BWC to cover drug disposal bags for opioid prescriptions

By Miranda Williams, PharmD, RPh, Director of BWC’s Pharmacy Program

In our latest step to mitigate the opioid epidemic on Ohio’s workforce, we will provide injured workers with drug disposal bags that destroy leftover opioids.

Governor Mike DeWine, BWC Administrator/CEO Stephanie McCloud and RecoveryOhio Director Alisha Nelson announced this new statewide effort Thursday, Oct. 17, in Columbus at a local pharmacy.

You may view the announcement on BWC’s Facebook page. In addition, many media outlets attended the event. Here are some of the stories: Click here for WSYX-TV, ABC 6, in Columbus and here for the Statehouse News Bureau story.

Starting Nov. 1, retail pharmacies will automatically issue the disposal bags to Ohio injured workers receiving an opioid prescription for the first time within the last 12 months.

The bags destroy opioid pills, liquids, and patches in a chemical process rendering them useless.

Unused medications
“Newly injured workers don’t always need every opioid pill in their prescription, and this new effort will simplify the process for safely disposing of these dangerous drugs,” said Governor DeWine, who praised BWC for the initiative. “By giving these drug disposal bags to injured workers at the time they fill a prescription, we can not only educate them about the dangers of opioid addiction, but also reduce the risk that unused pills will end up where they shouldn’t – in the hands of children, for example.”

We’re covering the cost of every disposal bag, so there is no cost to the pharmacy, the injured worker, and the employer. “The bag is extremely simple to use and it’s completely biodegradable,” noted Administrator McCloud.

The bags destroy the drugs in a simple process, as Administrator McCloud and Governor DeWine demonstrated during the news conference:

  1. Toss any unused medication into the bag.
  2. Fill it with warm water and wait 30 seconds.
  3. Seal it and shake it. Throw the bag out.

“Along with the Governor’s RecoveryOhio initiative, we want to safeguard our community’s medicine cabinets from becoming gateways to youth and adult drug experimentation,” said Administrator McCloud.

Gov. DeWine and Administrator/CEO Stephanie McCloud demonstrate how to use the drug disposal bag.

Here’s a sobering statistic from the National Survey on Drug Use and Health: Nearly one-third of people ages 12 and over who used drugs for the first time began by using a prescription drug for non-medical purposes.

The disposal bags are one more tool in BWC’s comprehensive program to mitigate the opioid epidemic’s impact on Ohio’s workforce. Earlier this year, we dropped Oxycontin from our formulary and replaced it with opioids that have stronger abuse-deterrent technology.

We estimate up to 175 injured workers a month will be eligible for a drug disposal bag. That’s not a huge number — we covered 164,761 opioid prescriptions in calendar year 2018 — but if it saves one life, it’s worth doing. As Governor DeWine has often said, the opioid and substance-use epidemic is a complicated public health issue. There is no easy solution, and it requires all of us, from state leaders to you and our next-door neighbors, to fight this battle.

In addition, we are a leader in our industry. Other state agencies and workers’ comp systems across America look to us for guidance on a host of issues, from building strong pharmacy and safety programs to fighting fraud. Let’s hope they follow our lead on this effort, too.

For more information about drug disposal bags, email or call BWC’s Pharmacy Department at 877-543-6446,  8 a.m. – 4:45 p.m., EST, Monday – Friday.

‘Wired for addiction’

Addiction specialist addresses work comp health symposium

By Tony Gottschlich, BWC Public Information Officer

Many believe drug addicts are weak-willed people of diminished moral character who choose drugs, getting high and even criminal behavior over a proper, law-abiding life.

And they would be wrong, a longtime psychiatrist and addiction specialist said Friday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Addiction is not about the drugs or the behavior, it’s all about the brain,” said Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. “This is a genetically inherited brain disease.”

Blank, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for an hour on the topic, “The Perfect Storm: Pathophysiology of Controlled Substance Misuse and Addiction.” Her presentation was the first continuing education session on the final day of the two-day symposium for health care professionals.

Blank explained there are three key forces behind addiction, and choice has little, if anything, to do with it. They include:

  • Genetics. Our brains are hardwired for addiction because of our genes. Some of us inherit malfunctioning “dopamine feedback loops.” When we experience pleasure, whether from food, drugs or sex, it’s because our brains are releasing the feel-good neurotransmitter dopamine. In addicts, that feedback mechanism doesn’t shut down and they just want more and more, regardless of the consequences. “It’s never enough,” Blank said. This is particularly hard to overcome if the addiction started in one’s youth. That’s because drug and alcohol abuse can damage the prefrontal cortex, our brain’s impulse-control center, which is still developing into our mid 20s.

Worried your children might be future addicts? Look for the thrill-seeking child who thrives on adrenaline, the child who’s the first to take a dare. These are behaviors that demonstrate he or she is seeking a dopamine release, Blank said.

  • Exposure. Growing up around addicts increases the likelihood of addiction.
  • Environment. There must be an environmental trigger or stressor – loss of a job or loved one, for instance – that keeps the addiction cycle going.

“You have to have all three legs of that stool for addiction to manifest itself in your life,” said Blank, who is also president of the Georgia Society of Addiction Medicine. Genes alone won’t doom you.

Addictions often start through prescription drugs, she said, and can’t stop without outside help. They lead to brain changes that can’t be undone. “Our rational brain is gone.”

Drug overdose is the leading cause of accidental death in the United States in recent years, fueled by powerful opioids, heroin especially. Ohio is the nation’s overdose death capital, with 3,050 OD deaths in 2015, or more than eight per day, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation.

Blank noted that addictions aren’t limited to painkillers and street drugs, of course. People can be addicted to sugar, sex, tobacco and other dopamine triggers, too. It’s all about the dopamine. (Surprising fact to nonsmokers: “Nicotine is better than food, sex and morphine,” Blank said.)

Blank provided a number of sobering facts and statistics, including this one: “This is a chronic disease and there is no cure.”

But there is hope, she said. Addictions can be managed, and many addicts go on to live long, productive and healthy lives. Nationwide, opioid prescriptions are falling and there’s a growing awareness and understanding that addiction is a disease.

She concluded her remarks with a warning: “If you can’t escape addiction, choose yours carefully.”

The health symposium concluded Friday. It was held in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation’s annual safety, health and workers’ compensation conference.

Ohio prescription drug monitoring program showing positive outcomes

By Nick Trego, BWC Clinical Operations Manager

Established in 2006, the Ohio Automated RX Reporting System (OARRS) is Ohio’s state wide prescription drug monitoring program. OARRS collects information on all controlled substance prescriptions written by Ohio licensed prescribers and dispensed by pharmacies across the state.

The OARRS data base can be accessed by pharmacists, prescribers and law enforcement. Pharmacists use the database to review all controlled substance prescriptions being taken by a patient. OARRS allows the pharmacist to see the details of those prescriptions for an individual patient.

Prescribers access the database to ensure the appropriate treatment for patients and to assess compliance with prescribed medication regimens.

Law enforcement officials can review OARRS reports when legal issues emerge surrounding controlled substance use.

The OARRS database promotes the use of best practices when prescribing opioids, benzodiazepines and other medications that can have dangerous side effects if used inappropriately.

A recent report published by the Ohio Board of Pharmacy on opioid prescribing between 2012 and 2016 shows encouraging outcomes including:

  • 4% (162 million dose) decrease in the total number of opioids doses dispensed
  • 20% (2.5 million) decrease in number of opioid prescriptions
  • 5% (43 million) decrease in the total number of benzodiazepine doses dispensed
  • 2% decrease in the number of individuals who see multiple prescribers to obtain controlled substances illicitly (“doctor shopping”)
  • 11 million requests for OARRS reports in 2016

Ohio BWC statistics, likewise, show a decline in opioid prescribing over the same time period. During this period BWC has encouraged the use of best clinical practice guidelines and a state of the art closed formulary to provide medication management. Ohio BWC is the first state agency to establish a prior authorization (PA) process where clinical nursing staff reviews each medication request. The successes of the closed formulary, best practice guidelines and clinical nursing staff PA processes are listed below:

  • 5% decrease in opioid doses achieved by BWC
  • With less than 1% of the opioids receiving population in Ohio, BWC accounted for 9% of the reported decline in doses dispensed

These statistics leave no doubt that the OARRS database is having a positive influence on prescribing and dispensing controlled substances. Increased safety to patients in the state of Ohio and reducing the chances for opioid/benzodiazepine abuse and misuse are valuable benefits provided by OARRS.

Opioid education: the dangers of addiction and dependence

By Nick Trego, BWC Clinical Operations Manager

Opioid analgesics are potent pain relieving medications that can cause numerous side effects that range from itching to chronic constipation to hormone deficiencies.

The United States Drug Enforcement Administration (DEA) considers opioid analgesics to be dangerous drugs with a high potential for abuse and with use potentially leading to severe psychological or physical dependence.

Prior to initiating therapy with opioid analgesics, patient education surrounding the risks and benefits of these medications is essential to understanding and developing realistic expectations of treatment outcomes.

Due to the addictive nature of these medications, the Ohio BWC is also taking additional steps to prevent addiction, including collaborating with other organizations to develop fact sheets to help providers, employers and injured workers better understand the potential risks of excessive opioid use.

A few statistics show the importance of understanding the impact opioids are having in Ohio and across the United States:

  • Prescription opioids are associated with more fatal overdoses than any other prescription or illegal drug including cocaine and heroin.1
  • In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.2
  • Unintentional drug overdose continued to be the leading cause of injury-related death in Ohio in 2015, ahead of motor vehicle traffic crashes – a trend which began in 2007.3
  • Unintentional drug overdoses caused the deaths of 3,050 Ohio residents in 2015, the highest number on record, compared to 2,531 in 2014. The number of overdose deaths increased 20.5 percent from 2014 to 2015, which is similar to the increase from 2013 to 2014.4

Increased understanding of the safety and risks associated with the use of opioids will benefit those seeking the best possible medical treatment without facing the consequences of dependence or addiction.

We invite you to review these new educational materials and share them with your colleagues, family and friends.

The fact sheets can be found on BWC’s website:

BWC’s medical director, Dr. Stephen Woods, addressed the importance of balancing short term pain management and the longer term risk of addiction in an earlier blog post

For more information, email Pharmacy.Benefits@bwc.state.oh.us.

 

1 Ohio’s Opiate Epidemic, Mental Health & Recovery Board – Erie and Ottawa Counties, Alcohol and Other Drugs (AOD) Committee

2 CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016

3, 4  2015 Ohio Drug Overdose Data: General Findings, Governor’s Cabinet Opioid Action Team