As the opioid epidemic deepens, Yale researchers say starting treatment with medication is the most cost-effective way to treat patients in hospital emergency departments. People with opioid addiction often seek treatment in EDs for overdoses and other ailments. Those who receive buprenorphine, a medication that reduces drug cravings, in the ED incur lower health care costs over the following month than those who get a referral to treatment services or receive a brief intervention with a facilitated referral, according to a new analysis of a randomized clinical trial. The analysis, published today in the journal “Addiction,” compared the estimated health care costs for patients over the 30 days following their ED visit. Those costs included ED care, addiction treatment, inpatient and outpatient costs and medications.
Stephanie Almada’s journey to opioid addiction began with a prescription to relieve her premenstrual symptoms and accelerated after she had a cesarean section. “The pain pills came, you know, very quickly and I had bottles at home anyway,” she said. “And then it became energy for me. It became the way I coped with life.” Today Almada, 44, is a peer recovery specialist at Wheeler Clinic in Plainville, where she helps women get off opioids. Americans are using opioids at record rates.
In less than eight hours last June, Yale New Haven’s emergency department treated 12 patients who had overdosed on opioids. Three died; nine were saved. With opioids in wide circulation, Dr. Gail D’Onofrio, chief of emergency medicine at the hospital and chair of emergency medicine at Yale School of Medicine, isn’t sure that one-day spike will stand as a record. “To be honest, no, I don’t expect the numbers to get better,” D’Onofrio said. “We’re going to have more treatment options in Connecticut, I think, more safe prescribing — but I don’t know that we’ll see improvements in the numbers of people using.”
D’Onofrio’s concerns are borne out in a recent report by the Agency for Healthcare Research and Quality (AHRQ) that ranks Connecticut the 5th highest among 30 states in the rate of opioid-related emergency department (ED) visits — 254.6 per 100,000 population in 2014, well above national rate of 177.7.
A federal judge has agreed to a six-month delay in sentencing a Derby nurse who pleaded guilty to accepting kickbacks in exchange for prescribing a powerful opioid painkiller because she is cooperating in “numerous ongoing criminal investigations,” according to court records. U.S. District Judge Michael Shea approved a Jan. 17 agreement between federal prosecutors and attorneys for Heather Alfonso that delays her sentencing another six months, until July 2017. Alfonso was charged in June 2015 with accepting $83,000 in kickbacks from Insys Therapeutics in exchange for her high prescribing of the drug Subsys. In arguing for the new sentencing delay, the U.S. attorney’s office in Connecticut said Alfonso “continues to cooperate in (investigations in) several federal and state jurisdictions, including the District of Connecticut.” A previous story by C-HIT reported on prior sentencing delays because she was cooperating in an ongoing federal probe.
In an unusual move, the FBI is reaching out publicly to patients who were prescribed the powerful narcotic medication Subsys, which federal agents allege was improperly dispensed by practitioners across the country, including a nurse in Derby. In a posting on its Victim Assistance Program website, the FBI asks people who were prescribed Subsys between March 2012 and December 2016 to complete a brief questionnaire that will assist in a federal probe of Insys Therapeutics, the company that makes Subsys. The appeal follows the indictments in December of six top executives and managers of Insys on charges they led a nationwide conspiracy to bribe doctors and nurses to prescribe Subsys, which is approved for treating cancer patients suffering episodes of breakthrough pain. In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for patients, most of whom were not diagnosed with cancer, the indictments allege. One of the practitioners named in the indictments is Heather Alfonso, formerly an advanced practice registered nurse (APRN) at the Comprehensive Pain and Headache Treatment Center in Derby. She has pleaded guilty to accepting kickbacks from Insys through a sham “speakers’ program,” in exchange for prescribing Subsys.
Connecticut saw one of the highest increases in the nation in preventable deaths from unintentional injuries from 2010 to 2014, mainly because of a spike in opioid overdoses, according to a new report from the Centers for Disease Control and Prevention (CDC). An analysis of the report shows that the state’s rate of potentially preventable deaths from accidental injuries jumped 97 percent – the sixth- highest increase nationally, after Maryland, Massachusetts, New Jersey, New York and Virginia. Nationally, preventable deaths from accidents – namely, overdoses from prescription and illicit drugs, as well as falls – rose 23 percent. Connecticut had 1,142 unintentional injury deaths in 2014— the second highest in New England, after Massachusetts. About half (568) were accidental drug intoxication deaths, according to the Office of the Chief Medical Examiner.
Ten Connecticut prescribers, including a Derby nurse who is at the center of a federal kickback probe, were responsible for more than 23 percent of the state’s Medicare spending on opioids in 2014, suggesting that the largest share of those prescriptions is concentrated among a small number of clinicians. Recently released federal Medicare data show that Heather Alfonso, formerly a nurse with the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, and four other advanced practice registered nurses (APRNs) at the clinic in 2014 dispensed more than $8.4 million in opioids in the Medicare program – accounting for a full 15 percent of all such prescriptions in the state. They were among the top 10 opioid prescribers in 2014, who accounted for $13 million of the $56 million spent on the drugs, the data show. More than 4,800 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, fentanyl and other opioids. But the prescribing was not evenly spread out – only two-dozen prescribers wrote out more than $250,000 worth of prescriptions.
Connecticut’s shift next month from weekly to “real-time” reporting of prescriptions for opioids and other controlled substances is an effective way to help stem opioid-related deaths, a new study suggests. Researchers from Vanderbilt University who analyzed states’ prescription drug monitoring programs – central databases that log controlled substances dispensed to patients — found that programs that were “updated with greater frequency” and that reported data for a broad range of drugs were associated with greater declines in opioid-related deaths. The study in the journal Health Affairs comes as Connecticut prepares to put a policy in place requiring that pharmacies report controlled substance (Schedule II to V) prescriptions “immediately,” or at least within 24 hours after they are dispensed, into the central database, known as the Connecticut Prescription Monitoring and Reporting System (CPMRS). The CPMRS, maintained by the Department of Consumer Protection, can be accessed by doctors and pharmacists to give them a complete picture of a patient’s medication use, including prescriptions by other providers. It also can be used by law enforcement officials to investigate physician prescribing.
Taking certain prescription painkillers or anxiety medications for long periods of time may increase patients’ risk of death, according to a recent Yale School of Medicine study of veterans. Researchers who examined the medical records of about 64,000 veterans found that patients who took opioids or benzodiazepines long-term, for 90 days or more, had a higher risk of death – from any cause – than those who did not. The risk of death was even greater for patients who took both types of medication at the same time. More than a quarter of the veterans studied were HIV-positive, and they had a higher risk of death than those without the virus. Opioids are painkillers that include Vicodin and Oxycontin while benzodiazepines, such as Valium, typically are prescribed to treat anxiety and insomnia.
Lawmakers this session approved bills that put in place new initiatives to stem substance abuse and opioid overdoses, change the way restraints and seclusion are used in Connecticut schools and limit the use of shackles on juveniles in court. Those were just some of the legislature’s health and safety measures reported on by C-HIT during the year. The session, which ended last week, was largely dominated by budget and transportation issues. Under the bills approved:
• Any prescriber supplying more than a 72-hour supply of a controlled substance must first review the patient’s record in a statewide database. In addition, practitioners must review the patient’s record at least every 90 days if prescribing for prolonged treatment.