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CHCF Report on Curbing Opioid Use

MARCUS THYGESTON, M.D., M.P.H. – Today, the California Health Care Foundation is releasing a major report about the role California health plans are playing to reduce opioid usage. The report, entitled “Changing Course: The Role of Health Plans in Curbing the Opioid Epidemic,” takes a look at specific approaches health plans are implementing to increase public health and safety by decreasing use of opioids.

The paper includes a survey of 30 health plans, and offers in-depth case studies of opioid safety initiatives from three health plans:  Blue Shield of California, Partnership HealthPlan of California and Kaiser Permanente Southern California.

At Blue Shield, we established our “Narcotics Safety Initiative” program in 2015 and set an aggressive goal to reduce the total amount of opioids dispensed to our members by 50 percent by the end of 2018.

The focus of our NSI program is twofold:  We want to reduce unnecessary initial use of opioids for acute and chronic pain so that members are not unnecessarily exposed to the potential for chronic opioid dependence or addiction, and to promote safer opioid doses for those already on chronic opioid therapy. While engaged in these efforts, we will also ensure access to appropriate opioid therapy for acute self-limited pain, palliative care, and hospice care.

We will also work together with our existing partnerships to reach our goals, including our accountable care organizations (ACOs).

Why does Blue Shield of California consider this issue of opioid misuse and abuse so important?

It’s a significant public health issue that’s had deadly consequences, as the recent death of Prince from an accidental overdose of the opioid fentanyl so terribly illustrated.

Consider these facts:


  • Over the past 15 years, opioid prescriptions have quadrupled, leading to a cascade of interrelated health, social and economic problems.

  • Accidental deaths from drug overdoses exceed those caused by motor vehicle accidents and firearms, and more of these deaths are caused by prescription opioids (primarily hydrocodone and oxycodone) than heroin and cocaine

  • Hospital admissions for opioid addiction treatment have increased fivefold (this includes prescription painkillers and heroin).

  • Since 2000, five times as many babies now need treatment for opioid exposure versus 16 years ago.


Health plans like Blue Shield are in a unique position to influence the behavior of both prescribers and patients because of our role as primary payers for prescription drugs. We have educational resources and tools to reduce the number of patients who are prescribed opioids for the first time by using other effective treatments. Additionally, we can help prescribers transition patients on chronic opioids to lower and safer doses, and we can identify and stop fraud.

We can also recognize problematic opioid use and deploy case management, behavioral health and other resources to steer patients towards more effective alternative treatments, and work with community and county organizations.

The California Health Care Foundation report concludes the health plan’s work fall into four major efforts: Supporting judicious prescribing practices; focusing on improved member outcomes; identifying overuse, misuse and fraud; and supporting safe communities. These are all laborious efforts, but they are work that we must engage in to help improve the health of all Californians.

To read the complete report and case studies, click here.

Marcus Thygeson, M.D., M.P.H., is senior vice president and chief health officer at Blue Shield of California


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