The following is an excerpt from the 2018 Magellan Community Impact Report.

It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

No one is exempt from experiencing the effects of the opioid crisis. Magellan’s own Janet Edwards, RN, senior clinical director of Magellan’s Chronic Pain Management program, describes how close to home the opioid epidemic hit her:
It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

“My daughter, Nikki, was 26 when she  died of a Fentanyl overdose. As the mother of a six-year-old and a critical care nurse working in a respected healthcare organization, Nikki was the picture of success. But to handle the pressures of nursing school, a full-time job, and life as a single mother, Nikki sought prescriptions for Adderall and Xanax from multiple physicians. Over time, her addiction to these substances gave way to a new addiction: Fentanyl, which she began to confiscate from the critical care unit where she worked.
Like many others, Nikki didn’t show any signs of addiction. But five years after her son was born, Nikki sat at my kitchen table and admitted that she was addicted to heroin. She was afraid to get help, because she did not want to lose her job or the respect of her peers. She insisted she could recover on her own. Even though I, as a nurse, knew the odds were not good that Nikki could manage her recovery alone, I respected my daughter’s wishes. It’s a decision I will forever regret. Eleven months later, Nikki died of an accidental overdose in front of her son and a friend.”

Following the loss of her daughter, Janet has openly shared Nikki’s story, becoming an advocate for helping prevent opioid addiction. Further, Janet has taken on clinical leadership of Magellan’s Chronic Pain program, which offers alternatives to opioid use.

Meeting opioid users where they are

No matter where or how someone encounters opioids or where they may be in the cycle of use, dependence or addiction, Magellan offers many other ways to address the opioid problem. Our behavioral health products forged from decades of serving the public, our specialty healthcare solutions supported by clinical excellence, and our customized pharmacy programs are ready to answer the call as organizations and individuals look for answers.
Hosting a forum for sharing successes  and discussing solutions

In September 2018, Magellan brought together  national and local leaders in Pennsylvania to  exchange ideas, share successes and  discuss solutions to the opioid  epidemic in our communities.  The free, second-annual  conference featured  keynote addresses and  workshops and highlighted  the proactive efforts of local  organizations. Participants included  national and state officials, county human  services and drug and alcohol leaders, legislative  staff, providers and community stakeholders.

Not staying silent on the silent epidemic

Magellan is actively helping individuals and families on their path to recovery. Further, to educate the public, doctors and other healthcare providers, we offer resources on our Magellan Health OPIOID INSIGHTS microsite. The site includes links to blog posts, videos, resources and published articles.

Hosting a forum for sharing successes and discussing solutions

InSeptember2018, Magellan brought together national and local leaders in Pennsylvania to exchange ideas, share successes and discuss solutions around the challenge we face together in addressing the opioid epidemic in our communities. The second-annual conference featured keynote addresses and workshops and highlighted the proactive efforts of local organizations. Participants at the free one-and-a-half-day conference included national and state officials, county human services and drug and alcohol leaders, legislative staff, providers and community stakeholders.

Primary care providers can be responsible for everything from first line dermatology to behavioral health to musculoskeletal injuries. In a world of rapidly changing technologies, and in which new therapies can cure or alter diseases that only a few years ago would have never been thought possible, the basics still matter. As a clinician, I’ve practiced internal medicine and psychiatry, and still have the opportunity to work with a FQHC in building integrated care. Those experiences and my national view of utilization and prescribing patterns highlight the need for provider support to care for persons with mental health conditions, including opioid use and abuse.

It is often challenging to translate new medical knowledge to the clinic setting. How does a provider care for the individual on a potentially lethal combination of opioids, benzodiazepines, and muscle relaxants? Or, how does one address the young child who has been placed on a combination of psychotropic medications.

In our current health system, primary care providers are in the best place to begin patient care journey or change the course of an already established treatment plan. An effective solution for supporting providers in delivering high quality care is in the form of provider support, especially through programs that involve data analytics, followed by one on one academic detailing. PBMs are in a unique position, having the ability to assist providers in working with patients on complex behavioral health or opioid regimens. PBMs have access to data that allows for identifying outlier member and provider behavior and finding patients who are at risk for adverse outcomes. While PBMs don’t have access to prescription drug monitoring programs, they can see what prescriptions are filled, where there is overlap, and where there are multiple providers interacting with a patient.

Magellan Rx developed the Live Vibrantly: Whole Health program to address those outlier providers and members, with the goal of achieving higher quality care. This program uses evidence-based algorithms to find members who may be at risk for adverse outcomes, and targets prescribers who may be over-prescribing. We become the provider’s go-to source for translating the evidence to the bedside through assistance with difficult issues, such as withdrawing an individual from high dose opioids. Through taking an approach to support providers in delivering high quality care, we’ve been able to truly partner in leading our members to leading more healthy vibrant lives.

By Sam Srivastava and Mostafa Kamal

This week, the federal government took a significant step forward in helping address the opioid epidemic with the signing of the nation’s first comprehensive opioid legislation.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addresses a broad range of Medicare, Medicaid, public health and law -enforcement issues and aims to advance the recovery landscape for individuals living with opioid use disorder (OUD) and other substance use disorders (SUDs).

As longstanding advocates for access to mental health and substance use disorder treatment and services, we’re deeply appreciative of the bicameral, bipartisan work of the Congress to successfully drive this critical effort forward. The legislation contains a number of impactful policies we at Magellan Health, and many others, have pushed for, including those recommended in our testimony to Congress this past spring. These critical policies promote clinically appropriate opioid prescribing, support opioid misuse prevention, and enhance access to evidence-based treatment and recovery services.

The signing of this law marks a significant milestone and step in the right direction, and we believe there are several ways it has the potential to address some of the day-to-day challenges of the nation’s opioid epidemic. Three key areas stand out.

Safer prescribing patterns. The SUPPORT for Patients and Communities Act encourages the use of safe and effective alternatives to opioids for pain management, which – in addition to clinically appropriate prescribing practices – are key in breaking the cycle of prescription opioid misuse. These include the establishment of grant programs incentivizing the use of non-pharmacological opioid alternatives, the required implementation of safety limits for opioid prescriptions, new electronic prescribing requirements in Medicare, and beneficiary screening requirements in initial Medicare prevention exams, to name a few.

Our experience demonstrates the power of these and other safe-prescribing interventions—such as the Centers for Disease Control and Prevention’s prescribing guidelines, which Magellan has already implemented—to reduce opioid misuse rates.

Americans consume 80 percent of all opioid painkillers produced worldwide—and the risk of addiction after just four or five days of treatment is high. Opioid prescribing rates have decreased in recent years thanks to nationwide efforts to ramp up provider education. Yet the supply of prescription opioids remains high – approximately 66.5 opioid prescriptions for every 100 Americans in 2016 – reflecting the work still needing to be done.

By exploring alternative therapies to pain management, including non-pharmacological digital therapies, we can eliminate the risk of opioid misuse and addiction, and also equip individuals living with chronic pain with the tools and resources needed to live healthier, more vibrant lives.

Boosted access to evidence-based treatment. One of the most effective, evidence-based treatments for OUD is medication-assisted treatment (MAT)—considered the gold standard for reducing the risk of overdose and death. When combined with psychosocial interventions, like cognitive behavioral therapy and contingency management, and recovery supports, including peer and family, MAT empowers the recovery journey while building resiliency.

Increasing access to MAT is critical to promoting recovery and preventing relapse. Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT and, as a result, access to care is often limited or stigmatized. The SUPPORT for Patients and Communities Act expands providers’ ability to prescribe MAT, including by expanding eligibility for certification to new provider types. With stigma also playing a role in the lack of widespread adoption of MAT, this provision is a solid and necessary step toward expanding access to treatment.

Reaching underserved communities. The SUPPORT for Patients and Communities Act facilitates telehealth options for OUD treatment. In communities with limited resources for one-on-one OUD recovery support, telehealth services or a combination of virtual and in-office services provide the basis for the most evidence-based, person-centered and well-rounded approach to treatment. The package also authorizes pilot programs to provide temporary housing services for individuals recovering from OUD. We believe this is crucial to supporting those living with OUD and other SUDs, especially in rural and underserved communities, return to healthy and vibrant lives.

 The SUPPORT for Patients and Communities Act provides practical policy solutions necessary for addressing this national crisis. From expanded treatment options, to more effective care coordination, to improved prescription drug monitoring programs used to enhance detection and prevention of opioid misuse in real time, this legislation is an important step in the right direction.

We applaud Congress and the Administration on this bipartisan effort and important law, which will have a deep and lasting impact on health for generations to come.

 About the authors:

Sam Srivastava is Chief Executive Officer of Magellan Healthcare, and Mostafa Kamal is Chief Executive Officer of Magellan Rx Management.

There is no mistaking that opioid addiction is a major social issue in the United States but there is also a lot of confusion and misinformation. We’ve included seven frequently asked questions about opioid addiction below.

1) What are opioid medications?

Opioids are medications prescribed to relieve physical pain. Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain’s reward areas, and producing intense feelings of euphoria. As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dangerously high tolerance levels, dependence, and later, addiction.

2) What are the names of some common opioid medications?

• Codeine

• Fentanyl citrate

• Hydrocodone (e.g., Vicodin)

• Hydromorphone (e.g., Dilaudid)

• Mepedridine (e.g., Demerol)

• Morphine (e.g., Kadian, Avinza)

• Oxycodone (e.g., OxyContin, Percocet)

3) What are opioid medications used for?

Opioids are used to treat moderate to severe pain that may not respond well to other pain medications. They provide relief from an array of symptoms associated with respiratory illnesses, severe coughing, injuries, trauma, surgery, dental procedures and chronic pain.

4) How do people become addicted?

Taken as prescribed, opioids can be used to manage pain safely and effectively. However, since these drugs also affect the brain regions involved in reward, some people experience a euphoric response. Those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed.

5) What is the difference between opioid dependence and opioid addiction?

Physical dependence on opioids means that the body relies on an external source of opioids to prevent withdrawal. Normally the body is able to produce enough endogenous opioids (i.e., endorphins) to prevent withdrawal. However, as tolerance increases over time, eventually the body’s ability to maintain its equilibrium is exceeded and the body becomes dependent on the outside source of opioids. Physical dependence is predictable, easily managed with medication, and is ultimately resolved with a slow tapering off of the opioid.

Unlike physical dependence, addiction is a change in behavior caused by biochemical changes to the brain after continued substance abuse and it is classified as a disease. Addiction takes the form of uncontrollable cravings, the inability to control drug use, compulsive drug use, and continued use despite doing harm to oneself or others. Strong cravings are common to all addictions. These cravings are rooted in altered brain biology. Recovery is the process of reversing, to the extent possible, these brain changes. This is accomplished through therapy and replacing the addictive behaviors with healthy alternative behaviors.

6)  What are the signs of an opioid addiction?

• Constricted pupils

• Nausea

• Itchiness

• Drowsiness

• Reduced social interaction

• Anxiety

• Poor memory and concentration

• Slowed breathing, movement and reactions

• Mood swings

• Apathy and depression

7) What does treatment involve?

Opioid addiction is a chronic disease, like diabetes, asthma and hypertension. While it can’t be cured, it can be treated to help the person regain a healthy, productive life. Treatment programs typically include detoxification, medication for opioid withdrawal, counseling and the support of family and friends. The goal of the treatment program is to help the person get through the withdrawal successfully and learn new coping skills to address addictive behaviors over the long-term.

Additional Resources

Centers for Disease Control and Prevention (CDC)

The CDC website features a section devoted to opioid information, data and FAQs. In addition, there are guidelines for prescribing opioids for chronic pain to help ensure patients have access to safer treatment options.

National Institute on Drug Abuse (NIDA)

NIDA provides information odrugabuse.govn commonly abused drugs, the latest science and treatments, trends and statistics to improve individual and public health.

The American Society of Addiction Medicine

A society of physicians aimed at increasing access to addiction treatment. They offer a nationwide directory of addiction medicine professionals.

The Substance Abuse and Mental Health Services Administration (SAMHSA) or 1-800-662-HELP

Find locations for residential, outpatient, and hospital inpatient treatment programs for drug addiction and alcoholism throughout the country.

The Partnership at Drugfree.org or 1-855-378-4373

Provides information and resources on teen drug use and addiction for parents to help them prevent and intervene in their children’s drug use or find treatment for a child who needs it.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about opioid addiction here.

1. Those who abuse prescription opioids are 40% more likely to use heroin than those who don’t.
2. The United States consumes 80% of the world’s prescription painkiller supply, despite not even making up 5% of the world’s population.
3. It’s possible to die the first time you use cocaine, consumption quadruples the risk of sudden death.
4. An estimated 88,000 people die per year due to alcohol.
5. Only about 11% of those addicted to drugs or alcohol actually receive treatment for their substance abuse disorder.

Source: Drugabuse.com

“Strung out. Looking for the next fix. A full time job that doesn’t pay, but just takes.”

That’s how one of Magellan’s Recovery Support Navigators defined her addiction to opiates. She has since overcome the stranglehold of addiction and is now in long term recovery.  Her experiences, and those of her fellow Recovery Support Navigators, provide the credibility needed to influence their peers who are still struggling with addiction and mental illness that recovery is possible and that desperation does not have to define a life.

An estimated 20.2 million Americans live with a substance use disorder[1]. That’s the population of my home state of Florida. Of that, 2.1 million Americans live with an opioid disorder. Similar to serious mental illnesses, substance use disorders can be difficult to address. Those with the lived experience of walking the path from hopelessness to wellness are experts at engaging individuals with the services and supports that foster the recovery process. Stories of changed lives are not the only proof.

A January 2018 study of our internal recovery support navigation program at Magellan Health found statistically significant improvements for individuals living with substance use and mental health disorders. A key component of the Magellan’s internal peer support program is meeting people where they are. The first engagement with members often happens in an emergency room, inpatient setting, or on the streets. Members then choose where future meet-ups happen. Often, that choice is in the comfort of their own home.  If they are experiencing homelessness, the member chooses a safe place.

The study compared utilization of services six months prior to receiving peer support services and six months following the completion of peer support services. Seventy-five percent of the members in the study had a co-occurring mental health and substance use disorder and 50 percent had a co-occurring substance use disorder, mood disorder and psychotic disorder. The study found that members in Magellan’s internal peer support program cost the health plan significantly less in the six months following completion of the peer support program than members who only had care management or who did not receive any intervention from the health plan. The study also found that six months after completing peer services, peer support decreased emergency room and inpatient hospitalizations.

The role modeling by a peer specialist of a life lived well in recovery is evidence for the individual struggling that there can be long term sustainment of recovery. In addition, the data from this study replicates prior findings that peer support has a lasting impact on the lives of those living with substance use and mental health disorders.

[1] Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders

The following is an excerpt from an article appearing in Advances in Addiction & Recovery

Deaths from prescription opioid abuse have more than quadrupled since 1999, prompting President Donald Trump to declare the opioid epidemic a national public health emergency.[1] But while discussions around opioid abuse prevention have intensified, numerous barriers to recovery continue to exist.

For example, one of the most effective ways to combat opioid addiction is through medication-assisted treatment (MAT), an evidence-based approach that combines medication with psychosocial intervention. MAT empowers those suffering from opioid use disorder (OUD) to recover from their addiction while rebuilding their lives.

However, the stigma often related to MAT—on the part of both the medical community and addiction support professionals as well as family members of patients—continues to limit its use across the industry. Further, the need to educate communities and legislators about the complex issues surrounding addiction treatment cannot be overstated. Addiction should be considered a chronic condition, and such treatments need to be viewed the same way.

You can read the rest of the article on pages 24-25 in Advances in Addiction & Recovery.

[1] https://www.cdc.gov/drugoverdose/epidemic/index.html

Magellan Health today announced the launch of a new thought leadership website, www.MagellanHealthResources.com.

With a curated assortment of materials, focused around individual topics, Magellan Health Resources was designed as a repository of research, information and materials for healthcare professionals, members of the media and researchers.

To launch, Magellan Health Resources is showcasing information and materials around the opioid crisis.

The site includes videos  webinars, downloadable white papers, research, a news archive and more.

You can take a look here