“Prescription Opioid Abuse: Fighting Back on Many Fronts” was discussed by experts at a briefing held September 29th on Capitol Hill sponsored by the Alliance for Health Reform www.allhealth.org and the Pharmaceutical Care Management Association (PCMA) www.pcmanet.org. According to statistics, prescription drug abuse is the nation’s fastest growing drug problem with more than 20,000 Americans dying each year from overdoses.
To lead the discussion, Ed Howard of the Alliance and Mark Merritt of PCMA reported that opioid abuse causes enormous problems not only for healthcare providers, but also for employers and law enforcement when faced with the enormous problem of drug abuse in this country.
Grant Baldwin, PhD, Director for the Division of Unintentional Injury Prevention at the National Center for Injury Prevention and Control at CDC www.cdc.gov/injury reports, “There has been a dramatic increase in overdose deaths related to opioid pain relievers in patients receiving opioids from multiple prescribers and/or pharmacies especially in the rural areas of the south and for patients on Medicaid.
As he reports, “CDC is working hard to improve data quality and to track trends, strengthen state efforts. This is being accomplished by scaling up effective public health interventions, supplying healthcare providers with the resources needed to improve patient safety, performing research on how to deal with the epidemic, and building new tools to use for monitoring the epidemic.”
Allan Coukell, Senior Director for Drugs and Medical Devices for The Pew Charitable Trusts www.pewtrusts.org, mentioned how Pew has undertaken a Prescription Drug Abuse Project. He also discussed how physicians and pharmacists are being helped by the Prescription Drug Monitoring Program (PDMP), a statewide electronic database. The system is able to gather information from pharmacies on dispensed prescriptions for controlled substances and then analyzes the data.
According to Coukell, “Patient Review and Restriction (PRR) programs, also called “lock-in” programs enable state Medicaid programs to rein in a Medicaid patient’s overuse and possible abuse of physicians prescribing harmful drugs without having to terminate Medicaid benefits altogether.”
This is done by enabling Medicaid programs to restrict patients suspected of over utilizing prescriptions prescribed by a single designated provider, pharmacy, or both. The PRR program has been effective and has been adopted by commercial plans and state Medicaid programs, but is not currently permitted in Medicare Part D.
In her role at Express Scripts www.express-scripts.com, Jo-Ellen Abou Naderin looks at Rx Drug abuse from a unique position as she studies fraud, waste, and abuse within the organization’s 90 million members that take 1.4 billion prescriptions per year.
As she pointed out, “Catching fraud, waste, and abuse requires a comprehensive approach. It is important for Express Scripts to obtain medical and pharmacy data, billing data that goes beyond PDMPs, develop predictive models, and utilize clinical and enforcement investigative skills.”
Successful investigations have resulted in clients being notified where there is evidence of fraud and abuse and at that time, actionable outcomes are discussed. If the investigation shows that physicians and pharmacies are guilty, physicians may be blocked, pharmacies removed from the network, or events may even be reported to the proper agencies.
If members are found guilty of abuse, then they will be locked into one physician and one pharmacy where at that point, Express Scripts will take part in their case management to insure patient safety, but even so, at times members can be terminated from benefits.
As a rural practitioner, Sarah Chouinard MD, Medical Director for Community Care of West Virginia www.communitycarewv.org has dealt with an enormous amount of prescription drug abuse in central West Virginia. This is especially true since many residents work in labor intensive jobs such as coal mining where workers can experience many painful injuries.
As she explained, “Doctors aren’t equipped to treat chronic pain as it requires special training, so as a result, there aren’t any pain clinics in the rural area. She however, feels that it is very important to have an effective pain management program in the rural community.
She explained how a contract was devised to provide pain management but first it must be determined who legitimately needs pain medications. Failure for patients to comply with the plan can result in the health center refusing to continue prescribing the patient’s pain medication.