[BLOG]: Examining US prescription opiates utilization trends

January 3, 2015

The findings of a new research report from Express Scripts on the use of prescription opiates in the United States indicate that physicians are being more cautious about prescribing pain medications.1 The report shows both a drop in the short-term use of opioids and stabilization in the number of patients using these medications longer term.

Dr Nowak

The findings of a new research report from Express Scripts on the use of prescription opiates in the United States indicate that physicians are being more cautious about prescribing pain medications.1 The report shows both a drop in the short-term use of opioids and stabilization in the number of patients using these medications longer term.

The research, however, uncovered some concerning increases in the amount of prescription opioid medications used by US citizens and in the frequency in which these medications are used in dangerously high doses and in risky combinations with other medications.

Dangerous combinations

Nearly 60% of patients taking opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period. Two-thirds of patients using these medication mixtures were prescribed the drugs by 2 or more physicians, and nearly 40% filled their prescriptions at more than 1 pharmacy, signaling a communications breakdown that leads to dangerous use.  

Among those taking dangerous drug mixtures last year:

·         A total of 27% were taking multiple opiate pain treatments simultaneously.

·         Nearly 1 in 3 patients were on both an opiate and benzodiazepine (which treats anxiety), a combination that is the most common cause of multiple drug overdose deaths.

·         Approximately 28% took both a prescription opioid and a muscle relaxant, and 8% were combining an opioid, muscle relaxant, and a benzodiazepine. Opioids, muscle relaxants, and benzodiazepines all have sedating effects and can slow down the respiratory system. Taking these medications together could increase these reactions exponentially.

·         Women accounted for nearly two-thirds of those taking these potentially hazardous mixes of medication.

Study: Many opioid users are taking Rx drugs in potentially harmful combinations; education needed

Clinically, there may be some instances when prescribing an opioid in combination with these other medications is appropriate. To see this concurrent use on such a large scale and involving multiple prescribers and pharmacies, however, indicates there could be a breakdown in communication among a patient’s care team or potential abuse.

 

 

Propensity for longer-term use

Prescription opioids can provide patients with clinically safe and very effective pain management, but the goal should always be to treat the underlying cause of pain and discontinue opioid therapy as soon as possible. That does not, however, seem to be happening in clinical practice as frequently as it could be.

In the report, nearly half of patients who took opiate painkillers for more than 30 days in the first year continued to use them for 3 years or longer. In addition, almost half of chronic opioid users took only short-acting medications, potentially increasing their risk for addiction and making the goal of discontinuing therapy more difficult to achieve. Although some patients’ pain may respond better to short-acting opioids, the risk profile of these drugs should be considered when prescribing them for management of chronic pain.

Age matters

Prevalence of longer-term opioid use increases with age and is highest among those aged 65 years and older, with 8.9% of that population taking opiate pain medications in 2013. Middle-aged US citizens, however, are the heaviest users of these drugs given the size of the population and the quantity of medicine they consume. Younger adults (aged 20–44 years) who use opiate pain medications filled more opioid prescriptions per person than any other age group-averaging 10.2 prescriptions in 2013-and showed the greatest increase in the number of days of medication per prescription, rising nearly 10% between 2009 and 2013.

Protecting patients

The use of prescription opiates requires vigilance by patients and all other parties in a patient’s care, including physicians, nurses, caregivers, pharmacists, and benefit providers, and exemplary coordination of care. Collaborating with benefit providers, like Express Scripts, can help providers identify potential abuse and improve coordination of care, thus reducing potentially dangerous prescribing of these medications.

In fact, a subanalysis of the research shows that, when compared to those who filled their prescriptions at a retail pharmacy, 23% fewer patients who filled their medication via the Express Scripts home delivery pharmacy were using a potentially dangerous combination of medications. Further, 15% fewer patients were prescribed medications by multiple prescribers. In addition, the rate of concurrent use of potentially dangerous medications was 7.6% less in patients whose benefit plan was enrolled in the Express Scripts fraud, waste and abuse (FWA) program in 2013 compared to patients whose benefit plan was not enrolled in the FWA program. 

Read more on overdoses

Data are vitally important to accurately identify cases of abuse and key to intervention. By catching potential misuse early on, those who have an addiction to these medications can get the help they need to fight their addiction before it becomes fatal. The challenge is finding the right balance between abuse prevention and availability of these medications for patients in real pain. 

To read the full report, please visit http://lab.express-scripts.com.

 

Dr Nowak is Medical Director of Express Scripts, St. Louis, MO.

 

Reference

1. Express Scripts. A nation in pain. December 9, 2014.  http://lab.express-scripts.com/publications/a-nation-in-pain. Accessed December 31, 2014.