As opioid use disorder diagnoses skyrocket nearly 500%, treatment falls behind

A study from the Blue Cross and Blue Shield Association adds to the growing mound of evidence that the number of patients diagnosed with opioid use disorder far exceeds how many are getting treatment.

Blue Cross and Blue Shield analyzed medical and pharmacy claims data for more than 30 million of its plans' commercially insured members. It found that the number of members diagnosed with having opioid use disorder skyrocketed 493% from 2010 to 2016.

In 2010, about 1.4 out of every 1,000 plan members was diagnosed with opioid use disorder, according to the report. That rate jumped to 8.3 members out of every 1,000 in 2016.

But the number of members accessing medication-assisted treatment, or MAT, for opioid use disorder hasn't kept up. Just 3.4 out of every 1,000 members received MAT in 2016, up 65% from 2.1 in 2010.

The report comes a week after Senate Republicans published a "discussion draft" of their bill to repeal the Affordable Care Act. Provider organizations, policy experts and some governors in states hardest hit by the opioid epidemic fear the bill would thwart the little progress that's been made in fighting a crisis that has cost thousands of lives, while also making it harder for those affected to get treatment.

The draft Senate bill offers only $2 billion through 2019 to address the opioid crisis. Republican senators from states suffering from high rates of opioid addiction, including Ohio and West Virginia, have pushed for $45 billion in extra funding over 10 years for substance abuse treatment.

The bill would also cap how much money the federal government provides states for Medicaid—the single largest payer for addiction treatment. It would eliminate the ACA's requirement that Medicaid managed-care plans cover 10 essential benefits, which includes treatment for substance abuse disorders, and also allow states to opt out requiring insurers to offer those essential benefits. Providers worry that will prompt plans to stop covering costly addiction treatment at a time when the death toll is rising.

In 2015, opioids led to more than 33,000 overdose deaths, up more than 15% from 28,600 in 2014, according to the Centers for Disease Control and Prevention. In half the fatal cases, the overdose involved a prescription opioid.

The BCBSA report showed that 21% of its commercially insured members filled at least one opioid prescription in 2015. The analysis excluded cancer and palliative care patients.

Of those members who filled an opioid prescription, 6% were prescribed a high dosage for longer than 90 days. Patients with high-dosage opioid prescriptions have much higher rates of opioid use disorder than patients with low-dose prescriptions, according to the study.

The BCBSA said its 36 member plans, like other insurers, are working independently and together to reduce the amount of opioid prescriptions written by physicians in the network. The association endorsed the CDC guidelines for opioid prescribing and hopes they will have an impact on physicians' prescribing behavior, said Kim Holland, the BCBSA's vice president of state affairs. The plans are also working to remove barriers to addiction treatment. Providers and addiction specialists have questioned, though, if health plans are doing enough to increase access to treatment.

"Our responsibility in this is to make sure that we are facilitating that effective treatment in whatever way we can, whether that's working with our prescribing community, but also doing broader things," she said, adding that the BCBSA is paying for research on substance use disorder relapse rates and how health plans can better support members so they don't relapse.

Regarding the Senate bill to repeal and replace the ACA, Holland said there are ongoing discussions to increase funding for states to address the opioid crisis and congressional members from both parties are committed to fighting the epidemic.

"Our commitment at the association is to support the efforts of Congress," she said. "We've been meeting with members and certainly making them aware that we want to be part of any solution, and continue to work with our states on that same basis."