The United States is currently experiencing an epidemic of opioid abuse. According to the Centers for Disease Control and Prevention, the amount of prescription opioids sold in the U.S. nearly quadrupled since 1999. Opioids include codeine, fentanyl, morphine and forms of oxycodone (e.g., Oxycontin and Percocet) as well as hydrocodone (e.g., Vicodin). They are typically prescribed to treat moderate to severe pain that do not respond well to other pain medications. This large increase in opioid prescriptions might lead you to believe that there has been an increase in the amount of pain experienced by Americans, but this is not the case. Unfortunately, the impact of this abuse can be tragic. More than 165,000 Americans died from overdoses related to prescription opioids from 1999 to 2014.
Given these statistics, you might question what is being done about opioid abuse. The implementation of drug-monitoring programs has provided some positive results. A study by Bao and colleagues at Cornell Medical College found that doctors in states that track painkiller prescriptions were nearly one-third less likely to offer patients dangerously addicting opioids. Twenty-four states have implemented drug-monitoring programs. In these states, the probability of a doctor prescribing a Schedule II opioid dropped from 5.5 percent to 3.7 percent – a more than 30 percent reduction. The results were immediate and held for three years.
Dr. Caleb Alexander, who directs the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore, believes that many overdoses could have been avoided if doctors had been able to check a prescription drug-monitoring database. A database could show when patients are obtaining opioids under their own name from multiple doctors, which might assist in identifying potential abuse and dependency.
Bao and colleagues feel that drug-monitoring databases may make doctors think twice before prescribing pain medications for a variety of reasons in addition to uncovering “doctor shopping” by patients. Knowing that they’re being watched may serve as a deterrent, and the programs may generally increase awareness of the dangers of prescribing opioids.
According to the Washington Post, health insurance companies also believe monitoring the prescribing of opioids can bring positive results. Using the vast amount of data it collects from insurance claims by pharmacies, Aetna has begun contacting doctors whose prescribing habits are far outside the norm. In a letter it wrote to 931 physicians across the country earlier this month, Aetna stated, “You have been identified as falling within the top 1 percent of opioid prescribers within your specialty.”
Harold Paz, Aetna’s chief medical officer, said his experience has convinced him that the best way to change doctors’ behavior is to provide them with the numbers. “By nature, doctors are data-driven…If you show them how they’re doing, they’ll want to do better,” he said. Paz shared that if the 931 doctors brought their refill rate in line with the average for all physicians who prescribe opioids, 1.4 million fewer pills would be dispensed annually. The physicians receiving the letter had an average refill rate of 4.5 for each prescription written (the overall average was 0.3 refills per prescription).
The opioid abuse epidemic is real. Fortunately, physicians, researchers and insurance companies are recognizing it and taking steps to address the issue. While there is no quick fix, actions taken to date are showing some promising outcomes.
(Photo: pop life, Flickr)