Many Americans on Long-Term Painkillers Take Potentially Fatal Drug Combinations

ST. LOUIS, Dec. 9, 2014 /PRNewswire/ -- Nearly 60 percent of patients on opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period, according to a report released today by Express Scripts (NASDAQ: ESRX). Two-thirds of patients on these medication mixtures were prescribed the drugs by two or more physicians, and nearly 40 percent filled their prescriptions at more than one pharmacy.  

The new report, A Nation in Pain, provides a comprehensive analysis of the use of prescription opioid medications – such as codeine, morphine, oxycodone and hydrocodone – in the U.S. between 2009 and 2013.

Among  those taking dangerous drug mixtures last year, nearly  one in three patients were on both an opiate and an anti-anxiety benzodiazepine, a combination that is the most common cause of multiple drug overdose deaths. Approximately 28 percent of opioid users were taking a muscle relaxant. Eight percent were combining an opioid, muscle relaxant and a benzodiazepine – a popular combination among pill mills known as the "Houston Cocktail." Additionally, 27 percent were taking multiple opiate pain treatments simultaneously.

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

"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, M.D., 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."

Same Number of Patients, Increasing Number of Prescriptions

From 2009 to 2013, the number of Americans taking opioids on a long-term basis remained fairly constant, stabilizing the upward trend seen in recent decades. However, the amount of medication taken by people filling opioid prescriptions increased significantly. Both the number of opioid prescriptions filled and the number of days of medicine per prescription rose more than 8 percent over the past five years. 

Pain Prescriptions Most Prevalent in Southeastern Small Cities

While 3.9 percent of Americans were using prescription opioids on a longer-term basis in 2013, the prevalence rates were significantly higher – 5.1 percent – in small cities.

Among small U.S. cities with fewer than 28,000 residents, the top five had between 12.3 percent and 18 percent of their population using prescription opioids, and were located predominately in Alabama, Arkansas, Georgia and Kentucky.

Other Utilization and Demographic Trends

• Nearly half of patients who took opiate painkillers for more than 30 days in the first year continued to use them for three years or longer.
• Almost half of chronic opioid users took only short-acting medications – rather than longer-acting formulations – thus increasing their risk for addiction.
• Women were 30 percent more likely than men to use an opioid pain medication, but men tended to fill more frequent and potent opioid prescriptions.
• While the elderly had the highest prevalence rate of opioid use, younger adults tended to fill more frequent opioid prescriptions.

Express Scripts Protecting Patient Safety and Preventing Abuse

"Prescription opioids can provide patients with clinically safe and very effective pain management. However, their potential for misuse and addiction requires vigilance by all parties in a patient's care – doctors, nurses, caregivers, pharmacists and benefit providers," said Dr. Nowak. "Express Scripts has several programs available to help prevent misuse of these medications, and to identify and take action on potential cases of abuse."

When patients fill their prescriptions via Express Scripts Home Delivery Pharmacy, they are cared for by a specialist pharmacist with advanced training in pain treatments who can identify cases of suboptimal pain management and help patients use opioids safely and effectively. Compared to those who filled their prescriptions at a retail pharmacy, 23 percent fewer patients who filled their medication via the Express Scripts Pharmacy were using a potentially dangerous combination of medications, and 15 percent fewer patients were prescribed medications by multiple prescribers. 

Express Scripts' Fraud, Waste and Abuse program identifies potential cases of drug abuse, conducts extensive investigations and recommends interventions where necessary. The rate of concurrent use of potentially dangerous medications was 7.6 percent less in patients whose benefit plan was enrolled in Express Scripts Fraud, Waste and Abuse program in 2013 compared to patients whose benefit plan was not enrolled in the program.

"That 7.6 percent is a significant difference when you consider the lengths patients will go to support their addiction, including seeking unnecessary medical treatment solely to obtain a prescription pain medication," explained Jo-Ellen Abou Nader, Senior Director, Fraud, Waste and Abuse at Express Scripts. "As we identify potential cases of abuse, we are able to intervene, which in turn can help those with an addiction obtain the treatment they need before their addiction becomes fatal."

Methodology

The analysis examined the de-identified pharmacy claims of 6.8 million Americans of all ages who filled at least one prescription for an opioid to treat acute or longer-term (non-acute) pain from 2009 through 2013.

To access the full report please visit: http://lab.express-scripts.com/insights/drug-safety-and-abuse/americas-pain-points

About Express Scripts

Express Scripts manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science^SM, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

Media Contact

Jennifer Luddy
Express Scripts
201-269-6402
[email protected]

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SOURCE Express Scripts

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