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Broker News | Vol. 7, No. 17 | August 24, 2012
Broker News | Vol. 7, No. 17 | August 24, 2012

Curbing Prescription Painkiller Abuse in Upstate New York

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Deaths from prescription painkillers have surged in the past decade. But efforts by Excellus BlueCross BlueShield and local health care providers have shown success in identifying and treating people at risk of abusing these drugs.

One in 20 people age 12 and older uses prescription painkillers for nonmedical reasons, without a prescription or for the “high” some drugs produce, according to the Centers for Disease Control and Prevention.

Excellus BCBS launched an initiative in 2007 to help doctors and patients safely treat pain and reduce abuse of prescription painkillers such as OxyContin and Vicodin.

As a result of the Excellus BCBS initiative:

  • More than 100 doctors and 50 outpatient chemical dependency providers in upstate New York are certified to treat patients with Suboxone, the first prescription drug approved for use in an outpatient setting to treat people who are addicted to painkillers.
  • The number of Excellus BCBS members receiving Suboxone treatment doubled from 2008 to 2011.
  • There were 10 percent fewer member visits to inpatient detoxification units in 2011 compared to 2009. More people addicted to prescription painkillers are now receiving care in the community through treatments such as Suboxone, avoiding what can be a lengthy, expensive and disruptive stay at an inpatient facility such as a hospital.

“Given our unique position as the largest nonprofit health plan in upstate New York, we have the data and resources needed to help providers fight what has become our nation’s largest drug problem,” said Mona Chitre, Pharm.D., clinical services director, Excellus BCBS.

The results have been published in a national publication, the CDMI Report (PDF).

Finding at-risk patients

To help providers identify which patients are at risk of abusing prescription painkillers, Excellus BCBS reviews claims data and issues reports twice a year to providers listing which patients are engaging in all three of the following risky behaviors:

  • Having more than 90 days of prescription painkiller therapy in a 180-day time frame;
  • Being prescribed painkiller therapy by three or more prescribers; and
  • Receiving painkiller prescriptions at two or more pharmacies.

In each report, Excellus BCBS has identified about 1,400 members who are at risk of abusing prescription painkillers and also offers support and resources to providers tackling this issue. The reports often trigger conversations between providers and patients about their care and treatment.

“Our initiative is yielding positive results,” said Chitre. “Seventy-seven percent of members we flagged in the initial reports were not flagged in subsequent reports, meaning that they no longer met the three triggers indicating a risk of abusing prescription painkillers. Unfortunately, each subsequent report identifies new members at risk for abusing these drugs.”


Suboxone is a newer treatment for patients addicted to prescription painkillers, and is a key part of a patient’s comprehensive addiction treatment plan. Excellus BCBS works with the health care community to recruit more doctors to become certified to prescribe Suboxone.

Certified doctors are limited by the federal government in how many patients they can treat with the drug. Doctors can treat no more than 30 patients with the drug in the first year of certification, and can obtain permission to treat up to 100 patients after the initial year.

Dr. Michael Foster of Gates Family Medicine, an eight-year prescriber of Suboxone in suburban Rochester, said a shortage of doctors prescribing the drug means that he typically has 30 to 40 people on a wait list for the medication.

“The medication is a terrific breakthrough,” he said. “The drug eliminates withdrawal symptoms, but doesn’t produce a narcotic high.

“The physical withdrawal from prescription painkillers is dramatic,” he added. “I’ve had patients cramping and writhing in pain on the floor, crying as they battled severe diarrhea and sweats, just because they went 24 hours without prescription painkillers.”

In addition to issuing reports to doctors and recruiting more Suboxone prescribers, the Excellus BlueCross BlueShield initiative also includes:  

  • Collaborating with local physicians to create community guidelines on how to assess and treat prescription painkiller addiction;
  • Eliminating preauthorization for Suboxone treatment of painkiller addiction;
  • Enhancing reimbursement to providers for prescribing Suboxone.

“If the health care community continues to collaboratively tackle this issue, more progress will be made in curbing prescription painkiller abuse,” Chitre said.

Click on the following links for video sound bites from the following experts:


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