The Virginia Hospital and Healthcare Association’s (VHHA) Analytics Team evaluated two years’ worth of Medicaid and commercial insurance prescription claims datai in the Virginia All-Payer Claims Database (APCD) to identify trends in prescription volume, refills, and dispensing habits. The results of that analysis, based on available data sets in the APCD, show that overall prescription volumes are on the decline. The chart to the left plots the trend line of prescription volume decline.
APCD prescription claims data show that during 2015 and 2016, approximately 2.5 million prescriptions were written for 677,000 patients, averaging out to roughly 3.7 prescriptions per patient. Records show significantly fewer refills occurred after an initial refill, and the available data reveals that family practice physicians and non-physician practitioners write the largest percentages of opioid
prescriptions. Beginning in January 2015, the monthly volume of opioid prescriptions written was 111,739. By December 2016, the monthly volume declined to 95,011. It is important to note that seven of 106 substances were excluded from the analysis, thereby reducing the total prescription volume from 5.5 million to 2.5 million.ii These seven substances were excluded due to their common use in treating opioid addiction.iii
Virginia’s community hospitals and health systems have been active in responding to the opioid epidemic by supporting efforts to reduce opioid misuse, reassessing prescription protocols, and working with partners to help educate patients and their families, caregivers, and the general public, among other initiatives.
One example of that work is the Task Force on Prescription Opioid Abuse established by the VHHA Board of Directors in January 2016 to identify strategies for combating opioid abuse. The Task Force developed prescribing guidelines for hospital emergency departments. VHHA member hospitals, the Virginia College of Emergency Physicians, and the Virginia Chapter of the American Academy of Emergency Medicine created 14 recommendations that provide a general standard on opioid prescribing at Virginia hospital emergency departments. The guidelines, which are in effect at hospitals throughout the Commonwealth, can be found here.
Another collaboration involves the VHHA Center for Healthcare Excellence’s engagement in the Virginia Neonatal Perinatal Collaborative (VNPC). The VNPC brings together neonatal and obstetric physicians, nurses, hospital-based clinicians, and other health care stakeholders dedicated to promoting birth health for mothers and babies, and to combating issues like Neonatal Abstinence Syndrome (NAS), a condition that afflicts babies who experience withdrawal symptoms after being exposed to drugs in the womb during pregnancy. In 2016, more than 770 Virginia infants were diagnosed with NAS (equivalent to 1 percent of live births).
In 2017, members of the Virginia hospital community supported bi-partisan legislation approved by the Virginia General Assembly that focused on curtailing opioid misuse, including bills that establish regulations for prescribing opioids; require prescribers to request information about a patient from the Prescription Monitoring Program (PMP) before prescribing opioids; and require electronic prescriptions for any controlled substance containing an opiate starting in 2020.
Hospitals are also supportive of the REVIVE! opioid overdose and naloxone education (OONE) program established by the Commonwealth. This multi-agency effort in Virginia provides training in opioid abuse response, such as recognizing and responding to an opioid overdose emergency by giving patients the anti-overdose drug naloxone.