When Dr. Ken Duckworth learned that librarians in Philadelphia were administering opioid overdose reversal drugs, it got him thinking: Why not us?
Blue Cross and Blue Shield of Massachusetts, where Duckworth serves as medical director for behavioral health, had already sought to make prescribing and treatment more accessible and had invested in educational programming on opioid use, but the insurer is now working to help the people those measures don't reach. The insurance giant is the first health plan in the state to give opioid overdose reversal toolkits to five large employers, including its own employees, through a test that could ultimately extend to all employers it covers.
"This is an underutilized tool in the war we face with opiates," Duckworth told Modern Healthcare.
Massachusetts has been hard hit by the opioid epidemic. The state saw 1,909 opioid-related deaths last year, and another 657 deaths in the first six months of 2018. U.S. Surgeon General Dr. Jerome Adams in April urged more Americans to keep naloxone on hand.
The employers included are Shawmut Construction, a union called the New England Regional Council of Carpenters, the city of Brockton and the town of Ware. Blue Cross itself will comprise a significant part of the program, with 3,700 employees.
Because of their propensity to suffer on-the-job injuries that lead to opioid prescriptions, construction and extraction workers comprise 24% of opioid-related deaths among the state's working population, according to an August report from the Massachusetts Department of Public Health. Allison Gifford, a spokeswoman for Shawmut Construction, wrote in an email that the company does not have an issue with opioid abuse and has never had an overdose on site.
"But we recognize we would be remiss to not add these toolkits as a part of our robust safety preparedness protocols," she said. "Right now they are in our offices and we plan to roll them out to our larger jobsites."
Seventy people died of opioid-related overdoses in Brockton, a city of roughly 96,000 people, in 2017 alone, according to the state's Department of Public Health, the third highest of all 351 cities and towns in the state last year. City representatives were not available for comment.
Ware, a town of about 10,000 people, saw five overdose deaths in 2017 and double that in 2016. Town Manager Stuart Beckley plans to keep the kits in parks, town hall, the senior center and the library. Ware had an overdose death in a park a few years ago, a tragic event Beckley believes employees will be able to prevent once they know how to recognize the symptoms of overdoses and can administer Narcan.
"Certainly there could be saves in the future by our own employees," he said.
Each employer in the program will receive kits containing two doses of the opioid overdose reversal drug, Narcan, the only FDA-approved form of naloxone in nasal spray form. Naloxone is also available in injectable versions, but Narcan is favored in many cases because it's widely considered to be easier to use and less intimidating than using a needle. The kits will also have a surgical mask, gloves and instructions for administering Narcan.
Blue Cross plans to work with each employer to learn how they could best use the kits. Municipalities will likely wish to keep them stocked at libraries, parks, pools and other public areas. Employees will also receive training on reversing opioid overdoses.
Duckworth said he's trying not to place restrictions on how employers want to use the kits, even if that means letting some employees take them home or keep them in their cars. Employers will also decide which employees receive training on how to use Narcan. Blue Cross has 800 kits ready for the pilot, but it's not yet clear how many will be used.
The pilot intends to focus beyond public spaces, emphasizing office settings too, such as Blue Cross' own offices. Duckworth said one of the employers involved in the pilot program had an overdose in one of their offices, although he couldn't say which one.
"Their staff was extremely traumatized by this," he said. "They basically said, 'We wish we had this a year ago.'"
A new Blue Cross survey found 70% of Massachusetts residents believe Narcan should be widely available in workplaces, similar to automated external defibrillators.
Before launching the pilot, Blue Cross conducted 507 interviews with consumers, half of whom had personal experiences with opioid addiction through family members or friends. The interviews yielded tips such as keeping the kits small—the size of a makeup kit rather than a toolbox. People also indicated they wanted the kits to include gloves, and that the kits shouldn't be black, like they were originally. Now they're royal blue.
Blue Cross' news comes as the American Medical Association issued a call Thursday for state and federal legislators to enforce the Mental Health Parity and Addiction Equity Act, signed into law in 2008, to help end the opioid epidemic. They said insurers need to be held accountable for complying with their legal obligations.
On that front, Duckworth said Blue Cross has taken a number of steps to increase access to addiction treatment, such as eliminating copayments and deductibles for methadone, a medication used to treat opioid addiction. The carrier also eliminated the requirement for notification when patients are transferred from emergency rooms to addiction treatment facilities and psychiatric hospitals. Duckworth said members are free to seek outpatient mental health services without prior authorization.
"We welcome that law and I think we've done a pretty good job of removing barriers here," he said.
