Although doctors and other prescribers play a key role in fighting opioid use disorder (OUD), they often don’t have the latest clinical information about the risks associated with opioids. To close that knowledge gap, Aetna is collaborating with Alosa Health and clinical experts to educate primary care doctors in their own offices on best practices for the appropriate use of opioids as well as how to screen and treat for opioid addiction.
The goal? To reduce the number of new opioid users and lower risks for patients who are currently on opioid therapy.
Battling Misconceptions about Opioid Prescribing
“More cautious prescribing can help prevent people from getting addicted to opioids and help those who are addicted to find alternative methods for managing their pain,” said Andrew Kolodny, M.D., co-director of opioid policy research, Brandeis University, and a nationally recognized expert on OUD.
The “academic detailing” pilot is deploying about 30 trained health care educators to doctor’s offices in Pennsylvania, Illinois, Maine, West Virginia and Ohio, some of the states hit hardest by OUD. These detailers—comprising physicians, nurses and pharmacists — develop individualized education plans with each prescriber and highlight opportunities to improve their clinical practices.
The program is providing physicians with the best peer-reviewed evidence on treating acute and chronic pain and recognizing and caring for patients with OUD utilizing medication-assisted treatments (MAT).
“From 1999 to 2013, prescribers quadrupled the number of opioid prescriptions, and although we’ve reduced it dramatically since 2013, we’re still at three times the level we saw in 1999,” said Elisabeth Fowlie Mock, M.D., M.P.H., an academic detailer based in Maine. “These days, we are seeing a lot of providers who are inheriting patients on high doses of opioids and are not sure what to do regarding the best next steps.”
Mock noted that the vast majority of patients on long-term opioid therapy who are tiered off appropriately and provided with other, better pain management options report less pain, fewer side effects and more functionality once they are off of the opioids.
“They say that they’ve gotten their lives back,” she said, adding that the program is needed because only 20 percent of people with OUD are receiving treatment for the disorder.
For the AdvocateCare Center, a busy multidisciplinary practice in Chicago that provides team-based care for patients with multiple chronic and acute conditions such as diabetes, heart failure and kidney disease, the opioid education provided helpful insights into the best solutions for pain management.
“It was great to have the training right in our office and be able to easily work it into the workflow of the day,” said Michael A. Richman, M.D.The entire team of social workers, nurses, behavioral health specialists and support staff participated in the training because they all encounter patients daily who are struggling with pain and/or addiction to opioids.
“Our detailer did a great job of laying out options for appropriate pain management,” he said, adding that evidence supports the use of multi-modal approaches such as movement and cognitive therapies, many of which are offered by the AdvocateCare Center. “The materials were easy to understand, and the evidence-backed background she presented was very valuable. The training was really helpful and appreciated.”
Daniel Knecht, M.D., vice president of clinical strategy and policy at Aetna, a CVS Health company, said that the program is helping to deepen Aetna provider partners’ knowledge base and comfort with treating OUD by providing insights around screening and treatment. He noted that many providers haven’t received formal training in pain management or addiction medicine.
Susan Reeves, R.N., a detailer who is working with providers in the Philadelphia area, said many of the physicians she is working with are excited to have access to the latest clinical information on opioids and other pain medications.
“One of their biggest concerns is, ‘What are my options?’ ‘What else can I do?’ ” she noted. “Luckily, evidence-based alternatives like physical therapy, chiropractic care, etc., offer great options. Doctors are relieved to hear the studies about these and other options because they really don’t have time to conduct their own research.”
Focusing on Proven Pain Management Alternatives
Studies of academic detailing have found that clinicians welcome the practice as it improves decision making and reduces health care costs.  It has successfully been used to educate physicians on a variety of health issues, such as atrial fibrillation, chronic obstructive pulmonary disease and appropriate antibiotic use, among others.  
“Evidence-based detailing programs are important because they provide direct, often in-person support to busy clinicians to help them screen, treat and manage patients with acute and chronic pain as well as substance misuse and addiction,” said Wilson Compton, M.D., deputy director of the National Institute on Drug Abuse (NIDA).
Stakeholders from across the health care system, including payers, can make a difference in guiding the safe and appropriate use of pain medication now and in the future, according to Dr. Kolodny.
“Aetna can have a very positive impact on opioid addiction, both through advocating for prescribing caution and by helping opioid-addicted people to have better access to treatment,” he said, adding that he’s “impressed with Aetna’s response to the epidemic by developing innovative solutions like the detailing program.”
The year-long pilot program is being guided by a national group of leading experts in pain management and the national opioid situation, drawn from universities across the country as well as NIDA and the Centers for Disease Control and Prevention.
 Academic Detailing: “Marketing” the Best Evidence to Clinicians; https://jamanetwork.com/journals/jama/article-abstract/2598775
 Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial; https://www.ncbi.nlm.nih.gov/pubmed/15282232
 Educational Outreach to Opioid Prescribers: The Case for Academic Detailing; https://www.ncbi.nlm.nih.gov/pubmed/28226336