Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools, and their families.

Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to .

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

What’s unclear, however, is how the reductions in prescriptions are affecting patients’ pain, she said.

Every day, from opioid overdoses, and about 40% of those deaths are caused by overdoses of prescription drugs. About one-quarter of the millions of patients who take the medications for chronic pain misuse them, the National Institutes of Health .

Prescription opioids — which are frequently prescribed for cancer patients and for orthopedic and dental pain — include hydrocodone, oxycodone, fentanyl, oxymorphone, morphine, codeine and others.

CalPERS has spent more than a decade trying to reduce prescription opioid use among its enrollees, working with health insurers and other state agencies to identify doctors who prescribe abnormally high amounts. In 2017, OptumRx, which manages CalPERS members’ pharmacy benefits, adopted a that includes limits on the quantity of opioids prescribed and requires prior authorization for some drugs.

CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the , the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Opioid medications act on receptors in the brain and spinal cord to reduce the intensity of pain perception, but they also activate regions of the brain that trigger euphoria, which underlies their potential for abuse.

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will reach a tipping point when opioid-related mortality begins to decrease.”

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”

The CalPERS data represents a cross section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

Reductions in their opioid use were across the board: The doctors cut back on numbers of people taking opioids for long periods of pain, but also how much people took daily. Prescriptions exceeding two weeks fell almost 32% from January to June 2017 and the same period in 2018. Daily average doses declined 14%.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

CalPERS members are still being prescribed considerable volumes of the drugs. For instance, 34,321 patients were prescribed opioids in the first half of 2018, according to the data. Of those, 1,168 were prescribed doses that are considered large — over the equivalent of 50 morphine milligrams per day.

Health experts said it’s important to wean people off the drugs properly, prevent relapses and ensure they don’t switch to heroin.

The surest sign of success, Donneson said, will be when patients with many types of chronic pain, such as knee or back pain, are “kept pain-free in other ways” and when opioids are reserved for patients who need them the most, such as those with cancer or in hospice or post-surgery care.

“We’re not there yet,” she said.

This <a target="_blank" href="/health-industry/opioid-prescriptions-drop-sharply-among-state-workers/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Last week, a federal jury ordered Monsanto, the maker of Roundup, to to a with cancer who had used it for three decades on his 56 acres in Sonoma County, Calif. The jury found that Roundup was a “substantial factor” in his illness.

Bayer AG, which bought Monsanto last year, said it would appeal the decision.

Last year, a California superior court jury in San Francisco reached a similar verdict against Monsanto in favor of a with the same disease — non-Hodgkin lymphoma, a potentially fatal cancer of the immune system. Monsanto also appealed that decision.

Glyphosate is by far the in the United States, and probably worldwide. It is used on of corn, cotton and soybeans grown in the U.S. You may have sprayed it on your lawn or garden.

But many jurisdictions, in more than , have banned or restricted its use. Among the latest: Los Angeles County announced last month that it on county property until more is known about its health effects.

Bayer says on its that the weed killer has been thoroughly tested, and “an extensive body of research” shows that products containing it “can be used safely and that glyphosate is not carcinogenic.”

Cynthia Curl, an environmental health scientist at Boise State University in Idaho who studies the chemical, said, “many assumptions have been made about the safety of glyphosate that are now being actively questioned. We will see an explosion of information about glyphosate, and it’s about time. We’re really playing catch-up on this one.”

Let’s try to provide a few answers:

Q: What is glyphosate, and what is it used for?Ìý

First sold commercially by Monsanto in 1974 under the name Roundup, glyphosate kills weeds by blocking enzymes that regulate plant growth.

Over the four decades after its launch, use of Roundup increased a hundredfold. Monsanto genetically engineered crops to tolerate glyphosate in 1996, and these seeds paved the way for the weed killer to be used on farm fields around the world.

Q: Roundup isn’t the only weed killer with glyphosate, right?

Right. glyphosate-containing products are sold in the United States, either in solid or liquid form. In addition to Roundup, common ones include Ortho GroundClear, DowDuPont’s Rodeo, Compare-N-Save Concentrate Grass and Weed Killer, RM43 Total Vegetation Control and Ranger Pro Herbicide, also made by Monsanto. If you don’t know whether a weed killer contains glyphosate, read the label. It would be listed under active ingredients.

Q: How extensive is human exposure to glyphosate?

Because of its widespread use, glyphosate is in water, food and dust, so it’s likely almost everyone has been exposed. And human exposure, through food and water, will probably increase in tandem with growing use of the weed killer, according to a published in the journal Environmental Sciences Europe.

But little is known about the magnitude of human exposure, because food and water are not regularly tested for glyphosate residue. However, a few years ago, researchers the urine of a small group of people across the United States and found glyphosate residue in 93% of them.

Curl said she is launching a project that will compare the exposure of pregnant women who live in farm areas and non-farm areas, then introduce organic diets to try to tease out how much of the glyphosate comes from food.

Q: What do we really know about the human health risks of glyphosate?Ìý

For decades, it was thought that glyphosate posed a risk only to plants, not people. That’s because it inhibits an enzyme that humans don’t even have.

Its possible link to cancer has prompted a blizzard of claims and counterclaims over the past several years, and major public health agencies disagree about it. The World Health Organization’s International Agency for Research on Cancer has called glyphosate a “probable human carcinogen,” and in 2017, the state of California added it to its .

The Environmental Protection Agency, however, decided in late 2017 that glyphosate was to cause cancer in humans.

But evidence is mounting that people who are heavily exposed to it — farmworkers and landscapers, for example — have an increased risk of non-Hodgkin lymphoma.

A led by University of Washington scientists published in February found that agricultural workers who used a lot of glyphosate had a 41% higher risk of contracting non-Hodgkin lymphoma over their lifetimes than people who used it infrequently or not at all.

On average, about 2 out of every 100 Americans develop non-Hodgkin lymphoma. For people who are highly exposed to glyphosate, the disease rate jumps to 2.8 per 100. That means they still have a relatively small chance of contracting the disease, but their risk is substantially higher because of glyphosate use.

Monsanto has submitted more than 800 studies to the EPA and European regulatory agencies suggesting that glyphosate is safe, according to Bayer.

Q: What about the risks to the rest of us, who only occasionally use glyphosate — and only on a small scale?

No one knows.

“The data is really starting to suggest that there is a correlation between high glyphosate exposure and non-Hodgkin lymphoma,” said Curl. “But we have a lot of unanswered questions about the rest of us. We don’t know what that means for people who don’t have high exposures, and we don’t know what it means with a chemical that is so widely used.”

Q: Should people still use glyphosate at home, or are there safer substitutes?

All chemical pesticides are toxic. Some gardeners have limited success using .

The best non-toxic solution for killing weeds is good old elbow grease: Get a trowel and dig them out.

“From a personal perspective, I prefer to use caution and avoid pesticides in my own garden,” said Rachel Shaffer, a Ph.D. student at the University of Washington’s School of Public Health and co-author of the university’s study on glyphosate and non-Hodgkin lymphoma.

“Our understanding of the health effects of glyphosate will continue to evolve as the science advances,” said Shaffer, who . “Individuals who are particularly concerned in the interim may want to take steps to reduce use in their home gardens.”

Q: If I use glyphosate products, what precautions should I take?

Carefully follow label instructions and warnings. Wear gloves and don’t let the chemical come in contact with your skin, clothing or eyes. Use it only on calm, rain-free days to prevent drift. Do not let it run off into waterways or gutters. Pets and people should wait until treated areas are dry before entering them.

This <a target="_blank" href="/courts/popular-weed-killers-alleged-link-to-cancer-spreads-concern/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools, and their families.

Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to .

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

What’s unclear, however, is how the reductions in prescriptions are affecting patients’ pain, she said.

Every day, from opioid overdoses, and about 40% of those deaths are caused by overdoses of prescription drugs. About one-quarter of the millions of patients who take the medications for chronic pain misuse them, the National Institutes of Health .

Prescription opioids — which are frequently prescribed for cancer patients and for orthopedic and dental pain — include hydrocodone, oxycodone, fentanyl, oxymorphone, morphine, codeine and others.

CalPERS has spent more than a decade trying to reduce prescription opioid use among its enrollees, working with health insurers and other state agencies to identify doctors who prescribe abnormally high amounts. In 2017, OptumRx, which manages CalPERS members’ pharmacy benefits, adopted a that includes limits on the quantity of opioids prescribed and requires prior authorization for some drugs.

CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the , the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Opioid medications act on receptors in the brain and spinal cord to reduce the intensity of pain perception, but they also activate regions of the brain that trigger euphoria, which underlies their potential for abuse.

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will reach a tipping point when opioid-related mortality begins to decrease.”

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”

The CalPERS data represents a cross section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

Reductions in their opioid use were across the board: The doctors cut back on numbers of people taking opioids for long periods of pain, but also how much people took daily. Prescriptions exceeding two weeks fell almost 32% from January to June 2017 and the same period in 2018. Daily average doses declined 14%.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

CalPERS members are still being prescribed considerable volumes of the drugs. For instance, 34,321 patients were prescribed opioids in the first half of 2018, according to the data. Of those, 1,168 were prescribed doses that are considered large — over the equivalent of 50 morphine milligrams per day.

Health experts said it’s important to wean people off the drugs properly, prevent relapses and ensure they don’t switch to heroin.

The surest sign of success, Donneson said, will be when patients with many types of chronic pain, such as knee or back pain, are “kept pain-free in other ways” and when opioids are reserved for patients who need them the most, such as those with cancer or in hospice or post-surgery care.

“We’re not there yet,” she said.

This <a target="_blank" href="/health-industry/opioid-prescriptions-drop-sharply-among-state-workers/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Last week, a federal jury ordered Monsanto, the maker of Roundup, to to a with cancer who had used it for three decades on his 56 acres in Sonoma County, Calif. The jury found that Roundup was a “substantial factor” in his illness.

Bayer AG, which bought Monsanto last year, said it would appeal the decision.

Last year, a California superior court jury in San Francisco reached a similar verdict against Monsanto in favor of a with the same disease — non-Hodgkin lymphoma, a potentially fatal cancer of the immune system. Monsanto also appealed that decision.

Glyphosate is by far the in the United States, and probably worldwide. It is used on of corn, cotton and soybeans grown in the U.S. You may have sprayed it on your lawn or garden.

But many jurisdictions, in more than , have banned or restricted its use. Among the latest: Los Angeles County announced last month that it on county property until more is known about its health effects.

Bayer says on its that the weed killer has been thoroughly tested, and “an extensive body of research” shows that products containing it “can be used safely and that glyphosate is not carcinogenic.”

Cynthia Curl, an environmental health scientist at Boise State University in Idaho who studies the chemical, said, “many assumptions have been made about the safety of glyphosate that are now being actively questioned. We will see an explosion of information about glyphosate, and it’s about time. We’re really playing catch-up on this one.”

Let’s try to provide a few answers:

Q: What is glyphosate, and what is it used for?Ìý

First sold commercially by Monsanto in 1974 under the name Roundup, glyphosate kills weeds by blocking enzymes that regulate plant growth.

Over the four decades after its launch, use of Roundup increased a hundredfold. Monsanto genetically engineered crops to tolerate glyphosate in 1996, and these seeds paved the way for the weed killer to be used on farm fields around the world.

Q: Roundup isn’t the only weed killer with glyphosate, right?

Right. glyphosate-containing products are sold in the United States, either in solid or liquid form. In addition to Roundup, common ones include Ortho GroundClear, DowDuPont’s Rodeo, Compare-N-Save Concentrate Grass and Weed Killer, RM43 Total Vegetation Control and Ranger Pro Herbicide, also made by Monsanto. If you don’t know whether a weed killer contains glyphosate, read the label. It would be listed under active ingredients.

Q: How extensive is human exposure to glyphosate?

Because of its widespread use, glyphosate is in water, food and dust, so it’s likely almost everyone has been exposed. And human exposure, through food and water, will probably increase in tandem with growing use of the weed killer, according to a published in the journal Environmental Sciences Europe.

But little is known about the magnitude of human exposure, because food and water are not regularly tested for glyphosate residue. However, a few years ago, researchers the urine of a small group of people across the United States and found glyphosate residue in 93% of them.

Curl said she is launching a project that will compare the exposure of pregnant women who live in farm areas and non-farm areas, then introduce organic diets to try to tease out how much of the glyphosate comes from food.

Q: What do we really know about the human health risks of glyphosate?Ìý

For decades, it was thought that glyphosate posed a risk only to plants, not people. That’s because it inhibits an enzyme that humans don’t even have.

Its possible link to cancer has prompted a blizzard of claims and counterclaims over the past several years, and major public health agencies disagree about it. The World Health Organization’s International Agency for Research on Cancer has called glyphosate a “probable human carcinogen,” and in 2017, the state of California added it to its .

The Environmental Protection Agency, however, decided in late 2017 that glyphosate was to cause cancer in humans.

But evidence is mounting that people who are heavily exposed to it — farmworkers and landscapers, for example — have an increased risk of non-Hodgkin lymphoma.

A led by University of Washington scientists published in February found that agricultural workers who used a lot of glyphosate had a 41% higher risk of contracting non-Hodgkin lymphoma over their lifetimes than people who used it infrequently or not at all.

On average, about 2 out of every 100 Americans develop non-Hodgkin lymphoma. For people who are highly exposed to glyphosate, the disease rate jumps to 2.8 per 100. That means they still have a relatively small chance of contracting the disease, but their risk is substantially higher because of glyphosate use.

Monsanto has submitted more than 800 studies to the EPA and European regulatory agencies suggesting that glyphosate is safe, according to Bayer.

Q: What about the risks to the rest of us, who only occasionally use glyphosate — and only on a small scale?

No one knows.

“The data is really starting to suggest that there is a correlation between high glyphosate exposure and non-Hodgkin lymphoma,” said Curl. “But we have a lot of unanswered questions about the rest of us. We don’t know what that means for people who don’t have high exposures, and we don’t know what it means with a chemical that is so widely used.”

Q: Should people still use glyphosate at home, or are there safer substitutes?

All chemical pesticides are toxic. Some gardeners have limited success using .

The best non-toxic solution for killing weeds is good old elbow grease: Get a trowel and dig them out.

“From a personal perspective, I prefer to use caution and avoid pesticides in my own garden,” said Rachel Shaffer, a Ph.D. student at the University of Washington’s School of Public Health and co-author of the university’s study on glyphosate and non-Hodgkin lymphoma.

“Our understanding of the health effects of glyphosate will continue to evolve as the science advances,” said Shaffer, who . “Individuals who are particularly concerned in the interim may want to take steps to reduce use in their home gardens.”

Q: If I use glyphosate products, what precautions should I take?

Carefully follow label instructions and warnings. Wear gloves and don’t let the chemical come in contact with your skin, clothing or eyes. Use it only on calm, rain-free days to prevent drift. Do not let it run off into waterways or gutters. Pets and people should wait until treated areas are dry before entering them.

This <a target="_blank" href="/courts/popular-weed-killers-alleged-link-to-cancer-spreads-concern/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">