Nearly one-fourth of 3.5 million opioid users had a least one indicator that suggested potential misuse by patients, or inappropriate prescription practices by providers, according to a study just published in The American Journal of Managed Care (AJMC).
FOR IMMEDIATE RELEASE
August 14, 2013
AJMC: Recognizing Certain Indicators Can Prevent Opioid Misuse and Overdose
PLAINSBORO, N.J. -- Nearly one-fourth of 3.5 million opioid users had a least one indicator that suggested potential misuse by patients, or inappropriate prescription practices by providers, according to a study just published in The American Journal of Managed Care (AJMC). Furthermore, among those patients who were prescribed opioids, twice as many received prescriptions for acute pain as for chronic pain, and about 15% had high daily doses. Women were more likely than men to indicate an overlap of opioid prescription use with other drugs, like benzodiazepine, which is used to treat anxiety.
Misuse and overdose of opioid prescriptions is a major public health issue in the United States. In 2010, nearly 40,000 Americans died from a drug overdose, and another 1.2 million landed in the emergency room due to prescription drug abuse. In 2009, opioid analgesics, either alone or in combination with other drugs, accounted for nearly half of the drug overdose deaths in the US and almost 75% of prescription drug-related emergency room visits.
Indicators for increased risk of misuse among the study population included having more than one opioid prescription, overlapping or early refill prescriptions, dose escalation, and having several days’ worth supply of opioids. Study authors, Ying Liu, PhD, Joseph E. Logan, PhD, Leonard J. Paulozzi, MD, MPH, Kun Zhang, MS, and Christopher M. Jones, PharmD, say that the New York City Department of Health, for example, recommends no more than a 7-day supply of opioids for acute pain.
“However, in this study 22.8% of opioid prescriptions for acute pain were for 10 or more days, and 9.5% were for 30 or more days,” the study authors wrote in AJMC. “The American College of Occupational and Environmental Medicine practice guidelines only recommend opioids on a limited basis for treatment of severe, acute low back pain, with treatment to last no more than 2 weeks. In this study, 42.3% of opioid prescriptions for back pain were for 30 days or more, clearly much more than recommended.”
While certainly not every patient is at risk for misuse, a substantial number of patients in this study were prescribed in a manner that implied risk for patient misuse or inappropriate prescription practice by providers. To remediate potential misuse or overdose, the authors suggest more rigorous review programs be implemented using integrated claims data. Managed healthcare professionals, government organizations, and other health professionals can utilize such information to flag patients who might require a more closely-monitored care plan.
“A number of tools and approaches clinicians should use to safely prescribe opioids,” the study says. “These include checking prescription drug monitoring programs, which track information on controlled substance prescriptions filled in a state, taking a careful history of substance abuse and other mental health problems, conducting routine urine drug screens in concert with pain management agreements, and making use of pain medicine consultants when problems arise.”
Having such safeguards in place can help providers avoid opioid misuse, and reduce the risk of adverse outcomes related to opioid medications, the authors state.
CONTACT: Nicole Beagin