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Attorneys general push alternatives to opioids



The Herald-Dispatch

HUNTINGTON, W.Va. — At 3 p.m. on a Thursday, while sitting in traffic in downtown Lexington, Kentucky, with two staff members, Kentucky Attorney General Andy Beshear saw a person banging on the window of a vehicle a few cars in front of them.

West Virginia Attorney General Patrick Morrisey, left and Kentucky Attorney General Andy Beshear speak during a press conference Monday in at Marshall University in Huntington. The press conference was held to announce a initiative involving many states that will focus on changing the way the health system regards non-opioid pain management and therapy.
(Herald-Dispatch photo by Lori Wolfe)


The driver of the vehicle had overdosed on carfentanil, and one of Beshear’s staff members revived the person with a dose of naloxone.

“That’s what we are facing,” Beshear said. “I saw it that day. You don’t watch someone go from blue to purple knowing what’s next and that not make a deep impact on you.”

Beshear joined West Virginia Attorney General Patrick Morrisey at Marshall University on Monday to announce a coalition of 37 states and territories urging health insurance companies to examine financial incentives that contribute to the opioid epidemic. The two attorneys general co-lead the coalition.

“What we are doing today is looking at financial incentives because there is an absence of incentives sometimes to prescribe these non-opiate therapy options,” Morrisey said. “Given that the underlying opiates are not treating the specific disease condition, if you can look at the alternatives, whether they are medication based or physical therapy or other forms that are designed to improve the condition of the patient, we think that is going to be more effective. We think there may be some financial incentives or lack thereof that is influencing that referral.”

The 37 attorneys general will send a letter to industry trade groups and major insurance providers nationwide that urges insurers to review their coverage and payment policies as the starting point in a dialogue focused on incentive structures across the industry.

“When you look at coverage and payment policies, you want to make sure that if you’re an insurance company that some of the non-opioid alternatives – maybe it’s physical therapy – and you look at the duration that physical therapy is going to be covered,” Morrisey said. “You want to make sure there’s not a financial incentive in place that says rather than get the physical therapy, I’m going to get the opiate instead. That’s a tangible example.”

Morrisey said they aren’t doctors and they aren’t trying to tell companies what a formula should look like, but they do want to start that open dialogue.

He said he is optimistic the companies will be willing and open to make a positive change to help curb the epidemic. Beshear said if they are not, they should take a look at what happened to tobacco companies when they refused to work with attorneys general.

“I believe this action is aimed at curbing or reducing the rate of new addiction,” Beshear said. “We’ve got a lot of people who are out there right now and they need our help. A lot of what we do to remove street-level drugs or even clean out existing medicine cabinets can help those people. Getting them in treatment helps those people. But we look at 80 percent of people who use heroin first becoming addicted through prescription pills, math tells us if we can lessen the number of prescription pills that are being prescribed and that are out there, we can truly impact the supply that’s driving a new addiction.”

West Virginia has made strides to reduce the number of opioids prescribed, reaching 96 prescriptions dispensed per 100 people in 2016, according to the Centers for Disease Control and Prevention. That’s down from 111.3 per 100 in 2015.

Morrisey said this will not affect those who truly need an opioid prescription for pain management, like cancer patients.

Morrisey and Beshear are joined by attorneys general from Arkansas, Florida, Kansas, Kentucky, Mississippi, New Mexico, Utah and Virginia as co-sponsors of this effort.

Other attorneys general signing the letter are from Arizona, California, Connecticut, District of Columbia, Georgia, Hawaii, Illinois, Indiana, Maine, Massachusetts, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Vermont and Wisconsin.

Follow reporter Taylor Stuck on Twitter and Facebook @TaylorStuckHD.

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