Watchdog Report Finds Over-Prescription Of Opioids For Some Medicaid Patients

Dec 22, 2020

Clients waiting for addiction treatment services in Berkeley Co., WV.
Credit Rebecca Kiger

A report from a federal oversight agency shows that over 4,000 patients in the Ohio Valley received high amounts of opioids in 2018 through Medicaid, potentially putting hundreds at risk of addiction and overdose. 

 

The Office of Inspector General for the Department of Health and Human Services focused the report on six Appalachian states in support of their partnership with law enforcement agencies who are in the Appalachian Regional Prescription Opioid Strike Force.

 

The IG’s Office found through claims data from Kentucky, Ohio, and West Virginia that nearly 400 Medicaid patients in the Ohio Valley who received high amounts of opioids are at serious risk of opioid misuse or overdose.

 

Patients are considered at serious risk if they’ve received an extreme amount of opioids, which is defined as 32 tablets or more of 5 milligram Percocet every day for a year. 

 

Patients who appear to be doctor shopping, or receiving high amounts of opioids from multiple prescribers and pharmacies, are also considered at serious risk. 

 

The report found five prescribers in Kentucky and 13 in Ohio have questionable prescribing patterns.

 

“Even legitimate use of prescription opioids could cause harm and that’s why it’s so important that people only get prescription opioids when absolutely necessary and if they do get them that they are at the lowest dose for the shortest period of time possible that is consistent with good medical care,” Hilary Slover said. 

Slover served as a team leader for the study. This is the first time the IG’s office has done an analysis on the Appalachian region. 

“We have done this before in Ohio and in Ohio we saw a decline in the number of beneficiaries at serious risk and the number of providers with questionable prescribing practices since May 2017,” Slover said. 

The oversight agency is concerned with the potential impacts COVID-19 maybe having on treatment and opioid prescribing, according to Slover.

“During this time some Medicaid programs have relaxed rules and suspended safeguards like the requirement for face to face visits with prescribers to receive opioid prescriptions. In addition, patients may be experiencing reduced access to in person treatment and recovery support,” Slover said. 

 

The agency is encouraging states to expand enforcement of prescription drug monitoring programs and sharing that data with Medicaid agencies. The IG’s office also suggested that data should be analyzed to identify patients who may be at risk.

 

COVID-19 could have a greater effect on patients with an opioid use disorder because the virus attacks the lungs. According to the report, respiratory disease is known to increase the risk of fatal overdose. 

 

The IG’s Office will release reviews that will assess the trends and challenges of opioid prescribing during the COVID-19 pandemic at a later date.