Systems turn to locking pill bottles as an early intervention in preventing substance abuse – a costly second-order effect of the pandemic

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By Matt Davis, Co-Founder and President, DSD Advisors, LLC

Pre-COVID, the opioid epidemic’s annual cost was benchmarked at over $200 billion, with a third consisting of excess healthcare costs borne by the system’s payors, large employers and the providers of uncompensated care.  While COVID headlines displaced opioid epidemic news coverage over the last year, COVID’s economic impact on households, and its social impact on mental health, have quietly driven substantial increases in substance abuse across the country.  

Now, over a year into the pandemic, policy makers and government agencies are recognizing the problem. After food security, homelessness and job security, substance abuse is becoming very well differentiated as the most urgent second order effect of COVID-19. Providers, systems and policymakers need to be taking considerable steps now in order to address the growth in this acute problem.   

The earliest interventions usually generate the best results, and after reduced prescribing of opioids, the second earliest intervention in substance abuse is access control and prevention of diversion.  With 80% of heroin users starting with a prescription opioid, and 90% of abusers starting in their teenage years, preventing teen initiation is the earliest intervention possible and the highest impact place to start.  

Unfortunately, most households don’t fully understand the medication risks associated with opioids and other controlled substances, and consequently don’t secure their medications beyond storing them in the provided child-resistant bottle, designed only to prevent access among children 5 years old and younger.  As a result, the home medicine cabinet is the number one source for teen drug abuse, and has held this ignoble distinction for almost a decade.

Fortunately, policymakers at the state level and leading health systems have begun to take notice.  Ohio, often considered ground zero for the opioid epidemic, through the leadership of the General Assembly, is developing a program to evaluate the impact of dispensing opioids in locking vials across the state.  Under the proposal, pharmacies will be paid an additional dispensing fee for each prescription filled in a locking vial, and the state will commission an academic study to evaluate the impact.  

In Ohio, key stakeholders in the state’s healthcare ecosystem, including large employers, systems and payors, who bear the brunt of treatment costs are expected to participate in program development.  According to the Kaiser Family Foundation, 53% of opioid addiction and overdose treatment costs are for treatment of plan enrollees’ children, suggesting that teen prevention carries a very high savings potential for employers.  A coalition of providers is leading the development effort and has achieved key support from Ohio state leadership to fund the program. 

“The opioid epidemic continues to worsen as a result of COVID and I am confident this locking vial program will offer a new and innovative way to reduce instances of diversion in our communities,” said Ohio State Representative and Assistant Majority Whip Cindy Abrams, the sponsor of the budget amendment funding the program.  Stakeholders in other states have started to explore similar programs, with coalitions forming among payors and providers to assist in developing the programs.  

Improved packaging security is a key solution cited by experts on the epidemic at the Bloomberg School of Public Health and other institutions. New locking vials designed for use in pharmacy dispensing operations have been proven effective in early trials and certified as teen-resistant in third party evaluations with 100% effectiveness.  Because of the extremely low cost of vials relative to the extremely high cost of addiction treatment, the implementation of locking vial dispensing is expected to generate significant return on investment to large employers, payors, and providers of uncompensated care.  

Outside of government-funded pilots, several health systems are independently evaluating locking vial dispensing in their pharmacy operations, with a view towards cost savings in their employee plan membership and improved provider and patient satisfaction and safety.  Systems are considering varied implementations, for both controlled substances and medications with pediatric fatality risk from accidental poisoning. 

The current child-resistant standards for prescription vials were established in 1970, in response to children overdosing on aspirin, but haven’t been changed or updated since, despite the dramatically expanded universe of drugs on the market today.  The standards only require that 85% or more of children aged 5 and younger can’t open the container in a timed test and don’t have any guidelines for preventing access by older children or teenagers.  

“One standard doesn’t fit all when it comes to keeping dangerous medications out of the reach of older children and teenagers,” said Milton Cohen, President & CEO at Safe Rx, the leading manufacturer of locking vials.  The Company is in the process of recruiting additional system customers to test its vials in their pharmacy programs, focusing on IDNs and ACOs, while also marketing locking vial dispensing to large employers, which benefit the most from its programs.  “Payors have a shorter-term return horizon due to the turnover from sponsors changing plans.  Large employers are better positioned to capture the full benefit,” added Mr. Cohen.

Matt is Co-Founder and President of DSD Advisors, LLC, a full-service government relations firm that partners with public, private, and nonprofit clients of all sizes to achieve their public policy goals at the local, state and federal levels. He formerly served as the Cincinnati USA Regional Chamber’s senior vice president for Government Affairs, where he led the organization’s efforts to advance the Chamber’s legislative agenda in the Greater Cincinnati region, Columbus and Washington, D.C. He lobbies elected officials on a number of issues, with a focus on tech innovation and healthcare, working with key stakeholders to think through new models for health care delivery. 

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