One out of three Missouri participants in Medicare’s prescription drug program were prescribed opioids last year, more than the national rate of 29%, according to a newly released government report.
About 973,000 Missourians were enrolled in Medicare Part D and 321,000 of them received opioids, the report by the U.S. Department of Health & Human Services’ inspector general finds.
Although the proportion of Missouri beneficiaries who received opioids has fallen every year since 2016, it was still higher than the national rate each of those years.
The inspector general study, part of an ongoing examination of opioid use in the Medicare Part D program, concludes that Missouri needs to take effective steps to address the opioid epidemic and suggests that it institute a statewide prescription drug monitoring program.
Missouri is the only state without such a program, which makes it easier for beneficiaries to engage in doctor shopping and tougher to detect the abuse of prescription drugs.
State health officials have taken a number of steps to combat the opioid epidemic, including creating a community response team to address the problem in St. Louis, where overdose deaths are the highest in the state.
Other steps include expanded access to Naloxone to counter the effects of an opioid overdose, increased disciplinary and enforcement actions against opioid prescribers, and identifying areas of the state at greatest risk for opioid overdoses.
"What we are dealing with in Missouri is an increased presence of fentanyl and carfentanil, which presents an even greater risk for opioid overdose," Randall Williams, director of the Missouri Department of Health and Senior Services, said earlier this summer.
All told, there were 47,600 opioid-related overdose deaths in the United States in 2017, making it the nation’s leading cause of injury-related death, according to the Centers for Disease Control and Prevention. Opioid addiction is thought to be a factor in the decline in life expectancy in the U.S.
Missouri’s rate of opioid-related overdose death, 16.5 per 100,000 people, is higher than that of the nation, at 14.6 per 100,000 people, according to the inspector general’s report.
The Missouri counties with the highest rate of opioid use among Medicare beneficiaries were concentrated in southeast Missouri, the site of some of the poorest counties in the state.
In seven southeast Missouri counties, at least 41% of Medicare Part D beneficiaries received at least one opioid last year. That contrasts with the Kansas City metro, where 32% of beneficiaries in Jackson and Clay counties and 31% in Platte County received at least one opioid.
All told, nearly 10,000 beneficiaries statewide received high amounts of opioids even though they did not have cancer and were not in hospice care – two circumstances where opioid prescriptions are deemed appropriate. Of those, 1,400 received what the inspector general’s report described as “an extreme amount” of opioids and another 240 appeared to have engaged in doctor shopping.
“A beneficiary’s receiving extreme amounts of opioids or receiving high amounts of opioids from multiple prescribers and pharmacies raises concern,” the report states. “It may signal that the beneficiary’s care is not being monitored or coordinated properly or that the beneficiary’s care needs to be reassessed. It may also indicate that the beneficiary is seeking medically unnecessary drugs, perhaps to use them recreationally or to divert them or that the beneficiary is addicted to opioids and at risk of overdose.”
The study cites one beneficiary who received 47 opioid prescriptions from 14 prescribers and filled them at six different pharmacies, according to the report. All of the prescriptions were for oxycodone.
It cites another beneficiary who received 42 opioid prescriptions from 18 prescribers and filled them at nine different pharmacies. In just one month, the same beneficiary received eight opioid prescriptions from six different prescribers and filled them at three different pharmacies.
“The severity of the national crisis makes it imperative that States, including Missouri, take effective steps to address the epidemic,” the study concludes. “In 2018, Missouri began limiting certain initial prescriptions of opioids. Starting in 2021, Missouri will require electronic prescribing of opioids, in most cases. In addition, Missouri is coordinating with its partners to increase prevention, treatment, and recovery services.”
Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.