This morning’s NYTimes has a heart-crushing story about a town in Ohio devastated by abuse of OxyContin and other prescription narcotics.
Here’s what prescription drug abuse has done to Ohio.
– in 2007, deaths from prescription drug abuse (PDA) in Ohio surpassed deaths from motor vehicle accidents.
– more people died from PDA in Ohio in two years than died in the World Trade Center in 2001.
– almost one in ten babies born in Scioto County tested positive for prescription drugs.
Around the nation, the numbers are equally terrifying.
– Prescriptions for opiates (hydrocodone and oxycodone products) went from 40 million in 1991 to nearly 180 million in 2007
– The U.S. consumes 99 percent of the world total for hydrocodone (e.g., Vicodin) and 71 percent of oxycodone (e.g., OxyContin).
– PDA grew by 400% from 1998 to 2008. Four hundred percent.
And that’s just the statistics.
There’s no figure, no number or percentage, that can describe the pain felt by parents, spouses, siblings who lost someone to PDA.
These abusers are getting the drugs from somewhere, and some portion of the drugs that are killing these people are paid for by insurers. At some point, some enterprising attorney is going to ask the question; “What did you know about this person’s drug profile, when did you know it, and what action did you take?”
Play that conversation thru in your mind.
Which leads to the question, what are we going to do about it?
And more precisely, what are YOU going to do about it?
If you work for an insurer or TPA, are you monitoring potential PDA? Looking for possible abuse or diversion? Tracking provider prescribing patterns? Identifying claimants at risk for doctor shopping or use of multiple pharmacies?
Or are you thinking about it, debating, discussing, having meetings and writing memos? Getting ready to get ready?
Not only is there a societal cost of PDA, there’s also a fiduciary obligation. Payers have the technology, data, and analytical abilities to identify potential PDA. It’s time to stop ignoring the problem, get off our collective butts, and take action.
Apr
20
Workers comp claims payers need to be much more assertive in controlling over-prescribing of opioids. A study published in the Journal of the American Medical Society (JAMA) reports that the overdoes death rate of patients (1) with prescriptions equal or over 100 mlg/day, and with known substance abuse problems, is 2.97 per 1000 person months, which to me means a 7% mortality rate for these patients over a 2 year period….over ten times the rate of patients taking 50 mlg or less/day and without substance abuse problems.
Amen
There is no system in place to prevent an addict from getting prescriptions from multiple physicians filled at multiple pharmacies to allow the addict to abuse the opioids if the addict is willing to pay cash for the medication. With a drug like Vicodin being relatively inexpensive (at least compared to Oxycontin) the accessibility is quite dangerous to those with an addiction and an ever increasing tolerance for it. To address this issue the FDA needs to put a monitoring system in place at the pharmacy level that tracks prescriptions by user/drug type and would cause alarms to go off at the pharmacy level if an individual was trying to fill a duplicate prescription prior to the appropriate time.
Surely someone much smarter than me has already proposed this solution or something similar, right?
I also want to lay more blame on the physicians who prescribe these opioids on a long term basis but in the situation above you almost have to excuse them if it is a new patient and they have no way of knowing what medications are being prescribed by another dr.
On a positive note in WC we are seeing increasingly more of the pain management physicians utilize a “narcotics agreement” that includes periodic drug testing. It is far from a solution but is a step in the right direction.
Very good article…but what is the solution ? hopefully not more government intervention and regulation. We know how productive that has been in the past.
Dan – thanks for the comment.
I’d suggest that the ONLY solution is a much more assertive and intelligent monitoring program. If you read what law enforcement is saying, they are desperate for PDMPs, which have been shown to have a positive impact (this despite the fact that many are so watered-down as to be far less than they should be).
If you have other ideas I’d love to hear them.
I think that doctors need to be held more accountable; if prescription drugs are such a big problem, where are they coming from…the doctors who are prescribing them. Maybe there could be regulations regarding what conditions may get a narcotic and a length of time for them to be given then cut off…