In 2017, everyday, more than 130 people died in the US after overdosing on opioids. This document talks about America's worst drug crisis ever and shares how technology can play a role to cope up with this epidemic.

1. This document is confidential and contains proprietary information, including trade secrets of CitiusTech. Neither the document nor any of the information
contained in it may be reproduced or disclosed to any unauthorized person under any circumstances without the express written permission of CitiusTech.
Opioid Epidemic: Causes, Impact &
Future
January 2020| Author: Shiven Kalelkar; Sr. Healthcare Consultant
CitiusTech Thought
Leadership

2. 2
Agenda
▪ Opioid Epidemic: Key Trends
▪ Opioid Epidemic: Measures for Controlling the Epidemic
▪ Opioid Epidemic: What Lies in the Future
▪ References

3. 3
Opioid Epidemic: America’s Worst Drug Crisis Ever (1/2)
2011 2012 2015 2016 2017 2018
An estimated 10.3 million Americans aged
12 and older misused opioids, including 9.9
million prescription pain reliever abusers and
808,000 heroin users
>70,200 overdose deaths in
the United States and 47,600
of those overdose deaths
involved opioids
19% of US population
received one or more
opioid prescriptions
Prescription opioid volumes peaked,
with the equivalent of 240 billion
milligrams of morphine prescribed,
according to the market research firm,
IQVIA Institute for Human Data
Science
>52,000 people died of drug
overdoses, nearly two-thirds of
which were linked to opioids
like Percocet, OxyContin,
heroin, and fentanyl
US physicians wrote 259 million
prescriptions for opioid painkillers —
enough to give a bottle of pills to every
adult in the country

4. 4
Opioid Epidemic: America’s Worst Drug Crisis Ever (2/2)
▪ Drug overdoses now kill more people than gun homicides and
car crashes combined
▪ 57.8 – Highest deaths per 100,000 individuals in the state of
West Virginia
▪ Between 2007 and 2016, the most widely prescribed opioid
was hydrocodone (Vicodin)
▪ In 2016, 6.2 billion hydrocodone pills were distributed
nationwide

5. 5
Opioid Epidemic: Key Driving Factors
Creation of “Pill-Mills”
▪ Massive marketing by drug manufacturers about effectiveness & safety of opioid drugs
▪ Uncontrolled prescriptions by physicians to improve patient satisfaction & profit margins
Growth in Instances of Chronic Pain
▪ Continuous growth in patients with chronic pain – about 50mn suffer from chronic pain, with
20mn having high-impact chronic pain
▪ Opioids are the easiest, economical and readily available means to reduce the pain
▪ Alternate therapies are expensive & mostly not covered under benefit plan
Easy Access to Opioids
▪ For many years, there was neither legislation nor any kind of monitoring on consumption of
prescription drugs
▪ Easy availability of illicit drugs such as Heroin acts as substitute for opioids
Socio-economic Causes
▪ The rate of opioid mortality is found to be higher in areas with higher poverty, unemployment,
disability, single parent families, and divorce/separation
▪ Major section of population under the abuse of legally available opioids are found to be middle-
aged women (over 40 years)

6. 6
Opioid Epidemic: Multi-Dimensional Impact
Growing mortality rate
▪ Leading cause of death – Deaths due to opioids are 1.5 times the deaths caused due to road
accidents
Economic Burden
▪ Opioid Epidemics’ estimated cost to the nation in 2017: $78 Bn
Loss in Productivity
▪ Highest rate of opioid overdoses in population in age range 25 – 54 years
Burden on high cost settings
▪ The rate of ER visits for opioid overdose cases has grown to 45% in 45 states in 2017
Pre-natal effects
▪ Around 75 – 90% of the prenatal opioid–exposed infants are diagnosed with Neonatal Abstinence
Syndrome
Family crises
▪ A large section of victims are middle-aged females leading to massive disruptions in family lives

7. 7
Opioid Epidemic: Measures to Fight the Epidemic (1/2)
Litigations against drug
manufacturers &
distributors
▪ Multiple lawsuits across states against Pharma companies for fueling the crisis by
misleading data and unethical marketing practices
▪ Key defendants include Pharma giants such as J&J, Purdue Pharma, Amerisource
Bergen, McKesson Corp, Cardinal Health, etc.
▪ Purdue pharma has 2,000+ opioid lawsuits totaling to around $12 billion in
compensation
New regulations for
managing OUD (Opioid Use
Disorder)
▪ A Prescription Drug Monitoring Program (PDMP) is a statewide electronic
database to track all controlled substance prescriptions
• Data available to authorized users – medical professionals, regulatory
bodies, public health agencies, etc.
• 49 states currently participate in this program
▪ Medication Assisted Treatment (MAT) is a statewide program for rehabilitation
of OUD patients
• A combination of antidotes such as Methadone, Buprenorphine &
Naltrexone along with focus on behavioral health
• Only 22 states have currently implemented this program
▪ Modification in MIPS program – removal of Pain Management Questions from
HCAHPS survey

8. 8
Opioid Epidemic: Measures to Fight the Epidemic (2/2)
Preventive Care
▪ Increase proportion of providers using evidence-based guidelines while prescribing
opioids
▪ Develop additional tools for patients as well as care givers for using opioids
appropriately
▪ Provide timely and accurate notifications to curb overuse of opioids
▪ Modify the benefit plans to have prior authorizations/referrals for opioids
▪ Population Health Management programs to manage high risk patients
Research &
Educational Programs
▪ HHS has a 5-point strategy to fight opioid crisis which includes:
• Better research
• Improved pain management
• Availability of overdose reversing drugs
• Timely reporting of overdose data
• Better services for prevention and recovery
▪ CDC created a Strategic Framework for the opioid crisis which includes:
• Campaigns to create awareness for negative impact of opioids
• Building public health advisories to empower local communities in the fight
against opioids
• Evidence-based community level intervention programs
• Surveillance programs to improve prevention

9. 9
Opioid Epidemic: What Lies in the Future
Immediate Impact
▪ Latest reports from CMS
indicate no decline of the
opioid epidemic despite
the efforts
▪ Industry observers agree
that the rates of addiction,
overdose, and death is
likely to get worse in the
coming years before they
start improving
Ecosystem Approach
▪ An ecosystem approach
could become the best
hope in the battle against
opioid addiction
▪ Regulatory bodies and
state governments will
need to work with
providers, payers, local
agencies, law enforcement
bodies, community groups,
and individual citizens for
an optimum solution
Evidence-based Measures
▪ Stakeholders need to
develop & implement
mitigation plans that are
data driven in nature &
and responsive to
emerging trends in the
epidemic as well as best
practices
▪ Few health plans,
providers, and pharmacy
benefit managers are
taking a data driven,
evidence-based approach
to help change patient and
physician behavior
▪ There is a need for a
cutting age technology to
support these to ensure
the success of such
endeavors

10. 10
Opioid Epidemic: A Step by CMS in the Right Direction
Prevention
Significant progress has been
made in identifying
inappropriate prescribing
pattern
Treatment
Medicare, Medicaid, and
private health plans provide
some coverage for pain and
opioid use disorder treatment
Care
Data provides insights into
doctor, pharmacy, and patient
use of prescription opioids and
effectiveness of treatment
1. Identify and stop
inappropriate prescribing of
opioids
2. Enhance diagnosis of OUD to
get people the support they
need earlier
3. Promote effective, non-
opioid pain treatments
1. Ensure access to treatment
across CMS programs and
geography
2. Give patients options for
broader range of treatments
3. Support innovation through
new models and best
practices
1. Understand opioid use
patterns across populations
2. Promote sharing of
actionable data across the
continuum of care
3. Monitor trends to assess
impact of prevention and
treatment efforts
CMS can build on these efforts to further:
CMS has published a roadmap outlining its efforts to address this issue of national concern

11. 11
Key Considerations
1. Control Cost
2. Maintain High Quality of Care
3. Access to Patient Data
4. Continuous Engagement
5. Timely Interventions
Key Enablers
1. Virtual Care
2. Remote Patient Monitoring
3. Advanced Analytics
4. AI / ML
5. Natural Language Processing (NLP)
6. Digital Therapeutics
7. Internet of Things (IoT)
Opioid Epidemic: Role of Technology
Healthcare facilities need to leverage technology and tools to address prescription opioid misuse and
abuse.

12. 12
Opioid Epidemic: Potential Areas for Technology Vendors
Opioid Registries
Create a longitudinal view of OUD patient by integrating data across
multiple sources & formats – clinical, claims, SCM, social history, etc.
Regulatory Compliance
Leverage BI / Analytics and Reporting services for assisting providers with
regulatory needs – MAT program, MIPS/MACRA, etc.
Advanced Analytics
Implement multiple Population Health use cases – creating patient
cohorts, identifying high risk patients, physician prescription patterns,
biomarkers for pain severity, etc.
NLP
Leverage cognitive technologies in NLP to read unstructured data residing
in clinical notes, etc. & convert these into usable format
Mobile-based Apps
Build mobile apps for OUD patients – medication adherence, medication
impact & outcomes as well as for physicians – alerts and notifications
during an adverse event, etc.
Opioid-based KPIs
Determine key domains for reporting – prevention, pain management,
oud treatment outcomes, etc. and metrics under each for performance
evaluation

13. 13
References
▪ https://www2.deloitte.com/content/dam/insights/us/articles/fighting-opioid-crisis-heroin-abuse-ecosystem-
approach/DUP_3406_Opioid-ecosystem_MASTER_FINAL.pdf
▪ https://www2.deloitte.com/content/dam/insights/us/articles/4392_Health-plan-strategy-Opioid-
crisis/DI_Health-plan-strategy-Opioid-crisis.pdf
▪ https://www.pwc.com/us/en/industries/health-industries/top-health-industry-issues/opioid-crisis.html
▪ https://www.healthcareitnews.com/news/opioid-epidemic-why-arent-prescription-drug-monitoring-programs-
more-effective
▪ https://www.modernhealthcare.com/article/20180619/TRANSFORMATION01/180619893/mat-underutilized-
by-hospitals-in-treating-opioid-addiction
▪ https://medium.com/wagovernor/what-are-hubs-and-spokes-and-how-can-they-help-fight-the-opioid-
epidemic-d65f4f20345f
▪ https://www.healthcareitnews.com/video/tech-and-innovation-bring-hope-combating-devastating-opioid-
crisis?mkt_tok=eyJpIjoiTVRSa01qWmxPVFV5TlRSbSIsInQiOiJ5YzBxUFR6VjVcLzRUb3hJQ1BlTkFHeWV0V2paZ2Ny
NEZhdFJnZjR2V2o1akVYT2hlT2NMSG1LSWgzS1wvc0FDVE9pa28rVGdXdm53TlhCd0YwY3NXeWJ6TUgzb0lZalNO
WWlzQ25EcTZlcUhPNmpla1wvNVVIN3F3VTFVOGVZYWRhNSJ9
▪ https://www.healthcareitnews.com/news/clinicians-need-better-opioid-data-within-their-workflows-says-
ehra?mkt_tok=eyJpIjoiTkROa1pqQmlZelpsTlRZeSIsInQiOiJpdnAxU3d1OGtmeXhBOW12QXM2MHdobVFuSzBDe
lJzcjVhUXgwbWYraTEwbktZcFFxXC9KbVZPcVBydXdoUG1nbXc3bFwvNnZHUTliaGJaNlNjRUFKaWJiSlJJTnh1Vk13O
GU2MlpiejhQSVVwV051MW5Kb3ozOU5ldEhZRXFuNThDIn0%3D
▪ https://edition.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html
▪ https://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts

14. About CitiusTech
4,000+
Healthcare IT professionals worldwide
1,500+
Healthcare software engineering
400+
FHIR / HL7 certified professionals
25%+
CAGR over last 5 years
110+
Healthcare customers
▪ Healthcare technology companies
▪ Hospitals, IDNs & medical groups
▪ Payers and health plans
▪ ACO, MCO, HIE, HIX, NHIN and RHIO
▪ Pharma & Life Sciences companies
14
Thank You
Author:
Shiven Kalelkar
Sr. Healthcare Consultant
thoughtleaders@citiustech.com