Rogue prescribers and Medicaid “doctor shoppers” are using taxpayer-funded insurance to fuel the deadly opioid epidemic, according to a new audit Tuesday that found 1 in 6 people on Ohio’s government-run health program for the poor were prescribed opioids and hundreds of them were at “serious risk” of overdosing.
One Medicaid patient racked up 41 prescriptions from 16 prescribers and eight pharmacies during a one-year period.
Another tapped 15 different prescribers for 22 prescriptions, six of which were obtained from a doctor 145 miles away from home, according to the Health and Human Services Department’s inspector general.
“Our results suggest that some prescribers and pharmacies may not be following Ohio’s opioid prescribing policies, potentially putting Medicaid beneficiaries at risk,” the IG report says, noting that doctors should see whether patients have a history of substance abuse, adhere to federal guidelines on opioid dosing, and see whether patients are getting prescriptions elsewhere.
The inspector general’s office said it is poring over claims to examine opioid use under Medicaid — the federal-state insurance program for the poor — as a nationwide addiction crisis kills more people than gun homicides and car crashes combined.
The HHS watchdog said it will look at other states but started with Ohio, which suffers from one of the worst overdose rates in the nation and lost nearly 3,500 people to the epidemic in 2016.
“It is sad that even at this late date, doctor shopping and opioid abuse is still a serious problem,” said Richard C. Ausness, a University of Kentucky law professor who tracks the issue. “This is no doubt a problem in other states as well and won’t go away any time soon.”
Between June 2016 and May 2017, roughly 540,000 of the nearly 3.5 million people enrolled in Ohio Medicaid received an opioid, including 40,500 residents under age 18, even though research shows using prescription opioids for “legitimate purposes before high school graduation is associated with increased risk of future opioid misuse,” the IG report said.
A small share of those receiving pills needed them for pain related to cancer treatment or hospice care, and opioid use can be appropriate under other circumstances, too. But the inspector general’s office and key lawmakers found ample cause for alarm.
Sen. Rob Portman, Ohio Republican, found it shocking that tens of thousands of children without cancer were receiving opioids. His office said it underscored the senator’s legislative push for a three-day prescribing limit for acute pain.
“Too many patients, including children, continue to be prescribed opioids when they may not even need them,” said Portman spokesman Kevin Smith.
Investigators said nearly 5,000 Ohio beneficiaries received what’s considered to be a “high” amounts of opioids, including about 480 who received “extreme” amounts — defined as an average morphine equivalent dose of more than 240 milligrams daily for at least 12 months.
The IG said those receiving extreme amounts — plus 231 other enrollees who appeared to be “doctor shopping” by receiving prescriptions from multiple physicians and pharmacies — are at serious risk of overdose.
“We have long known that doctor shopping exists and that is certainly true in Medicaid,” said Keith Humphreys, a Stanford University professor in psychiatry and behavioral sciences. “It is also true in Medicare, but that is rarely brought up because senior citizens are a group every politician is terrified to offend.”
The inspector general warned that excessive doses under Medicaid will result in diversion of those pills to recreational use and street sales, and some users will turn to heroin.
Heroin is often laced with potent fentanyl, which is driving opioid-related overdose deaths that reached 42,000 in 2016. That number likely increased in 2017, though government officials are still collecting the data.
Ohio has been trying to crack down on overprescribing, the inspector general noted. For instance, it saw a decline from 2016 to 2017 in the number of high-dosage opioids doled out and greater use of its prescription-drug monitoring program, to ensure patients don’t get opioids elsewhere.
“However, the fact that some Medicaid beneficiaries continued to receive high amounts of opioids despite these protections suggest that some prescribers may not always adhere to these policies,” the IG report says.
The IG report singled out 47 prescribers who doled out opioids to multiple Medicaid enrollees at serious risk of overdose.
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