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Opioid Consumption Among Medicaid Patients

By Dr. Sultan Rahaman

Many state governments across the United States are reducing spending this year in order to balance their budgets. Some states are drastically cutting their budgets for social services, education and Medicaid. With smaller Medicaid budgets it is imperative that medical expenditures are well targeted. Among my Medicaid patient population there is a significant percentage of opioid use and dependence. In my family practice there is a much higher percentage of patients on Medicaid demanding inappropriate prescriptions for controlled substances than among my other patients. Coping with these demands has been more stressful for me and my staff than actually taking care of Medicaid patients with serious acute or chronic diseases.

According to this medical article, "Costs of opioid abuse and misuse determined from a Medicaid database", "Medicaid opioid abuse/dependence patients had more comorbidities and higher medical costs in 2002-2003 than Medicaid control patients. Successful interventions to prevent opioid abuse and manage comorbidities could help to reduce costs associated with opioid abuse in the Medicaid population."

Another article, "Economic burden of prescription opioid misuse and abuse” concludes, "Efforts to establish and maintain a balance between access to these drugs for legitimate pain management while decreasing the risk of abuse and misuse are critically important and include such tools as patient and provider education, patient screening, and use of technology."

Presently there is national political debate concerning the scope and future of Medicaid. On the right end of the political spectrum many argue that lower income citizens should not necessarily be entitled to free medical care at taxpayer’s expense, especially those using illicit drugs. Many on the left  are standing up for all lower income citizens having access to free medical care, while asking for  those who can afford it to receive subsidized medical insurance. The correct solution is somewhere in the middle. The economic situation in the country today has resulted in tight budgetary constraints which will likely affect the funding of Medicaid for many years to come. Money spent on providing opioid medications to patients who do not have a legitimate medical need, could instead be diverted to preserving access to care and medications for those truly in need, such as children with asthma and women with breast cancer, among others.

This recent article, "Pain Clinic 'Pill Mills' In Florida Raided By Police", quoted U.S. Attorney Wifredo Ferrer in a news release, "According to recent estimates, Florida prescribes ten times more oxycodone pills than all other states combine,". In the same article Michele Leonhart, administrator of the U.S. Drug Enforcement Administration also states, "Prescription drug abuse is our country's fastest growing drug problem, and pill mills such as those in Florida are fueling much of that growth".

It was therefore shocking earlier this year when Florida's new Gov. Rick Scott threatened to stop the state's planned prescription monitoring database program, calling it a waste of financial resources. Even the manufacturer of the much abused pain medication OxyContin offered $1 million to help fund the drug database. Scott still refused.  According to the Orlando Sentinel even the wife of the Republican Senate President, “Dr. Stephanie Haridopolos, a family practitioner in Melbourne, said she practically yelled at her husband Thursday night about how important the legislation was and dragged him to talk to Bondi, the first-year attorney general and ex-prosecutor who made the bill her legislative priority". The Florida legislature eventually approved the drug database.

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