Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Poor Medication Reconciliation Puts 60% of Opioid Users at Risk

By Jennifer Bresnick

Electronic monitoring of opioid prescription data can improve medication reconciliation and reduce patient safety risks.

- Close to 60% of patients who are taking opioids for pain medication are also taking additional drugs that present serious patient safety risks when taken in combination, finds a new pain management trend report from Express Scripts.  These drugs are often prescribed by a series of providers who may not be aware of concurrent medications and may not have performed adequate medication reconciliation.  The report also shows the significant impact that electronic drug monitoring systems can produce on reducing the potential for patient harm, addiction, and overdose-related death.

medication adherence and chronic disease management

Express Scripts analyzed the deidentified data of 6.8 million prescriptions from 2009 to 2013 to compile the report.  Among the patients taking risky drug combinations, nearly one third were taking an opiate and an anti-anxiety benzodiazepine, which is the most common combination involved in overdose deaths.  Twenty-eight percent were taking a muscle relaxant in addition to an opiate, while eight percent were medicated with all three types of medications.  Twenty-seven percent of patients were taking multiple short-acting opiate medications, which puts them at higher risk for developing dependence or addiction.

“There could be instances when prescribing these combinations of drugs is appropriate, but not at this scale. The fact that the majority of these patients are being treated by multiple physicians and pharmacies signals a communication breakdown that leads to dangerous use,” said Lynne Nowak, MD, medical director at Express Scripts and a former hospice care physician. “Government- and insurer-run drug monitoring programs can help prevent these possibly life-threatening scenarios, but unfortunately they are underused and vary by state. As more people gain access to health coverage, this problem will worsen if the country doesn’t use every tool at its disposal to ensure the safe use of these medications.”

Local health and law enforcement authorities constantly attempt to combat large-scale opioid use and overdose deaths, which have more than tripled since 1990, but healthcare providers can play a large part in reducing unintentional overdoses and the development of addiction by prescribing potentially dangerous drugs with discretion while paying attention to behavioral patterns that may indicate “doctor shopping.”

More than two thirds of patients who were taking these dangerous combinations were prescribed the drugs by two or more physicians.  Close to 40% filled the prescriptions at two or more different pharmacies.  Express Scripts found that patients who use home pharmacy delivery from a single source are 23% less likely to be taking a potentially dangerous combination of medications, and 15% fewer patients were prescribed medications from multiple sources.

While forty-nine out of the fifty states currently have prescription drug monitoring programs (PDMPs), only sixteen states require prescribers to report to these databases when writing a prescription.  In Maryland, the state’s PDMP system is integrated with the Chesapeake Regional Information System for Our Patients (CRISP), the state’s health information exchange.  This allows providers to see what controlled substances have previously been prescribed by other care facilities, and aids in medication reconciliation, care coordination, and the delivery of drug addiction counseling or other treatments to prevent overdoses or other harm.

While Tennessee and Florida have seen drastic cuts in the number of opioid-related overdose deaths thanks to the utilization of the electronic system and an aggressive effort to shut down illegal “pill mills,” the report notes that the only state without a PDMP, Missouri, has seen a marked increase in out-of-state patients filling opioid prescriptions within the unmonitored territory.

“The bottom line is this: PDMPs can be a highly effective tool in curbing abuse, but they are only effective when states consistently apply the necessary resources and enforcement to ensure their success,” the report asserts. “States also need to collaborate with payers and benefit providers, who can provide additional data and resources to identify cases of abuse, including those who travel across state lines to obtain medications. Working together, we can more efficiently and effectively identify abuse, and most importantly, help these patients obtain the necessary treatment to fight their addiction.”


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