern age. The FDA report involved twenty case studies for expensive ailments, including heart disease, autism and cancer. Researchers gave examples from these case studies, such as an ovarian cancer test that was never shown to be effective, but was used anyway, fetal abnormality tests that were actually false-positives, and a genetic variant test for heart disease in which the link between the two was never proven. In all, the agency concluded: “Patients have been demonstrably harmed or may have been harmed by tests that did not meet FDA requirements.”
Read complete coverage from NYT here.
Global Drug Spending to Increase 30 Percent by 2020
New research from the IMS Institute for Healthcare Informatics has found that more than half of the world’s population will live in countries where medicine use will exceed one dose per person per day by 2020, up from 31 percent in 2005, as the “medicine use gap” between developed and emerging markets narrows. IMS expects total spending on medicines to reach $1.4 trillion by 2020 due to greater patient access to chronic disease treatments and “innovations” in drug therapy and forecasts a four to seven percent global compound annual spending increase over the next five years.
Read the results and access the report via Workers’ Compensation 360 here.
AMA Calls for a Ban on Direct-to-Consumer Drug Advertising
The American Medical Association made a high profile call on members and regulators to ban the pharmacy ads on TV and in popular magazines that have become commonplace. The organization claims that such ads drive patients to demand expensive treatments over less costly, but equally effective methods. The new policy reflects the AMA’s perception that physicians are concerned that direct-to-consumer marketing is helping to drive up drug prices. The group voted at its annual meeting in Atlanta to support a ban. For context, the United States and New Zealand are the only two countries in the world that allow popular advertisement of prescription drugs. A series of court decisions has determined the ads cannot be banned outright because they are a form of commercial speech protected by the U.S. Constitution. The AMA did not address how the ban could be accomplished without being overturned in court.
Read further coverage from Reuters here.
National Public Health Spending Continues to Fall
According to a new analysis by the American Journal of Public Health, U.S. public health spending has steadily decreased in recent years and the trend is expected to continue. According to a Reuters report on the data, real, inflation-adjusted public health expenditures surged from $39 per capita in 1960 to $281 per capita in 2008, then fell 9.3 percent to $255 per capita in 2014. Public health’s share of total U.S. health expenditures rose from 1.36 percent in 1960 to 3.18 percent in 2002, then fell to 2.65 percent in 2014. By 2023, public health’s share of total health expenditures is projected to fall to 2.4 percent. The Affordable Care Act contained provisions to boost public health spending by $15 billion, but the funds have been cut due to legislative efforts aimed at limiting the law’s impact. Public health appropriations for the 2015 fiscal year are less than half of the $2 billion originally budgeted.
Read more from Reuters here.
Finally, a major fraud scheme in California is linked to the ongoing massive Drobot scandal:
Five People, Including Two Doctors, Charged in Kickback Schemes Involving Nearly $600 Million in Fraudulent Claims
The U.S. Justice Department announced last week that, in a series of related cases, the former CFO of a Long Beach, California, hospital, two orthopedic surgeons and two others have been charged in long-running health care fraud schemes that illegally referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings over an eight-year period. According to the Justice Department statement as published on November 23rd, “two of the defendants have pleaded guilty and three others have agreed to plead guilty in the coming weeks. All five defendants have agreed to cooperate in the government’s ongoing investigation.” The accusations center around tens of millions of dollars in illegal kickbacks to dozens of doctors, chiropractors and others. As a result of the illegal payments, thousands of patients were referred to Pacific Hospital in Long Beach, where they underwent spinal surgeries, despite in many cases being closer to other qualified medical facilities.
The statement notes that “many of the fraudulent claims were paid by the California workers’ compensation system and the federal government” and explicitly links the cases to Michael D. Drobot, the former CEO and owner of the same Pacific Hospital, who pleaded guilty to participating in the scheme in April 2014.
Image Credit: OrthoSpineNews