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Prescriptions for powerful painkillers dropped significantly among patients covered by Massachusetts' largest insurer after measures were introduced to reduce opioid use, a federal report concluded Thursday.

The Morbidity and Mortality Weekly Report , a publication of the US Centers for Disease Control and Prevention that is widely read in public health circles, extols the Blue Cross Blue Shield of Massachusetts program as an example of a private health insurer collaborating on a public health goal.

Excessive opioid prescribing has been blamed for fueling an epidemic of overdose deaths, which in 2014 were 2.5 times more common in Massachusetts than in the nation overall. In 2011, about 30,000 Blue Cross members received new prescriptions of more than 30 days for short-acting opioids such as Percocet and Vicodin. Of those people, 25 percent obtained the prescriptions from multiple providers, a sign of possible misuse.

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In 2012, the insurer — the state's largest, with 2.8 million members — instituted a program intended to induce doctors and patients to weigh the risks of opioids and consider alternatives.

As part of that initiative, first-time opioid prescriptions are limited to 15 days, with a refill allowed for 15 more days. Blue Cross must approve in advance any prescription for longer than a month or for any long-acting opioid such as OxyContin. Pharmacy mail orders for opioids are prohibited.

Doctors and others who prescribe must assess the patient's risk of abusing drugs and develop a treatment plan that considers options other than opioids. And patients with chronic pain are referred to case managers who advise on therapies other than opioids.

By the end of 2015, the average monthly prescribing rate for opioids decreased almost 15 percent, from 34 per 1,000 members to 29. About 21 million fewer opioid doses were dispensed during the three years covered in the study.

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The report, written by officials from Blue Cross and the CDC, acknowledges that other factors may have contributed to the decline in prescribing, including changes in state and federal policies and a growing focus on overdose deaths in the media.

The article also notes the potential for unintended consequences. Cancer patients were exempt from the requirements. But even so, opioid prescriptions for cancer patients declined 9 percent. The authors advise insurers that may emulate the program to endeavor to make sure cancer patients' pain is properly managed.

The analysis provides no insight into the restrictions' impact on other people with pain. "It is not known from these data how patient pain and function were affected by limiting access to opioid prescriptions," the article states.


Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer