By Douglas Nemecek

The statistics are so daunting that they can be difficult to grasp: From 2000 to 2015, more than half a million people died from drug overdoses. In 2015, opioids killed 33,000 people in the United States—more than any year on record. And every day, 91 Americans die from an opioid overdose.1

For communities across the country, however, these statistics aren't simply numbers in a chart. They represent family members, friends, neighbors, and coworkers whose lives have been shattered. Local government leaders are on the front lines of a battle to combat the opioid overdose crisis that is impacting their communities.

The facts are clear, but the remedy is much more complex. What can communities do to stem the tide?

Understanding the Causes

First, it's important to understand how people in the U.S. reached this point. The rise in opioid prescriptions is partly due to health care providers' well-intentioned efforts to relieve patients' chronic, non-cancer pain, including back ailments, osteoarthritis, and other conditions.

Doctors were trained to treat pain as the "fifth vital sign" or something to be controlled and managed no matter what. When prescription opioids were first introduced, their addictive properties were not fully understood or well communicated. As a result, many patients have come to believe they can't live without painkillers, and doctors continue trying to help by writing more opioid prescriptions.

But medical knowledge has advanced. Doctors now know that opioids shouldn't be used to treat pain caused by many medical conditions and injuries beyond the initial period of healing. A patient doesn't need a 30-day prescription for a high-dose opioid following a tooth extraction or a minor injury.

Necessary Changes

To reverse this epidemic, people need to change not only how they view and treat pain, but also how they view and treat substance misuse. Substance use disorders need to be treated the same way other chronic illnesses are treated—with compassion coupled with evidence-based care.

One of the first steps is to raise awareness among doctors and patients that there are successful chronic pain treatments that don't require long-term use of addictive pain medications.

Another key is for society to adopt a new vocabulary that recognizes that addiction is an illness, not a weakness or moral failing. Instead of substance abuse or addiction, we should say substance use disorder. Instead of labeling people as addicts, we should refer to them as people living with a substance use disorder.

This shift in language will help mitigate the fear and shame that prevent many people from seeking life-saving treatment due to concerns about their reputation or job security.

As a critical player in the health care system, Cigna is tapping into its extensive experience with prevention, wellness, and chronic disease management programs, and working with clients, physicians, and others on ways to increase prevention and treatment of substance use disorders.

During 2016, we made a commitment to reduce our customers' opioid use by 25 percent by 2019. By April 2017, the numbers were already down 12 percent.

Researching Best Treatments

To help develop the best treatment protocols, we provided two years of our customers' substance use treatment claims data—without personal identifying information—for a medical research project with the American Society of Addiction Medicine (ASAM) and Brandeis University.

The findings will be used to guide the development of national standards for treating substance use disorders and helping patients receive high-quality care that's based on what's been proven to work.

We believe states should require prescribers to check their state prescription drug management program (PDMP) database prior to writing an opioid prescription. By monitoring prescribing behavior and potential "doctor shopping" for multiple prescriptions, PDMPs are essential state-level tools with the potential to inform clinical prescribing practices and protect at-risk individuals.

Cigna also supports limiting the quantity of painkillers when appropriate, and exploring additional controls for high-risk customers identified by our customer data. We've also asked medical practices to join the effort by signing a pledge (see https://www.cigna.com/newsroom/knowledge-center/opioid-pledge) to follow guidelines (see https://www.cdc.gov/drugoverdose/prescribing/guideline.html) from the Centers for Disease Control and Prevention (CDC) for opioid prescribing and to treat opioid use disorder as a chronic condition.

Confronting and defeating this powerful crisis is not a task for any single entity; it requires all of us working together. We encourage community leaders across the country to join us and do all they can to help end the stigma and help people with substance use disorders find the treatment they need.

For more information, visit the Cigna website at https://www.cigna.com/about-us/healthcare-leadership/away-from-blame.

1 https://www.cdc.gov/drugoverdose/epidemic/index.html.

Douglas Nemecek, M.D., is chief medical officer for behavioral health, Cigna, Eden Prairie, Minnesota.

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