Preventing Opioid Dependence

August 12, 2019 HMS

The Value of Proactive Opioid Prevention

When it comes to healthcare, proactive prevention of conditions is preferable to reactive treatment of illnesses. This is especially true when it comes to drug addiction and opioid dependence.

Once a patient becomes dependent on opioids it may be difficult for healthcare professionals to reach them and intervene. Connecting individuals with the right behavioral health and clinical assistance requires more effort and resources.

The Human and Economic Costs of Reactive Treatment

If dependent patients can’t get access to prescription medications, they may turn in desperation to other illegal substances such as heroin or other street drugs. IV drug abuse can lead to further public health crises, such as hepatitis and HIV. For example, Indiana’s Scott County experienced a major HIV outbreak between 2011 and 2014 among individuals who were addicted to illegal drugs.

In addition to the human cost associated with reactive treatment of opioid dependence, the economic cost is also high. The National Institute on Drug Abuse estimates that the cost of opioid addiction treatments exceeds that of treating patients with kidney disease. Consider the following statistics:

  • Methadone treatment, with medication and integrated psychosocial and medical support services: $6,552 per year.
  • Buprenorphine for stable patients provided in a certified opioid treatment program: $5,980 per year.
  • Naltrexone provided in an opioid treatment program: $14,112 per year

In contrast, the typical annual expenditures for a patient with kidney disease are $5,624.

Shifting to Proactive Prevention of Opioid Dependence

A proactive approach to preventing opioid misuse from starting would benefit patients, insurers, and society at large. Here are three principles that can shift the balance away from opioid treatment and towards opioid prevention: Measurement, Management, and Mitigation.

  1. Measurement. Analytics based on patient, claims, and prescriber information can provide insight into patient characteristics that are correlated with a higher risk of opioid dependence. Some progressive health plans have adopted care management platforms that include population health and analytics components. These systems enable care managers to quickly identify members who may be at risk of opioid misuse. With this information, it’s possible to intervene early and explore different pain management approaches that do not rely on opioids or other habit-forming drugs.
  2. Management. Care management systems are an ideal solution for creating member-centric service plans. Taking a holistic view of members ensures that they receive care that is tailored to their unique needs and characteristics. Even if a member isn’t suffering from opioid dependence, he or she may benefit from behavioral health interventions that complement care from primary care physicians.
  3. Mitigation. Ongoing patient monitoring is a proven way to keep health plan members healthy and to encourage positive behaviors. A known risk factor for opioid misuse, for example, is regular contact with high-risk people and environments. Health plans may use different interventions to reduce the likelihood that members will fall victim to opioid dependence. For instance, a smartphone app called Hey, Charlie monitors an individual’s phone contacts and location. Smartphone users voluntarily enter information about contacts and neighborhoods that they consider risky. When the app detects that the smartphone user is heading towards one of these areas or is about to call or text a particular contact, it nudges the user to reconsider their plans.

As the war on America’s opioid epidemic continues, both treatment and prevention will be essential. In the medical community, the pendulum seems to be shifting towards a philosophy of preventing problems before they start. Health plans can play a role in this trend by focusing on measurement, management, and mitigation. Technologies, such as case management tools, population health management systems, and analytics platforms, are available to lighten the load. Automating data analysis and integrating insights into the daily workflows of case managers and physicians are promising ways to stop opioid misuse before it starts.


To learn more about how population health intelligence solutions can help address opioid abuse early before misuse and addiction occur, download our white paper. 

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