‘It’s a big deal’: Opioid prescriptions down in Medicaid and MinnesotaCare

Report cards for prescribers in Minnesota show drastic declines in the number of opioids prescriptions, the amount of drugs in each prescription and the number of patients being prescribed opioids.

The new data in the report cards from the Minnesota Department of Human Services show that between 2016 and September 2019, the number of annual opioid prescriptions for patients in Medicaid and MinnesotaCare programs dropped by a third.

“There have been lots of eyes and lots of attention on the opioid crisis and the way physician prescribing contributes to it,” said interim Assistant Commissioner Tom Moss. “It’s a big deal.”

Fewer people are being prescribed the drugs, too. The number of Medicaid or MinnesotaCare patients being given opioids in the state fell by 30 percent. Doctors are also prescribing smaller doses of opioids when necessary, according to the data. The number of opioid prescriptions that exceeded the state’s recommended dose fell by half.

“The intent of the program is to keep people safe, but also to address their pain — we don’t have a goal of bringing anything down to zero on this,” Moss said. “In all cases, they would be tapering people down and doing it very carefully.”

Prescribers have also drastically reduced the number of chronic patients being prescribed potentially lethal combinations of opioids and benzodiazepines.

“We are seeing a reduction of that co-prescribing. Prescribing those two drugs at the same time can be very dangerous for patients,” said program manager Ellie Garrett. “What we hear is that there is growing awareness around this potentially dangerous combination.”

The Centers for Disease Control and Prevention has said opioids are not usually effective in managing chronic pain. Data from the state showed that fewer chronic pain patients are being prescribed opioids that exceed recommended doses. But state guidelines warn that chronic pain patients who are already prescribed opioids should not have their medications rapidly tapered or cut off unless there’s a life-threatening health issue.

“What we want is for doctors to work with their patients one by one,” Moss said. “I hope that doctors are doing the best practice that they can, rather than operating out of any specific concern to get a good grade from the state of Minnesota.”

Doctors and other prescribers who treat Medicaid or MinnesotaCare patients will be receiving report cards in the coming days documenting how their opioid prescribing practices differ from their colleagues.

“These are busy physicians that are handling a lot of patients, doing a lot of good work,” Moss said. “This is just taking the data that we get through the course of things and turning it into information for them to help them make better decisions for their patients.”

This is the second time that some doctors and others have received a report card showing their opioid prescribing practices. After the next report card is released at the end of this year, doctors who exceed the state opioid prescribing recommendations could be required to sign onto improvements or could eventually lose the ability to treat Medicaid and MinnesotaCare patients.

Physicians at some medical systems in the state have found that informing doctors about their prescribing levels was an important step in reducing the number of opioid prescriptions.

Through report cards, individualized care plans and a task force to monitor patients being prescribed opioids, the Alexandria Clinic in west-central Minnesota reduced the number of opioid prescriptions by two-thirds.

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